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Background Adolescents’ presence on Social Media (SoMe) facilitates peer connections making them susceptible to peer-influences and approval. Negative experiences on SoMe can affect adolescent stress and wellbeing, impelling their use of alcohol. This paper provides a novel understanding of the relationship between negative experiences on SoMe and key indicators of alcohol use in adolescents. Methods Data was collected from upper secondary school students (n = 3528, ages 16–19, 45% boys) in Bergen (Norway) using a web-based questionnaire during school-hours in 2020 and 2021. Dependent variables were alcohol consumption, binge drinking and scoring ≥ 2 points on the CRAFFT instrument screening for substance use problems in adolescents. Independent variables were two scales indicating “negative acts and exclusion” and “unwanted attention from others”. Covariates included age, gender, country of birth and subjective socioeconomic status. Results are presented as relative risk ratios (RRR), odds ratios (OR) and incidence rate ratios (IRR) with 95% confidence intervals. Results Using multinomial logistic regression models, “negative acts and exclusion” and “unwanted attention” were positively associated with trying alcohol (OR: 1.50 (95% CI 1.28–1.76) and 1.86 (95% CI 1.66–2.09) respectively, both p ≤ 0.001), with frequency and amount of alcohol consumed. Findings from logistic regression models indicated that “negative acts and exclusion” and “unwanted attention” were positively associated with i. CRAFFT-caseness (OR: 2.13 and 1.86) and ii. frequent binge drinking (OR: 1.55 and 1.89). Conclusion Both exclusion and unwanted attention on SoMe were associated with indicators of problematic drinking, including frequency, quantity, and consequences related to alcohol.

Aspects of self-presentation on social media such as feedback-seeking, strategic self-presentation, and social comparison, may represent risk factors for experiencing negative mental health effects of social media use. The aim of this exploratory study was to assess how adolescents differ in aspects of self-presentation on social media, and whether these differences are linked to sociodemographic variables, lifestyle, or personality. The study was based on a cross-sectional survey performed in Bergen, Norway, and included 2,023 senior high school pupils (response rate 54%, mean age 17.4, 44% males). Nine self-presentation items were assessed using factor analysis, and latent class analysis was used to identify latent classes with distinct patterns of responses across the seven retained items. Associations between identified latent classes and covariates were assessed using regression analyses as well as non-parametric approaches. The self-presentation items converged into one factor, called ‘focus on self-presentation’. We identified three groups of adolescents with low, intermediate, and high focus on self-presentation. Membership in the high-focus group was associated with female gender, higher extraversion, lower emotional stability, more frequent alcohol consumption, and having tried tobacco. These results suggest some characteristics that are associated with a higher focus on self-presentation and that could inform targeted interventions.

Background and aims Research into the association between use of social media (SoMe) and alcohol use among adolescents is still in its infancy. The aim of the current longitudinal study was to examine if time spent on SoMe was prospectively associated with alcohol use among adolescents, and whether these associations differed for boys and girls. Design Prospective cohort study among Norwegian adolescents who completed e-questionnaires in the autumn of 2017 (t1), 2018 (t2), 2019 (t3) and 2020 (t4). Setting Norway. Participants A nation-wide sample of N = 3096 adolescents (mean age at t1: 14.3 years (SD = 0.85), 43% boys). Measurements Self-report data were collected on adolescents’ alcohol use, time spent on SoMe, parental monitoring, sensation-seeking, and positive and negative urgency, gender, and age. Findings Latent growth modelling adjusted for time invariant covariates (i.e., parental monitoring, sensation-seeking, and positive and negative urgency at t1) showed a positive association between time spent on SoMe and alcohol use at the start of the study; standardized b (β) = 0.17 (95% CI: 0.09, 0.26). Time spent on SoMe at t1 was a strong positive predictor of increase in alcohol use β = 0.31 (95% CI: 0.23, 0.40). There was also an association between degree of increase in alcohol use and increase in time on SoMe, β = 0.14 (95% CI: 0.05, 0.24). Subsequent multigroup analysis found little evidence for gender differences (p > 0.05). Conclusion The more time Norwegian adolescents aged 13–15 years spend on SoMe, the greater is their subsequent increase in alcohol use over time.

Objective This two-wave longitudinal study aimed at increasing knowledge about levels of parental stressors and rewards among mothers and fathers of children aged 1–18 during the first year of the COVID-19 pandemic in Norway. Background The COVID-19 pandemic and infection-control measures have caused changes to family life. Managing homeschooling or caring for younger children while working from home may have posed significant strain on parental stress, negatively impacting the quality of parent-child relationships and parents’ sensitivity to their children’s needs. Method We employed data collected in April 2020 and April 2021 from the longitudinal population-based survey in Bergen/Norway (Bergen in ChangE-study). 7424 parents participated (58.6% mothers and 41.5% fathers). Results The overall levels of parental stressors and rewards did not change significantly. Over the two time points, the factors associated with decreased parental stressors were being male, aged 40–49 years, having a relatively high income, and reporting initial difficulties with closed kindergartens or schools. For parents aged 18–29 years, the level of parental stressors increased. Conclusion The study suggests that the overall levels of parental stress remained unchanged during the first year of the pandemic. Even so, the study also uncovered that younger parents represented a vulnerable subgroup. Implications To prevent detrimental consequences in the wake of the pandemic, it could be important to increase awareness and competence among professional staff in kindergartens, primary schools, and child health clinics targeting young parents and their children.

Social media (SoMe) activity constitutes a large part of the lives of adolescents. Even though the behavior on SoMe is complex, the research on SoMe has mostly focused on negative effects, bad content, and online antisocial behavior (OAB). Less research has been conducted on online prosocial behavior (OPB), and to what extent OPBs are widespread is relatively unknown. A review was conducted to investigate to what extent OPB is related to SoMe use among adolescents based on studies published from 2014 to May 2021. To be included, the studies had to be quantitative, non-experimental, have participants aged 13–18, include measures of SoMe and OPB, and be published in peer-reviewed journals with full text available in English, Swedish, Danish or Norwegian. A research was conducted in databases PsychINFO, Ovid MEDLINE(R), EMBASE, COCHRANE Database of Systematic Reviews, Web of Science, Sociological Abstracts, Sociological Services Abstracts, and Eric. Two studies met the eligibility criteria. Both studies found an association between OPB and SoMe use. Methodological issues, however, were identified through a quality assessment using an adapted version of the Newcastle-Ottawa Scale (NOS) for cross-sectional studies, and the small samples in the studies prevent us from drawing any firm conclusions. Possible reasons for the scarcity of eligible studies and directions for future research are discussed.Systematic Review Registration: PROSPERO; ID CRD42020162161 and CRISTIN; ID 2038994.

