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Alcohol abuse is a growing problem in the military, and a costly one. The present study evaluates the potential role of psychological hardiness, an individual resilience resource, to stress-related problem drinking in a military population. We assess the association of psychological hardiness and avoidance coping style with alcohol use patterns in a large national sample of Norwegian military defense personnel. Results show that low hardiness and high avoidance coping are significant predictors of alcohol abuse. Also, the challenge facet of hardiness predicts risk of alcohol abuse among respondents with recent deployment experience, and this effect is greater for those with harsh deployment experiences. Older defense workers are also at higher risk, suggesting cumulative occupational stress may take a toll. This research indicates that hardiness and avoidance coping measures may serve as useful adjunct screening tools for alcohol abuse in the military. [ABSTRACT FROM AUTHOR]

Social network support can be important when adjusting to life after the death of a close family member or friend. However, research has yielded inconclusive results regarding the relationship between social support and complicated grief reactions. Persons bereaved after a drug-related death (DRD) are a group of people who are at high risk of developing bereavement complications. Based on a Norwegian study on DRD bereaved close family members and friends ( n  = 250), this study examines the association between perceived social support, societal stigma, own social withdrawal, and prolonged grief symptoms (PGS). Own social withdrawal predicts the most variance in PGS symptoms: 8%, perceived social support: 3%, and societal stigma: 1%. Together the three focal variables explain 17.5% of variations in PGS. Results from the study point to the importance of social network support, which could reduce bereavement complications after a DRD.

Background: A concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up., Methods: This was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19-47 (mean age 32.5, SD = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 (SD = 7.9) years. Mean number of prior treatment courses was 3.5 (SD = 3.3; range 0-20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up., Results: Validated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly (p < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89-3.68), whereas some moderate (0.60-0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up., Conclusions: The concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up., Trial Registration: ClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022., (© 2024. The Author(s).)

Background: Anxiety is prevalent among children and adolescents (termed youths), and leads to reduced quality of life, disability, loss of education and reduced life-span. Physical activity has shown promising effects on symptoms of anxiety in adult populations, and an increasing amount of research has also demonstrated some effect in youth. However, physical activity is not widely used in youth mental health care, and research is very limited., Methods/design: This single arm, pre-post study explores the effect of a manualized physical activity-based 14-session intervention termed Confident, Active and Happy Youth. Participants are youth attending specialized mental health care ( N =51, M age = 13.4, SD = 2.2). Changes in anxiety symptoms are examined using mixed models with residual maximum likelihood (REML). The potential effect of anxiety subtype differences, participant age, comorbidity, and time spent in out-patient care are explored., Results: Youths did not report any effect on anxiety symptoms after participation in CAHY, however, their parents report a significant reduction in youth's anxiety symptoms in general (b = -0.11, 95%, CI: -0.21 to -0.01) and specifically for social phobia (b = -0.19, 95% CI: -0.35 to -0.03). Age and comorbidity showed no significant effect on anxiety symptoms post treatment. Prior treatment time in youth mental health care demonstrated inconclusive results., Conclusion: The study finds initial evidence of symptomatic change in a clinical population of youth's receiving a physical activity-based intervention. Our research provides preliminary support for physical activity as a supplementary treatment method for mental health disorders among youths., Clinical Trial Registration: clinicaltrials.gov, NCT05049759., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Anker, Bøe Sture, Hystad and Kodal.)

The loss of a close one to drug-related death (DRD) has been characterized as a form of stigmatized bereavement, and research has shown that there is a high risk of bereavement complications. Social support can be a buffer against bereavement complications, but because of stigma, DRD bereaved persons access to social support can be challenged. Based on data from a Norwegian sample of DRD bereaved persons ( N = 252) the present study examines (1) bereaved persons' perceived access to different aspects of social support, and (2) the association between bereaved persons' experiences of societal stigma, own withdrawal, self-blame, and their perceptions of social support. Results show (1) that bereaved persons' access to contact with persons in the same situation is particularly low compared to other support aspects, and (2) that perceived stigma (4%) and own withdrawal (5%) predict variations in drug-related death bereaved persons' perception of social support., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted. In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes., Methods: Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up. The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3-4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up., Results: Of the 241 included participants (57% women, mean age 48 years, range 19-84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P<0.001., Conclusions: Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial., Trial Registration: ClinicalTrials.gov NCT05234281., (© 2023. The Author(s).)