Sense of time is a fundamental aspect of human psychology. The Zimbardo Time Perspective Inventory (ZTPI) is a widely used questionnaire meant to measure fundamental experiential dimensions of time, such as past, present and future. The aim of this study was to establish model fit of a Norwegian extended version of the ZTPI. The study is based on a convenience sample of 713 individuals. Based on previous findings, we employed confirmatory factor analysis and exploratory structural equation modelling to investigate different factor structures of ZTPI. The analyses were carried out using the WLSMV-estimation approach, and several fit indices was used as indicators of how well the data fitted the suggested factor structure. This first investigation of a Norwegian version of ZTPI did not find support for the original 56-item scale, the S-ZTPI version (64 items), nor an extended version that also incorporated the transcendental time perspective (74 items). In post-hoc analyses, we identified a model with 34 items and 7 factors that fitted the data adequately. Further studies should investigate the factor structure of ZTPI in a Norwegian context, and international studies should investigate how the transcendental time perspective relates to the rest of ZTPI.

Aims: The aim of the current study was to provide estimates of the distribution of alcohol-related problems in a large sample of college and university students. We also sought to examine trends in the distribution of alcohol-related problems from 2010 to 2018. Methods: Data stem from a recent national health survey from 2018 for higher education in Norway (the SHoT study) in which 50,054 full-time students (69.1% women; 30.9% men) aged 18–35 years participated. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess potential alcohol-related problems. Data on demographic characteristics were also collected. Results: More than half of the male students (52.8%) and 4 out of 10 of the female students (40.1%) reported risky, harmful or dependent alcohol use. Compared to women, men had an increased risk of risky alcohol use (relative risk ratio (RRR) = 1.57), harmful alcohol use (RRR = 2.45) and dependent alcohol use (RRR = 2.73). Younger students had higher rates of risky and harmful alcohol use compared with older students, while rates of dependent alcohol use were similar across the age span. Several demographic variables were associated with alcohol use. The trend analyses revealed that the rates of risky, harmful and dependent alcohol use, as well as mean AUDIT scores, among the students have remained relatively stable over the past 8 years. Conclusions: Alcohol use remains an important health concern among Norwegian college and university students, and the present study confirms the high rates of alcohol-related problems, and the need to address the issue within this population.

Background The continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has only been assessed in one large online population health survey. Methods Respondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n = 4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension. Results The overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%). Conclusions There appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.

Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.

Sexual harassment and assault is common in most domains of society, and has been linked to several adverse outcomes, including reduced sleep quality. However, less is known about the possible impact of sexual harassment and assault on various sleep problems among university students. In a sample of 49,051 students in Norway (69.2% women), we examined i) the associations of varying extents of sexual harassment (unwanted sexual comments, looks or gestures, photographs, indecent exposure, and physical harassment) and sexual assault (attempted or completed rape), with meeting Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria of insomnia and with sleep duration, ii) the association of cumulative exposure to sexual harassment/assault with insomnia and sleep duration, and iii) to what extent nightmares could explain the association between sexual harassment and insomnia and sleep duration. For both genders, all forms of harassments with the exception of “indecent exposure” and “unwanted sexual photographs” for men were negatively associated with sleep duration, with the strongest associations being found for “rape” and “attempted rape”. For both genders, the odds of insomnia increased as a function of cumulative harassment exposure. Similarly, a graded, negative association was found between cumulative harassment and sleep duration for both genders. Mediation analyses showed that 28% of the observed association between cumulative harassment and insomnia, and 15% of the association between cumulative harassment and sleep duration, was mediated by frequency of nightmares. publishedVersion

Introduction: Social media has become an integrated part of daily life, with an estimated 3 billion social media users worldwide. Adolescents and young adults are the most active users of social media. Research on social media has grown rapidly, with the potential association of social media use and mental health and well-being becoming a polarized and much-studied subject. The current body of knowledge on this theme is complex and difficult-to-follow. The current paper presents a scoping review of the published literature in the research field of social media use and its association with mental health and well-being among adolescents. Methods and Analysis: First, relevant databases were searched for eligible studies with a vast range of relevant search terms for social media use and mental health and well-being over the past five years. Identified studies were screened thoroughly and included or excluded based on prior established criteria. Data from the included studies were extracted and summarized according to the previously published study protocol. Results: Among the 79 studies that met our inclusion criteria, the vast majority (94%) were quantitative, with a cross-sectional design (57%) being the most common study design. Several studies focused on different aspects of mental health, with depression (29%) being the most studied aspect. Almost half of the included studies focused on use of non-specified social network sites (43%). Of specified social media, Facebook (39%) was the most studied social network site. The most used approach to measuring social media use was frequency and duration (56%). Participants of both genders were included in most studies (92%) but seldom examined as an explanatory variable. 77% of the included studies had social media use as the independent variable. Conclusion: The findings from the current scoping review revealed that about 3/4 of the included studies focused on social media and some aspect of pathology. Focus on the potential association between social media use and positive outcomes seems to be rarer in the current literature. Amongst the included studies, few separated between different forms of (inter)actions on social media, which are likely to be differentially associated with mental health and well-being outcomes.

BackgroundThe continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has not been assessed in a large online population health survey.MethodsRespondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n =4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.ResultsThe overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).ConclusionsThere appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.

Background: Self-report data indicate a deterioration of population mental health in many countries during the COVID-19 pandemic. A Norwegian epidemiological diagnostic psychiatric interview survey was conducted from January to September 2020, allowing for comparison of current prevalence of mental disorders from before through different pandemic phases. Prevalence of suicide deaths were compared between 2020 and 2014-2018. Methods: Participants from the Trondelag Health Study (HUNT) in Trondheim were recruited through repeated probability sampling. Using the Composite International Diagnostic Interview (CIDI 5.0) (n=2,154), current prevalence of mental disorders was examined in repeated cross-sectional analyses. Data on suicide was retrieved from the Norwegian Cause of Death Registry and compared for the first phase of the pandemic with the same months 2014-2018. Findings: Prevalence of mental disorders decreased significantly from the pre-pandemic phase (January 28th to March 11th 2020; 15·3% [95% CI 12·4-18·8]) to the first pandemic phase (March 12th – May 31st ; 8·7% [6·8-11·0]) and was fairly stable through the interim phase (June 1st July 31st ; 14·2% [11·4-17·5]) and the second phase (August 1st -September 18th ; 11·9% [9·0-15·6]). Suicidal ideation was non-significantly (n.s) increased during the pandemic. Suicide deaths were 15% lower (n.s) in March-May 2020 (n=140) compared with the same months pooled over 2014-2018 (n=165). Interpretation: We found no increase in mental disorders or suicides during the COVID-19 pandemic up through early autumn 2020. COVID-19 related mortality, transmission rates, intensity and implementation of measures and lockdowns have been less severe in Norway than many other countries and could account for these results. Funding: None Declaration of Interests: Dr. Hotopf reports grants from European Commission IMI/EFPIA, grants from National Institute of Health Research, grants from Medical Research Council, and grants from Economic and Social Research Council outside the submitted work. In the past 3 years, Dr. Kessler was a consultant for Datastat, Inc., Sage Pharmaceuticals, and Takeda. The authors Dr. Knudsen, Dr. Gustavson, Dr. Krokstad, Dr. Skogen, Dr. Stene-Larsen, Dr. Overland and Dr. Reneflot report no conflict of interest. Ethics Approval Statement: The survey was a collaboration between the Norwegian Institute of Public Health (NIPH) and the HUNT Research Centre and approved by the Regional Committee for Medical Research Ethics (2017/28/REK midt).

Aims: The literature on associations between internalising problems and subsequent alcohol/drug use and problems shows mixed results, and it is important to consider different aspects of internalising problems along with co-occurring externalising problems. Methods: In a longitudinal study ( n = 2438) followed up when the subjects were 7–9, 11–13, and 16–19 years of age, we investigated associations between parent/teacher-reported externalising and internalising problems (Strengths and Difficulties Questionnaire, SDQ) and adolescent self-reported alcohol and illicit drug use and problems. Socioeconomic status (SES), gender, and age were included as potential confounding variables. We also adjusted for the potential confounding effects from externalising problems on the association between internalising problems and alcohol/drug use, and vice versa. Results: Externalising problems were positively associated with all measures of alcohol/drug use and problems (adjusted odds ratios [ AORs] ranging from 1.24 to 1.40, all p < .05), while internalising problems were negatively associated with all measures of alcohol/drug use ( AORs ranging 0.83 to 0.88, all p < .05). Full-scale SDQ externalising problems were somewhat stronger and more robust predictors of adolescent alcohol/drug-related problems compared with SDQ externalising subscales, while only full-scale SDQ internalising problems were negatively associated with alcohol/drug-related problems. All estimates were similar across genders. Conclusions: Childhood externalising problems are positively associated while internalising problems are negatively associated with alcohol/drug use and problems in late adolescence.

Internationally adopted adolescents are at increased risk for mental health problems. However, little is known about problematic alcohol and drug use, which are important indicators of maladjustment. The aim of this study was to examine the level of problematic alcohol and drug use in internationally adopted adolescents compared to their nonadopted peers. The study is based on data from the youth@hordaland-survey, which was conducted in Hordaland County, Norway, in the spring of 2012. All adolescents born from 1993 to 1995 residing in Hordaland at the time of the study were invited to participate. Information on adoption was obtained from the Central Adoption Registry and linked to self-report data from the youth@hordaland-survey. Among 10,200 participants, 45 were identified as internationally adopted. No significant differences were found between international adoptees and their peers regarding whether or not they had tried alcohol or illicit drugs or their patterns of drinking behavior. However, adopted adolescents had a higher mean score on a measure of problematic alcohol and drug use compared to their nonadopted peers. The difference was attenuated and no longer significant when adjusting for measures of depression and attention-deficit/hyperactivity disorder. Results from a structural equation model indicated a full mediation effect of mental health problems on the association between adoption status and problematic alcohol and drug use. Our findings indicate that internationally adopted adolescents experience more problematic alcohol and drug use than their nonadopted peers, and the difference can largely be explained by mental health problems. (PsycINFO Database Record

Objective To determine if symptoms of depression and anxiety are differentially associated with clinical diabetes measures and self-management behaviours in individuals with Type 2 diabetes, and whether these associations vary by patient sex. Research design and methods A cross-sectional analysis using data from 2035 adults with Type 2 diabetes in the Nord-Trondelag Health Study. Multivariate logistic regression was used to explore associations between symptoms of depression and anxiety and waist girth, HDL cholesterol, systolic blood pressure, triglycerides, c-reactive protein, glycemic control, diet adherence, exercise, glucose monitoring, foot checks for ulcers, and the subjective patient experience. Analyses were stratified by sex. Results Depression was associated with a lower likelihood of avoiding saturated fats (OR = 0.20 [95% CI: 0.06, 0.68]) and increased odds of physical inactivity (OR = 1.69 [95% CI: 1.37, 2.72]). Anxiety was associated with increased odds of eating vegetables (OR = 1.66 [95% CI: 1.02, 2.73]), and an over two-fold increase of feeling that having diabetes is difficult. In women, anxiety was associated with elevated c-reactive protein levels (OR = 1.57 [95% CI: 1.05, 2.34]). In men, depressive symptoms were associated with elevated HbA1c (OR = 5.00 [95% CI: 1.15, 8.23). Conclusions Symptoms of depression and anxiety were differentially associated with some key diabetes-related measures. Our results suggest sex-specific differences with respect to two important clinical outcomes (i.e., anxiety and CRP in women and depression and glycemic control in men). These findings should alert practitioners to the importance of detection and management of psychological symptoms in individuals with Type 2 diabetes.

A social gradient in sleep has been demonstrated across the life span, but previous studies have been cross-sectional and used self-reported socioeconomic status (SES) indicators. Using registry-based data on family income trajectories, the current study examined the association between relative poverty in childhood and subsequent sleep in adolescence.Data on family income during 2004-2010 was obtained from the National Income Registry. Poverty was defined as household income60% of the mean national income. Information on self-reported sleep was based the youth@hordaland-survey (n = 8873) conducted in 2012 when the adolescents were 16-19 years old. Latent class analysis (LCA) was used to identify trajectories of family household poverty, and analysis of variance and general linear models were used to examine associations between income trajectories and sleep, adjusting for confounders.LCA identified four classes: 'never poor', two classes characterized by moving in or out of poverty, and 'chronically poor'. Compared to the 'never poor' group, adolescents from families in the 'moving into poverty' group displayed worse sleep across most sleep measures, including shorter sleep, lower sleep efficiency, and more nocturnal wake time (but not sleep onset latency). Neither adolescents from families who had moved out of poverty by increasing family income, nor the 'chronically poor' group differed significantly from the reference group.The study found that downward socioeconomic mobility was associated with increased adolescent sleep problems. More studies are required on the mechanisms that may account for the association, to find targeted and effective strategies to prevent short sleep duration in adolescents from families with unstable financial circumstances.