Chronic pain is associated with high levels of psychological distress, which can have implications for general functioning, acceptance, quality of life, and compliance with health-promoting behaviour. This study explored the association between pain-related factors and psychological distress in a sample of patients with long lasting temporomandibular disorder (TMD). In this cross-sectional study design, psychological distress was measured in 133 Norwegian patients with long lasting and severe TMD. Participants completed a survey including the hospital anxiety and depression scale (HADS), and questions about pain intensity, pain duration, catastrophizing, and causal attributions of their TMD symptoms along with a clinical interdisciplinary investigation. Higher levels of catastrophizing were associated with psychological distress. Pain intensity was associated with psychological distress in the unadjusted model, but not when controlling for the other variables. The majority attributed their TMD symptoms to physical factors. The findings support psychological interventions aimed at reducing catastrophizing in treatment of TMD. However, the patients emphasized physical causes for their TMD symptoms, suggesting that psychological interventions alone are not sufficient. The findings support a multidisciplinary approach to the treatment of TMD.

Background: Pulmonary rehabilitation has been demonstrated to be a highly effective treatment for people with chronic obstructive pulmonary disease (COPD). However, its availability is scarce worldwide, and new and innovative rehabilitation models are highly warranted. Recently, the group behind the present study published a protocol describing a novel concentrated, interdisciplinary group rehabilitation program for patients with chronic illnesses. The current paper describes an extension of this protocol to patients with COPD., Objective: The objective of this study is to explore the acceptability of concentrated, interdisciplinary group pulmonary rehabilitation for patients with COPD. The intervention is expected to improve functional status and be highly acceptable to patients., Methods: This study will include 50 patients aged over 40 years who fulfill the diagnostic criteria for COPD: a forced expiratory volume at the first second (FEV 1 ) <80% of expected and a FEV 1 /forced vital capacity ratio below the lower limit of normal according to the Global Lung Function Initiative. An interdisciplinary team consisting of physicians, physiotherapists, psychologists, pharmacists, clinical nutritionists, and nurses will deliver the treatment to groups of 6 to 10 patients over 3 to 4 consecutive days with a 12-month follow-up. The intervention is divided into three distinct phases: (1) pretreatment preparation for change, (2) concentrated rehabilitation, where the patient is coached to focus on making health-promoting microchoices, and (3) integration of the changes into everyday living, aided by digital follow-up and 2 on-site clinical examinations. Statistical significance will be set at α=.05., Results: The recruitment period will last from April 2022 until June 2023., Conclusions: If successful, this highly novel rehabilitation format might change the way we deliver care for patients with COPD, leading to substantial societal and socioeconomic gains. The study will expand knowledge on the concentrated treatment format as a rehabilitation model for people with COPD., Trial Registration: ClinicalTrials.gov NCT05234281; https://clinicaltrials.gov/ct2/show/NCT05234281., International Registered Report Identifier (irrid): PRR1-10.2196/40700., (©Bente Frisk, Kiri Lovise Njøten, Bernt Aarli, Sigurd William Hystad, Sidsel Rykken, Ane Kjosås, Eirik Søfteland, Gerd Kvale. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 26.10.2022.)

Background: A number of treatment approaches have shown efficacy for depression and/or anxiety, yet there is a paucity of research on potentially cost-effective concentrated approaches. Based on our previous experience with concentrated treatment in disorders such as Obsessive-Compulsive Disorder and chronic fatigue, we proposed that this novel approach could be useful for other conditions, including depression and/or anxiety. As a pre-requisite for a future randomized controlled trial, the aim of this study was to investigate the acceptability, satisfaction and effectiveness of a transdiagnostic, interdisciplinary group treatment delivered during 5 consecutive days to groups of 6-10 patients with depression and/or anxiety., Methods: This was a non-randomized clinical intervention pilot study in line with a published protocol. Forty-two consecutively referred patients, aged 19-47 (mean age 31.7, SD = 8.12) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age when the symptoms became a problem was 20.9 years. Mean number of prior treatment courses was 2.77 (SD = 2.19; range 0-8). Acceptability was defined as the proportion of eligible patients who accepted and completed the treatment. Satisfaction was evaluated by Client Satisfaction Questionnaire-8. Secondary objectives were to assess the treatment effectiveness by questionnaires at pre-treatment, seven days post-treatment and three months follow-up., Results: The treatment was highly acceptable (91.3% accepted, all completed), and patients were highly satisfied with the treatment, including the amount. Functional impairment, as measured by Work and Social Adjustment Scale (WSAS) improved significantly (p < .0005) from "severe" (mean 25.4 SD = 6.59) to "less severe" (mean 13.37, SD = 9.43) at 3 months follow-up. Using the Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), the effect sizes at 3 months follow-up were 1.21 for anxiety and 1.3 for depression. More than 80% reported reduced utilization of mental health care, and 67% had not used, or had used the family doctor less, for anxiety or depression. 52% had not used, or had reduced, medication for their disorder., Conclusions: The concentrated, interdisciplinary treatment approach yielded promising results. Long-term follow up is warranted., Trial Registration: This study is registered in Clinical Trials, identifier NCT05234281 and approval date 09/02/2022., (© 2022. The Author(s).)

Background: Treatment seeking children and adolescents with severe obesity often experience barriers to physical activity. Studies objectively measuring physical activity in this group and investigating explanatory factors for physical activity levels could inform clinical practice., Objectives: This study aimed to compare objectively measured physical activity levels among treatment seeking children and adolescents with severe obesity and normal weight peers, and to investigate explanatory factors for time spent in moderate physical activity and vigorous physical activity among children and adolescents with severe obesity., Methods: Children with severe obesity (n = 85) were matched 1:1 by age, gender, and the season for accelerometer measurements with normal weight peers (n = 85). Children wore accelerometers for seven consecutive days, yielding measures of physical activity, sleep duration and timing. Parents reported on screen time, parental body mass index and participation in organized sports., Results: Children and adolescents with severe obesity spent significantly less time in moderate physical activity (12 min, p  < 0.001) and vigorous physical activity (21 min, p  < 0.001) per day compared to normal weight peers. No difference for time spent in sedentary activity was found between groups. For participants with severe obesity, age ≤12 years ( p  = 0.009) and participation in organized sports ( p  = 0.023) were related to more moderate physical activity, while age ≤12 years ( p  = 0.038) and early sleep timing ( p  = 0.019) were related to more vigorous physical activity., Conclusion: Children and adolescents with severe obesity were less physically active than their normal weight peers. Factors related to more moderate and vigorous physical activity in children with severe obesity were lower age, participation in organized sports and earlier sleep timing., Competing Interests: The authors declares no conflict of interest., (© 2022 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

To compare the effectiveness of family-based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel-design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6-18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT (n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU (n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut-off for overweight (%IOTF-25). Secondary outcomes included changes in sleep, physical activity, and eating behaviour. From pre- to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10-0.28, p < .001) and %IOTF-25 (5.48%, 95%CI: 2.74-8.22, p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: -0.22 to -0.10, p < .001) and %IOTF-25 (6.53%, 95% CI: -8.45 to -4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: -0.03 to 0.09, p = .30) and %IOTF-25 (-1.04%, 95% CI: -2.99 to -0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre- to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight-related outcomes compared to TAU., (© 2022 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

The personality disposition hardiness has been shown to be associated with adaptive coping strategies and is considered an important protective factor against development of mental health symptoms. One of the criticisms found in the hardiness literature concerns the question whether the construct is equally important for men and women. Using a prospective design in a moderated mediation model, regression analyses were performed to examine the effect of avoidance coping in the association between hardiness and mental distress. The effect of biological sex was examined in the association between hardiness and avoidance coping. Our sample included 410 civilian personnel employed in a military organization. The results showed that higher hardiness levels were associated with lower reported use of avoidance coping, which in turn was associated with lower levels of distress symptoms. Avoidance coping mediated the effect of hardiness on anxiety symptoms and this indirect effect was not moderated by biological sex. These results indicate that hardiness operates similarly for women and men as a factor influencing mental distress symptoms., (© 2021 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Background: An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses., Objective: We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up., Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post-COVID-19 symptoms, anxiety and depression, and type 2 diabetes., Results: Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021., Conclusions: If successful, this study may have a substantial impact on the treatment of low back pain, post-COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions., International Registered Report Identifier (irrid): DERR1-10.2196/32216., (©Gerd Kvale, Bente Frisk, Marte Jürgensen, Tore Børtveit, Øystein Theodor Ødegaard-Olsen, Ane Wilhelmsen-Langeland, Bernt Bøgvald Aarli, Kristina Sandnes, Sidsel Rykken, Anne Haugstvedt, Sigurd William Hystad, Eirik Søfteland. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.10.2021.)