Aims: The Hopkins Symptoms Checklist (HSCL-25) is a widely used self-report measurement for mental health problems, but its factor structure is still uncertain, with divergent results in different social or cultural settings. We aimed to investigate the previously suggested factor structures of the HSCL-25, as well as a model including an explicit somatic factor among students in Norway. Methods: The study population is based on data from the Norwegian study of students’ health and wellbeing, SHoT (‘Studentenes Helse- og Trivselsundersøkelse’), and the present study comprises N = 13,525 participants. Using confirmatory factor analyses we investigated previously suggested factor structures, as well as a 3-factor structure, with specific subscales for anxiety, depression and somatic symptoms, suggested by the authors. After identification of the best-fitting model(s), measurement invariance across sexes, as well as associations with self-reported socioeconomic and social factors, use of medication and help-seeking behaviour were examined. Results: Based on the fit indices alone, bi-factor models fitted the data the best. However, upon further scrutiny when exploring the viability of the bi-factor models, we deemed the reliability of the specific subscales as extremely low and not viable as subscales. We therefore suggest that a uni-dimensional model was the most appropriate in our study. Conclusions: Based on considerations of fit indices, viability of subscales and associations with social and socioeconomic factors we suggest that a uni-dimensional model is most appropriate for HSCL-25 in a student population. Future investigations should examine how the revisions could improve the psychometric properties of the scale.

BackgroundAn increase in reported psychological distress, particularly among adolescent girls, is observed across a range of countries. Whether a similar trend exists among students in higher education remains unknown. The aim of the current study was to describe trends in self-reported psychological distress among Norwegian college and university students from 2010 to 2018.MethodsWe employed data from the Students' Health and Wellbeing Study (SHoT), a nationwide survey for higher education in Norway including full-time students aged 18–34. Numbers of participants (participation rates) were n = 6065 (23%) in 2010, n = 13 663 (29%) in 2014 and n = 49 321 (31%) in 2018. Psychological distress was measured using the Hopkins Symptom Checklist-25 (HSCL-25).ResultsOverall, a statistically significant increase in self-reported psychological distress was observed over time across gender and age-groups. HSCL-25 scores were markedly higher for women than for men at all time-points. Effect-size of the mean change was also stronger for women (time-by-gender interaction: χ2 = 70.02, df = 2, p < 0.001): in women, mean HSCL-25 score increased from 1.62 in 2010 to 1.82 in 2018, yielding a mean change effect-size of 0.40. The corresponding change in men was from 1.42 in 2010 to 1.53 in 2018, giving an effect-size of 0.26.ConclusionsBoth the level and increase in self-reported psychological distress among Norwegian students in higher education are potentially worrying. Several mechanisms may contribute to the observed trend, including changes in response style and actual increase in distress. The relative low response rates in SHoT warrant caution when interpreting and generalising the findings.

Background: For alcohol, the association with socioeconomic status (SES) is different than for other public health challenges – the associations are complex, and heterogeneous between socioeconomic groups. Specifically, the relationship between alcohol consumption per se and adverse health consequences seems to vary across SES. This observation is called the ‘alcohol harm paradox’. This study aims to describe different patterns of alcohol use and potential problems. Next, the associations between sub-groups characterized by different patterns of alcohol use and potential problems, and age, gender, educational level, full-time employment, occupational level and income is analysed. Methods: Employing data from the ongoing cross-sectional WIRUS-study, N=4,311 participants were included in the present study. Individual response patterns of the ten-item Alcohol Use Disorders Identification Test (AUDIT) were analysed and latent class analysis (LCA) was used to identify latent groups. Next, the associations between the classes identified in the best fitting LCA-model and sociodemographic factors were analysed and presented. Results: We identified three classes based on the response patterns on AUDIT. Class 1 was characterised by low-level alcohol consumption and very low probability of negative alcohol-related consequences related to their alcohol consumption. Class 2 was characterised by a higher level of consumption, but despite this, class 2 also had a relatively low probability of reporting negative alcohol-related consequences. Class 3, however, was characterised by high levels of alcohol consumption, and a high probability of reporting negative consequences of their consumption. The classes identified were systematically differentially associated with the included measures of SES, with class 3 characterised by younger age, more males and lower educational attainment. Conclusions: Our findings highlight the interconnectedness of alcohol consumption and alcohol-related consequences. Further, our related the identified classes and SES yields further insights into to intricate relationship between various socioeconomic factors, alcohol use patterns and related negative consequences.

Background For alcohol, the association with socioeconomic status (SES) is different than for other public health challenges – the associations are complex, and heterogeneous between socioeconomic groups. Specifically, the relationship between alcohol consumption per se and adverse health consequences seems to be different across SES. This observation is called the ‘alcohol harm paradox’.Aims This study aims to describe different patterns of alcohol use and potential problems. Next, the associations between sub-groups characterized by different patterns of alcohol use and potential problems, and age, gender, educational level, percentage of employment, occupational level and income is analysed.Methods Employing data from the ongoing cross-sectional WIRUS-study, N=4,318 participants were included in the present study. Individual response patterns of the ten-item Alcohol Use Disorders Identification Test (AUDIT) were analysed and latent class analysis (LCA) was used to identify latent groups. Next, the associations between the classes identified in the best fitting LCA-model and sociodemographic factors was analysed and presented.Results We found support for 3 classes based on the response patterns on AUDIT. Class 1 was characterised by low-level alcohol consumption and very low probability of negative alcohol-related consequences (items 4-10 on AUDIT) related to their alcohol consumption. Class 2 was characterised by a higher level of consumption, but despite this, class 2 also had a relatively low probability of reporting negative alcohol-related consequences. Class 3, however, was characterised by high levels of alcohol consumption, and a high probability of reporting negative consequences of their consumption. The classes identified were systematically differentially associated with the included measures of SES.Conclusions Our findings highlight the interconnectedness of alcohol consumption and alcohol-related consequences. Further, our related the identified classes and SES yields further insights into to intricate relationship between various socioeconomic factors, alcohol use patterns and related negative consequences.