Background: Shortage of nurses and instability in the nursing workforce due to turnover have become a global concern., Purpose: The aim of this study was to investigate whether symptoms of psychological distress mediated the impact of age, gender, workplace bullying, job satisfaction, and hardiness on turnover intention when controlling for living with children, marital status, percentage of full-time equivalent, and number of night shifts last year and whether the same variables (except full-time equivalent and number of night shifts last year) could predict real turnover., Methods: In all, 1,246 nurses took part in a survey in 2008/2009 (T1) assessing symptoms of insomnia, sleepiness, anxiety, depression, fatigue, alcohol consumption, age, gender, workplace bullying, job satisfaction, and hardiness. Three years (T2) later they completed a survey assessing turnover intention, living with children, marital status, percentage of full-time equivalent, and number of night shift last year. A total of 99 nurses had left the nursing profession during this period., Results: Workplace bulling was positively related to turnover intention, whereas job satisfaction and hardiness were negatively related to turnover intention. The impact of all three predictors was partly mediated by symptoms of insomnia and anxiety. Age was negatively whereas male gender was positively associated with turnover intention. These effects were partly mediated by harmful alcohol use. Nurses who were living with a partner at T2 and nurses with high scores on fatigue at T1 were more prone to leave the nursing profession during the study period compared to their counterparts., Conclusion: Symptoms like insomnia, anxiety, and alcohol consumption may mediate the impact of working conditions and personality traits associated with turnover intention in nurses., Practice Implications: Interventions aiming at counteracting bullying, improving job satisfaction, and alleviating fatigue may reduce turnover intention/turnover., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Ample evidence attests to the relationship between short sleep duration, sleep problems and childhood obesity. However, few studies have examined the association between sleep timing and obesity in children., Objectives: To investigate how sleep duration, problems and timing relate to obesity and obesogenic behaviours in children., Methods: Eighty-five children (58.8% girls) with severe obesity and mean (SD) age of 12.1 (2.9) years, were matched by age and sex with peers with normal weight (n = 85,12.0 [2.8] years). Sleep and moderate-to-vigorous physical activity (MVPA) were measured via accelerometer for seven consecutive days. Children self-reported emotional eating on the Dutch eating behavior questionnaire. Parents reported children's screen time and sleep problems., Results: Children with severe obesity had significantly later mean mid-sleep time, overall (36 minutes later, P < .001), on school nights (36 minutes later, P < .001) and weekend nights (39 minutes later, P = .002) compared to children with normal weight. Children with obesity had more sleep problems (P = .030), but no differences emerged in sleep duration or social jetlag. After adjusting for demographic factors, mid-sleep time was positively related to screen time (P = .030). Mid-sleep time and sleep duration were inversely related to time in MVPA (Ps ≤ .041). There were no other significant associations between the sleep variables and the obesogenic behaviours., Conclusions: Later sleep timing was related to obesogenic behaviours in children and may represent an obesity risk factor., (© 2020 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Because of its brevity, the 12-item General Health Questionnaire (GHQ-12) has become one of the most popular and used measure for detecting psychological distress. Originally intended as a unidimensional measure, the majority of subsequent factor-analytic studies have failed to support GHQ-12 as a unitary construct and have instead proposed a plethora of multidimensional structures. In this study, we further examined the factor structure in two different military samples, one consisting of crewmembers from four different frigates deployed in anti-piracy operations and Standing NATO Maritime Group deployments ( N = 591) and one consisting of crewmember from three different minehunters/sweepers serving in Standing NATO Mine Counter-Measures Group deployments ( N = 196). Results from confirmatory factor analyses (CFA) performed in the first sample supported a bifactor model, consisting of a general factor representing communality among all items and two specific factors reflecting common variance due to wording effects (negatively and positively phrased items). A multi-group CFA further confirmed this structure to be invariant across our second sample. Structural equation modeling also showed that the general factor was strongly associated with symptoms of insomnia and mental health, whereas the specific factors were either non-significantly or considerably weaker associated with the criterion variables. Overall, our results are congruent with the notion that the multidimensionality demonstrated in many previous investigations is most likely an expression of method-specific variance caused by item wording. The explained unique variance associated with these specific factors was further relatively small. Ignoring the multidimensionality and treating GHQ-12 as a unitary construct will therefore most likely introduce minimal bias to most practical applications., (Copyright © 2020 Hystad and Johnsen.)