Introduction: Globally, alcohol use is among the most important risk factors related to burden of disease, and commonly emerges among the ten most important factors. Also, alcohol use disorders are major contributors to global burden of disease. Therefore, accurate measurement of alcohol use and alcohol-related problems is important in a public health perspective. The Alcohol Use Identification Test (AUDIT) is a widely used, brief tenitem screening instrument to detect alcohol use disorder. Despite this the factor structure and comparability acrossdifferent(sub)-populations hasyetto bedetermined.Ouraimwasto investigatethefactorstructure ofthe AUDIT-questionnaire and the viability of specific factors, as well as assessing measurement invariance across gender, age and educational level. Methods: We employed data (N=4,318) from the ongoing screening study in the Norwegian national WIRUS project. We used Confirmatory Factor Analysis (CFA) to establish the factor structure of the AUDIT. Next, we investigated the viability of specific factors in a bi-factor model, and assessed measurement invariance of the preferred factor structure. Results: Our findingsindicatetheAUDITisessentiallyunidimensional, andthatcomparisonscanreadilybedone across gender, age and educational attainment. Conclusion: We found support for a one-factor structure of AUDIT. To the best of our knowledge, this is the first study to investigate the viability of specific factors in a bi-factor model as well as evaluating measurement invariance across gender, age and educational attainment for the AUDIT questionnaire. Therefore, further studies are needed to replicate our findings related to essential unidimensionality. The study was supported by the Norwegian Directorate of Health and the Research Council of Norway.

Norwegian universities and university colleges yearly arrange an introductory week to welcome new students. This study provides new insight about who takes part in the event, to what degree students are satisfied with the event, and whether participation is associated with social integration. Data from the Norwegian study of students’ health and well-being was used. Satisfaction with the introductory week and other variables of interest were described for individuals taking part, partly taking part and not taking part in the event. The associations between participation, satisfaction and social integration were investigated (linear regression). More than 70% of students were satisfied with the introductory week and the opportunity it provided for getting to know other students. Participation in the event was associated with higher satisfaction with the student community and student city, and better social integration. Individuals who were younger, single and had moved to the student city were more...

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.

To describe potential differences in unhealthy behaviours among ethnic Norwegian adolescents and minority adolescents from countries within the European Union, European Economic Area or US (EU/EEA countries) and adolescents from non-EU/EEA countries. Specifically, we aimed to investigate ethnic differences in use of alcohol, tobacco and illicit drugs, and potential confounding due to socio-demographic characteristics.Cross-sectional population-based study of adolescents aged 16-19 (N = 10,122), with self-reported ethnicity as grouping variable, and self-reported use of alcohol, tobacco and illicit drugs as dependent variables.We found that minority adolescents from EU/EEA and non-EU/EEA countries differed from ethnic Norwegian adolescents on important indicators of unhealthy behaviours. Compared to Norwegian adolescents, adolescents from EU/EEA were more likely to report having tried to smoke, to be a daily smoker and to ever having tried an illicit drug (adjusted odds ratio (OR) ranging from 2.01 to 3.74). They were, however, less likely to have tried snus (a form of smokeless tobacco; adjusted OR 0.64; confidence interval (CI) 95% 0.43-0.97) and to report daily snus use (adjusted OR 0.31; CI95% 0.15-0.67). There were no differences in having tried alcohol. Non-EU/EEA adolescents were less likely to have ever tried alcohol (OR 0.24; CI95% 0.18-0.31), snus (OR 0.47; CI95% 0.34-0.65) and to smoke (0.68; CI95% 0.52-0.91), and less likely to report daily snus use (OR 0.36; CI95% 0.21-0.62) compared to Norwegian adolescents. There were no differences with regard to having tried illicit drugs and reporting being a daily smoker. All differences observed were robust to adjustment for age, gender and family socio-economic status.The presents study identified important differences in unhealthy behaviours across different ethnic groups in Norway. The differences in the prevalence of unhealthy behaviours among ethnic minorities are still relevant in a public health perspective, and potential mechanisms should be investigated further.

IntroductionThe use of social media has risen steadily since its introduction in the early 2000s, and today there are between 2 and 3 billion users worldwide. Research on the link between use of social media and mental health has resulted in a vast number of studies covering diverse aspects of the link between them. The existing body of knowledge on use of social media, and mental health and well-being among adolescents is complex and difficult to follow. In this paper, we present a protocol for a scoping review to systematically identify and summarise the central research foci and knowledge gaps in the research field of social media use, and mental health and well-being among adolescents.Methods and analysisThe current scoping review will adhere to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. The first step is to search relevant databases for eligible studies. Relevant databases are CINAHL, Ovid Medline, Embase, PsycINFO, Sociological Abstracts, Sociological Services Abstracts, ERIC, Cochrane Database of Systematic Reviews, CRD (Database of Abstracts of Reviews of Effects), NHS EED, HTA and Epistemonikos. Next, two reviewers from the research team will independently screen the identified studies for eligibility. Data extraction and data synthesis will be performed and result in summarised themes based on the findings.Ethics and disseminationA scoping review can be described as a method of gaining an overview and understanding of a research area, with its strengths and weaknesses, and as it involves peer-reviewed and published articles, a scoping review does not require ethical approval. We expect that the results from the current scoping review will produce a consolidated overview of existing studies and research gaps, and gather this knowledge into a coherent review. The results will be disseminated through relevant journals and conferences.