Introduction: Minor mental health problems among service members deployed in combat areas are relatively common, but social support is a protective factor. With the advent of digital communication, as well as more frequent family separations, a stable family support system may be more important than before. In this exploratory study, we aimed to test the relationship between perceived family support and the development of minor psychiatric symptoms during a 4-month naval counter piracy mission in the Gulf of Aden., Materials and Methods: We measured minor mental health problems with the general health questionnaire 12 (GHQ-12) and family support at three intervals, 3 weeks before deployment, 2 months into the mission, and at the end of deployment. We used mixed multilevel regression analysis to analyze the main effects of family support and time, as well as their interaction. All analyses were controlled for military rank., Results: We found that minor psychiatric symptoms increased at both midway (B = 0.51, P < 0.05) and toward the end of the mission (B = 0.72, P < 0.01). The results also showed that receiving more family support is associated with fewer psychiatric symptoms (B = -0.87, P < 0.01). Family support also moderated the development of symptoms toward the end of the mission (B = -0.73, P < 0.01). The buffering effect was such that service members with a high degree of family support experienced no increase in minor psychiatric symptoms during the deployment., Conclusions: The results indicate that naval deployment is associated with a small increase in minor mental health problems and that having a high degree of family support buffers this effect. Efforts to increase support among military families may positively influence the wellbeing of naval sailors during combat missions., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Child welfare workers (CWWs) often work under conditions similar in nature to workers within safety critical organizations (SCOs). This is because most of their work surrounds child neglect, securing homes for foster children, haphazard, and intricate cases, among other things, and where making wrong decisions, inattention to details, and the likes could lead to adverse consequences especially for the kids within their care. Research has shown that employees who experience support at work often report less stress symptoms, burnout, and a host of other negative workplace experiences. Experience of support at work has also been found to boost employees' retention, job satisfaction, and productivity. Despite this development, research exploring the essence of workplace support among CWW is very scarce in the literature, and we know very little about the type of workplace support and their influence on a host of workplace outcomes, especially the negative ones like secondary traumatic stress, aggression, and violence toward CWWs. The purpose of the current scoping review was to uncover what is known about workplace support and their relationship with workplace outcomes among CWWs. The authors explored four databases and identified 55 primary studies investigating workplace support and workplace outcomes among CWWs in the review. Studies mostly framed support under three main support types of coworker/peer support, social/organizational/management support, and supervisor/leadership support. Findings showed that workplace support has a positive impact on workplace variables like job satisfaction, engagement, commitment, and reduces the risk of turnover, burnout, and other negative workplace variables. The review highlights possible directions for future research., (Copyright © 2020 Olaniyan, Hetland, Hystad, Iversen and Ortiz-Barreda.)

Many critical and unexpected situations are handled by people that have never met. In the literature, development of immediate trust has been identified as a prerequisite for such temporary groups and leadership to function well. Limited experimental research has studied what leadership stimulates immediate trust between strangers. The present study investigate how four leadership styles, combining autocratic or democratic leadership behavior with low or high emotional stability, is related to immediate trust in a leader displayed through a 45-s video vignette of a car accident. A sample of 280 adults, randomly assigned to one of four conditions (1, autocratic/stable; 2, autocratic/unstable; 3, democratic/stable; 4, democratic/unstable) rated immediate trust after watching the vignette. The results show that autocratic and emotionally stable leaders were on average rated higher on immediate trust than all other leadership styles, after controlling for generalized trust., (Copyright © 2020 Olsen, Heesch, Søreide and Hystad.)