Background Childhood sexual abuse (CSA) is associated with sleep disturbances in adulthood. However, longitudinal studies have yet to identify among CSA-survivors subgroups distinguished by the trajectory of their insomnia severity, or predictors of subgroup membership. Objective The objective of this study was to examine longitudinal insomnia symptom trajectories, as well as predictors and correlates of the identified trajectories, over a 4 year study period in a sample of adult, mainly female CSA-survivors. Participants and setting The sample comprised 533 adult survivors of CSA (94.9% women, mean age 39.2 years, mean age of abuse onset 6.5 years), recruited from support centers for sexual abuse survivors in Norway. Methods Latent class growth analyses were used to identify insomnia symptom trajectories. Results Three distinct trajectories of insomnia symptoms were identified; one characterized by high insomnia symptom scores minimally decreasing over the study period (‘high and decreasing’, 30.6%), one characterized by stable intermediate insomnia symptom scores (‘intermediate and stable’, 41.5%), and one characterized by stable low insomnia symptom scores (‘low and stable’, 27.9%). Predictors of belonging to the high and decreasing trajectory (using the low and stable trajectory as a reference), was lower age of abuse onset (expotentiated coefficient (EC): 0.93, p = 0.026), abuse involving penetration (EC: 2.36, p = 0.005), threats (EC: 3.06, p

Background: Harmful alcohol consumption is a major risk factor for ill-health on an individual level, a global public health challenge, and associated with workplace productivity loss. This study aimed to explore the proportion of risky drinkers in a sample of employees, investigate sociodemographic associations with risky drinking, and examine implications for intervention needs, according to recommendations from the World Health Organization (WHO). Methods: In a cross-sectional design, sociodemographic data were collected from Norwegian employees in 14 companies (n=3571) across sectors and branches. Risky drinking was measured with the Alcohol Use Disorders Identification Test (AUDIT). The threshold for risky drinking was set at ≥8 scores on the AUDIT. Based on WHO guidelines, risky drinkers were divided into three risk categories (moderate risk: scores 8–15, high risk: scores 16–19, and dependence likely risk: scores 20–40). The association between sociodemographic variables and risky drinking were explored with chi square tests for independence and adjusted logistic regression. The risk groups were then examined according to the WHO intervention recommendations. Results: 11.0% of the total sample reported risky drinking. Risky drinking was associated with male gender (OR=2.97, p

The trajectories and stability of self-reported sleep duration recorded at ages 13, 15, and 23 years on reported sleep duration at age 30 years among 1105 students (55% male) who participated in the Norwegian Longitudinal Health and Behaviour Study were examined. Questionnaire data were used to obtain demographic and sleep variables. Dichotomised short sleep duration was based on normative values and set as ≤ 8.5 h (age 13 years), ≤ 8 h (age 15 years) and ≤ 7 h (ages 23 and 30 years). Results indicated a significant overall reduction in total sleep duration (h per night) across age groups. Sleep duration (continuous) at age 15 and 23 years (whole group) was moderately but positively correlated with sleep duration at age 30 years (P < 0.01). When split by sex, at age 15 years, this association was present among females only (P < 0.01); however, at age 23 years, this association was present in both male and females (both P < 0.001). Categorical short sleep at age 23 years (whole group) was associated with short sleep at age 30 years (unadjusted odds ratio = 3.67, 95% confidence interval 2.36-5.69). Following sex stratification, this effect was significant for both males (unadjusted odds ratio = 3.77, 95% confidence interval: 2.22-6.42) and females (unadjusted odds ratio = 2.71, 95% confidence interval: 1.46-5.04). No associations were noted for categorical short sleep at ages 13 or 15 years, and subsequent short sleep at 30 years. Habitual short sleep duration during middle adulthood is not sustained from the time of early adolescence. Rather, these trends appear to be formed during early adulthood.

Aims: Economic gender equality is one of the goals of the Nordic Welfare states. Despite this, there is a considerable gender gap in pensionable income in the European Union, and an unmet need for measures that absorb more of the complexity associated with accumulated (dis)advantages across gender and population groups. The aims of the present study were to examine the gender difference in association between average earned pension points and 1) education and 2) current occupational prestige, and to discuss pension points as a possible indicator of accumulated disadvantages. Methods: We linked a community-based survey, the Hordaland Health study (HUSK), to the national register of insurance benefits (FD-trygd). This made it possible to trace gendered patterns of economic (dis)advantages associated with educational level, career development and gainful work over the life course for 17,275 individuals. Results: We found profound differences in earned accrued pension rights between men and women across socioeconomic strata, and a significant interaction between pension rights and gender in the association with education and occupational prestige. Our findings indicate that men, as a group, may have lower educational attainment and occupational prestige than women, and still earn more pension points throughout their career. These differences place women at risk for future economic strain and deprivation over and above their similarly educated and positioned male counterparts. Conclusions: We suggest that accrued pension rights may be a relevant measure of accumulated (dis)advantages over the course of working life, and a useful indicator when gender equality is measured and discussed.

ObjectiveThe aim of the current paper was to investigate the association between the patterns of duration, timing and sequencing of exposure to low family income during childhood, and symptoms of mental health problems in adolescence.SettingSurvey administered to a large population-based sample of Norwegian adolescents.ParticipantsSurvey data from 9154 participants of 16–19 years age (53% participation rate; 52.7% girls) were linked to registry-based information about childhood family income from tax return data.Outcome measuresMental health outcomes were symptoms of emotional, conduct, hyperactivity, peer problems and general mental health problems measured with the Strengths and Difficulties Questionnaire, symptoms of depression measured with Short Mood and Feelings Questionnaire and symptoms of attention-deficit/hyperactivity disorder (ADHD) measured with the Adult ADHD Self-Report Scale.ResultsLatent class analysis and the BCH approach in Mplus were used to examine associations between patterns of poverty exposure and mental health outcomes. Four latent classes of poverty exposure emerged from the analysis. Participants moving into poverty (2.3%), out of poverty (3.5%) or those chronically poor (3.1%) had more symptoms of mental health problems (Cohen’sd=16-.50) than those with no poverty exposure (91.1%). This pattern was, however, not found for symptoms of ADHD. The pattern of results was confirmed in robustness checks using observed data.ConclusionsExposure to poverty in childhood was found to be associated with most mental health problems in adolescence. There was no strong suggestion of any timing or sequencing effects in the patterns of associations.

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

The association between alcohol consumption and somatic symptoms is unclear. The aim of this study was to examine the cross-sectional association between the whole continuum of alcohol consumption, ranging from abstention to high-level consumption, and the overall level of common somatic symptoms in a large population-based sample. Data are from the Hordaland Health Study, conducted in 1997–1999 with participants aged 40–46 years (N = 15,018). The main exposure was a categorical variable based on self-reported abstention and alcohol consumption, while self-reported overall level of somatic symptoms was the outcome. The outcome was defined by the mean overall frequency of 17 commonly experienced somatic symptoms. Potential confounders included sociodemographic information, somatic diagnoses, and health-related behaviors. Linear regression models were computed in the statistical analyses. We found no association between different levels of alcohol consumption and overall level of somatic symptoms. Abstainers reported, however, a higher overall level of somatic symptoms compared to those who consumed alcohol at any level, even after adjusting for potential confounders. Investigating the individual somatic symptoms, we found that the abstainers had a higher frequency of 10 of the 17 symptoms compared to the remainder, while higher frequency was found for only 2 somatic symptoms among the 5 % with the highest alcohol consumption. We found no support for an association between alcohol consumption and overall level of somatic symptoms. There was, however, a small association between being abstinent and increased level of somatic symptoms. These findings may have several different explanations, and further investigation is called for.

Whiplash injuries show a variable prognosis which is difficult to predict. Most individuals experiencing whiplash injuries rapidly recover but a significant proportion develop chronic symptoms and ongoing disability. By employing longitudinal data, we investigated how psychological and physical symptoms, self-rated health, use of health services and medications, health behavior and demographic factors predict recovery from whiplash. Data from two waves of a large, Norwegian, population-based study (The Nord-Trondelag Health Study: HUNT2 and HUNT3) were used. Individuals reporting whiplash in HUNT2 (baseline) were identified in HUNT3 11 years later. The characteristics of individuals still suffering from whiplash in HUNT3 were compared with the characteristics of individuals who had recovered using Pearson’s chi-squared test, independent sample t-tests and logistic regression. At follow-up, 31.6 % of those reporting whiplash at baseline had not recovered. These individuals (n = 199) reported worse health at baseline than recovered individuals (n = 431); they reported poorer self-rated health (odds ratio [OR] = 3.12; 95 % confidence interval [CI], 2.20–4.43), more symptoms of anxiety (OR = 1.70; 95 % CI, 1.15–2.50), more diffuse somatic symptoms (OR = 2.38; 95 % CI, 1.61–3.51) and more musculoskeletal symptoms (OR = 1.21; 95 % CI, 1.13–1.29). Individuals still suffering from whiplash also visited more health practitioners at baseline (OR = 1.18; 95 % CI, 1.06–1.32) and used more medications (OR = 1.24; 95 % CI, 1.09–1.40). Poor self-rated health seems to be a strong risk factor for whiplash injuries becoming chronic. Diffuse somatic symptoms, musculoskeletal symptoms and symptoms of anxiety at baseline are important prognostic risk factors. Knowledge of these maintaining risk factors enables identification of individuals at risk of non-recovery, facilitating adequate treatment for this vulnerable group.

Background and aims Snus, a form of smokeless tobacco, is increasingly popular in its traditional Nordic markets, and was recently launched commercially in the United States. We examined the cross-sectional associations between snus use and cardiovascular risk factors, and compared them with the corresponding associations of smoking. Design Cross-sectional study. Setting The HUNT3 general population survey, Nord-Trondelag, Norway (2006–08). Participants A general population sample of n = 25 163. Measurements Measured triglyceride,- glucose- and high-density lipoprotein (HDL)-cholesterol levels, blood pressure and waist circumference, registry information on gender, age and education level, self-reported snus use, smoking, physical exercise and alcohol use. Findings In age- and gender-adjusted linear regression analyses, extensive snus use was associated with larger waist circumference (b = 1.65, 95% CI = 0.86, 2.43) and higher systolic blood pressure (b = 2.58, 95% CI = 1.48, 3.68), but with higher rather than lower levels of HDL-cholesterol (b = 1.66, 95% CI = 0.79, 2.53). These three differences remained significant after additional adjustment for smoking, education level, physical exercise and alcohol use. Smokers had higher triglyceride and lower HDL-cholesterol than snus users, but lower systolic blood pressure. Conclusions After adjusting statistically for major confounding variables, Norwegians who use snus extensively have a mixed profile in terms of cardiovascular risk: slightly higher waist circumference and systolic blood pressure but also higher high-density lipoprotein-cholesterol.

Objective Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. Methods Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n = 199) and those who had not (n = 20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses. Results Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR = 2.26, 95%CI: 1.68–3.04). Musculoskeletal pain also increased the risk (OR = 1.21, 95%CI: 1.15–1.26), as did diffuse somatic symptoms (OR = 2.09, 95%CI: 1.47–2.96), use of different health services (OR = 1.31, 95%CI: 1.19–1.45), high use of medications (OR = 1.28, 95%CI: 1.14–1.43) and symptoms of anxiety (OR = 1.93, 95%CI: 1.39–2.68). Physical activity was protective (OR = 0.67, 95%CI: 0.49–0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. Conclusion Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash.

Background Physical activity (PA) is associated with lower risk for non-communicable diseases and mortality. We aimed to investigate the prospective association between PA and all-cause and cause-specific mortality, and the impact of other potentially contributing factors. Method Data from the community-based Hordaland Health Study (HUSK, 1997–99) were linked to the Norwegian Cause of Death Registry. The study included 20,506 individuals born 1950–1957 and 2,225 born in 1925–1927 (baseline age 40–49 and 70–74). Based on self-report, individuals were grouped as habitually performing low intensity, short duration, low intensity, longer duration or high intensity PA. The hazard ratios (HR) for all-cause and cause-specific mortality during follow-up were calculated. Measures of socioeconomic status, physical health, mental health, smoking and alcohol consumption were added separately and cumulatively to the model. Results PA was associated with lower all-cause mortality in both older (HR 0.75 (95% CI 0.67–0.84)) and younger individuals (HR 0.82 (95% CI 0.72–0.92)) (crude models, HR: risk associated with moving from low intensity, short duration to low intensity, longer duration PA, and from low intensity, longer duration to high intensity). Smoking, education, somatic diagnoses and mental health accounted for some of the association between physical activity and mortality, but a separate protective effect of PA remained in fully adjusted models for cardiovascular (HR 0.78 (95% CI 0.66–0.92)) and respiratory (HR 0.45 (95% CI 0.32–0.63) mortality (both age-groups together), as well as all-cause mortality in the older age group (HR 0.74, 95%CI 0.66–0.83). Conclusion Low intensity, longer duration and high intensity physical activity was associated with reduced all-cause, respiratory and cardiovascular mortality, indicating that physical activity is beneficial also among older individuals, and that a moderate increase in PA can be beneficial.

OBJECTIVE Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes. RESEARCH DESIGN AND METHODS Using data for 64,177 Norwegian adults from the second wave of the Nord-Trøndelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline. RESULTS Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14). CONCLUSIONS This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.

ObjectivesWe used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR).MethodsThe burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs).ResultsFor musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3–1703.4) in 1990 to 1606.0 (95% UI 1141.2–2130.4) in 2013. During 1990–2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7–3.0) in 1990 to 4.7% (95% UI 3.6–5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2–136.0 for low back pain, 27.3–49.7 for neck pain, 9.7–37.3 for osteoarthritis (OA), 0.6–2.2 for rheumatoid arthritis and 0.1–0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries.ConclusionsThis study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

In the present study, our aim was to examine longitudinal posttraumatic stress symptom (PTSS) trajectories in a Norwegian sample of adults who had experienced sexual abuse during childhood, and to identify predictors of PTSS-trajectory belongingness. The sample consisted of 138 adult survivors of childhood sexual abuse (96.4% women, mean age=42.9years, mean age at the first abuse=5.9 years), recruited from support centers for sexual abuse survivors. The majority (78.3%) reported penetrative abuse, and a large proportion of the sample reported that the perpetrator was a biological parent (38.4%) or someone they trusted (76.1%), reflecting a high severity level of the abusive experiences. Latent Profile Analyses revealed the best overall fit for a two PTSS-trajectories model; one trajectory characterized by sub-clinical and decreasing level of PTSS (54.9%), and the other by high and slightly decreasing level of PTSS (45.1%). Increased odds for belonging to the trajectory with clinical level symptoms was found among those who reported higher levels of exposure to other types of childhood maltreatment (OR=3.69, p=0.002), sexual abuse enforced by physical violence (OR=3.04, p=0.003) or threats (OR=2.56, p=0.014), very painful sexual abuse (OR=2.73, p=0.007), or who had experienced intense anxiety, helplessness or fear during the abuse (OR=2.97, p=0.044). Those in the trajectory with clinical level PTSS reported lower levels of perceived social support and more relational difficulties compared to those in the sub-clinical PTSS trajectory. In conclusion, different longitudinal PTSS trajectories can be found among adult survivors of childhood sexual abuse. Significant predictors of PTSS-trajectory belongingness are discussed alongside their potential implications for preventive efforts and clinical interventions.

BackgroundCommon mental disorders (CMDs) are associated with occupational impairment and the receipt of disability benefits (DBs). Little is known about the relationship between personality disorders (PDs) and work disability, and whether the association between CMDs and work disability is affected by the presence of co-morbid PDs. The aim of this study was to examine the association between DB and individual categories of PDs, with special attention to the effect of co-morbid CMDs on this association.MethodThe association between DB and PD was examined using data from the 2000 British National Survey of Psychiatric Morbidity. Probable PD caseness was identified using the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) screening questionnaire. The impact of CMDs, assessed with the revised version of the Clinical Interview Schedule (CIS-R), was examined as a covariate and in a stratified analysis of co-morbidity. Other covariates included sociodemographic factors, long-standing illnesses and substance use.ResultsProbable PD was associated with DB, with the strongest associations found for borderline, dependent and schizotypal PD. Antisocial PD was not associated with DB. The relationship between PD and DB was strongly modified by CMD, reducing the association from an odds ratio (OR) of 2.84 to 1.34 [95% confidence interval (CI) 1.00–1.79)]. In the stratified analysis, co-morbid PD and CMD showed a stronger association with DB than PD without CMD but, when fully adjusted, this effect was not significantly different from the association between CMD without PD.ConclusionsIndividuals screening positive for PD are more likely to experience severe occupational outcomes, especially in the presence of co-morbid CMD.

Aims To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption ('sick-quitting') could explain some of the increased risk for DP among abstainers. Design Prospective population-based study. Setting and participants Data were from two waves of the Nord-Trondelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37,729 (alcohol consumption) and 34,666 (problem drinking) participants. Measurements Alcohol consumption was measured by self-reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health-related behaviour, socio-economic status and social activity. Findings Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92-1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08-3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48-2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01-2.74) were at higher risk for DP than constant abstainers. Conclusions Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by 'sick-quitting'.

Adolescence is a period in which many have an onset of alcohol use, but there is much heterogeneity in the individual development of alcohol use. Further, there is a general increase in depressive symptoms from early to late adolescence, but less is known about how different alcohol habit trajectories are associated with symptoms of depression. The aims of the present study were: to identify trajectories of alcohol consumption and drinking to intoxication during adolescence (age 13-18 years); and examine to what extent the different trajectories of alcohol use were associated with symptoms of depression over the same age span, from early to late adolescence.Data from the Norwegian Longitudinal Health Behaviour Study were employed. Latent class growth analyses were employed to identify different trajectories of both alcohol consumption and drinking to intoxication. The resulting trajectories for each participant were used to estimate the gender-adjusted association between different development of alcohol use and symptoms of depression.Four trajectories of both alcohol consumption and drinking to intoxication were identified. The trajectories with an early onset of alcohol consumption or drinking to intoxication were associated with higher levels of depressive symptoms compared with late onset or stable low use trajectories.The findings from the present study suggest that early onset developmental trajectories of alcohol use are associated with depression. Therefore, broad assessment and interventions targeting both alcohol and depression may be indicated among early onset alcohol users, especially if they report increasing levels of consumption. [Skogen JC, Knudsen AK, Hysing M, Wold B, Sivertsen B. Trajectories of alcohol use and association with symptoms of depression from early to late adolescence: The Norwegian Longitudinal Health Behaviour Study. Drug Alcohol Rev 2016;35:307-316].

Background Changes in sleep patterns and increased substance involvement are common in adolescence, but our knowledge of the nature of their association remains limited. The aim of this study was to examine the association between several sleep problems and sleep behaviours, and use and misuse of alcohol and illicit drugs using data from a large population-based sample. Methods A large population-based study from Norway conducted in 2012, the youth@hordaland study, surveyed 9328 adolescents aged 16–19 years (54% girls). Self-reported sleep measures provided information on sleep duration, sleep deficit, weekday bedtime and bedtime difference and insomnia. The main dependent variables were frequency and amount of alcohol consumption and illicit drug use, in addition to the presence of alcohol and drug problems as measured by CRAFFT. Results The results showed that all sleep parameters were associated with substance involvement in a dose–response manner. Short sleep duration, sleep deficit, large bedtime differences and insomnia were all significantly associated with higher odds of all alcohol and drug use/misuse measures. The associations were only partly attenuated by sociodemographics factors and co-existing symptoms of depression and ADHD. Conclusions To the best of our knowledge, this is the first population-based study to examine the association between sleep, and alcohol and drug use, by employing detailed measures of sleep behaviour and problems, as well as validated measures on consumption of alcohol and illicit drug use. The findings call for increased awareness of the link between sleep problems and alcohol and drugs use/misuse as a major public health issue.