Background: The Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment for patients with Obsessive-Compulsive Disorder (OCD) delivered during four consecutive days. The B4DT has in a number of effectiveness studies demonstrated promising results as approximately 90% of patients gain reliable clinical change post-treatment and nearly 70% are recovered on a long-term basis., Methods: The current study is the first randomized controlled trial evaluating the effects of the B4DT. Forty-eight patients diagnosed with OCD were randomized to B4DT, self-help (SH), or waiting list (WL) with 16 patients in each condition. All participants randomized to the B4DT underwent the treatment without any attrition., Results: The B4DT yielded significantly better effects than control conditions on measures of OCD, depression, and generalized anxiety. The response rate (≥35% reduction of the individual patient's pre-treatment Y-BOCS score) was 93.8% in B4DT, 12.5% in SH and 0% in WL, while remission rate (response criterion is fulfilled and the post-treatment Y-BOCS score is ≤12 points) was 62.5%, 6.3%, and 0%, respectively. Furthermore, patients who had received the B4DT, showed improved work- and social functioning. None of the patients treated with B4DT showed signs of deterioration. In comparison, one patient in the SH condition was in remission, and one showed significant clinical improvement, whereas the remaining showed no change., Conclusion: The results indicate that the B4DT is an effective treatment for patients suffering from OCD., Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02886780., (Copyright © 2019 Launes, Hagen, Sunde, Öst, Klovning, Laukvik, Himle, Solem, Hystad, Hansen and Kvale.)

There is a lack of research on the relation between obsessive-compulsive disorder (OCD) and resilience. Dispositional resilience, as described and defined in literature on hardiness, consists of three facets, namely beliefs about having control in everyday living, having a sense of purpose or commitment, and a positive attitude toward challenges. This study explores associations between dispositional resilience (measured with the Dispositional Resilience Scale (DRS-15-R)), symptom severity, and treatment outcome in a sample of 89 patients treated with concentrated exposure therapy (cET), and compares the findings with scores from two reference groups (students and soldiers). The patient group had significantly lower resilience scores than the two reference groups. Weak correlations were observed between dispositional resilience and OCD symptoms. Differences in dispositional resilience were weakly related to remission status at follow-up (odds ratio of 1.11). Furthermore, resilience improved from pre- to post-treatment (Cohen's d of 0.65). Our results imply that patients' initial resilience score does not hinder nor facilitate treatment effects to a great extent in this format of ERP treatment., (© 2019 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Military personnel often engage in excessive alcohol use after returning from deployments. Thus far, research has paid scant attention to personality factors that may increase or diminish the risk for increased alcohol consumption in this population. The present study explores how psychological hardiness, avoidance coping, and stress exposure may interact to influence alcohol consumption patterns in soldiers following deployment. U.S. Army National Guard soldiers (N = 357) were surveyed shortly after returning from combat operations in Afghanistan. Conditional process analysis was used to test for mediation and moderation effects. Mediation effects were further tested in a replication sample of Norwegian Army soldiers (N = 230) deployed to Kosovo. Findings show that hardiness is a significant (negative) predictor of increased alcohol use and that this relation is mediated by avoidance coping. Further, this effect was moderated by combat stress exposure in the U.S. sample, such that the mediation is stronger for those with greater exposure (moderated-mediation). Avoidance coping also mediated the effects of hardiness on alcohol consumption in the Norwegian sample. These findings suggest that avoidance coping and hardiness may be fruitful areas for interventions aimed at reducing risky drinking in high-stress groups like the military., (Copyright © 2016 John Wiley & Sons, Ltd.)

Background: Sleep is increasingly being recognised as important for the health and well-being of sailors. The aim of the current study is to investigate the relationship between hardiness and reported insomnia-symptoms in a maritime military setting during a 4-month counter piracy naval mission in the Gulf of Aden., Materials and Methods: A sample of 281 officers, sailors, and enlisted personnel were measured on levels of hardiness before the mission. The participants were split into low and high hardiness groups based on the group level mean. Insomnia-symptoms were measured before, midway and at the end of the mission., Results: The results showed a significant main effect of time and a significant main effect of hardiness. The crew experienced the most insomnia symptoms in the middle of the mission and the high hardy group experienced less insomnia symptoms, in total, during the mission. There was also found a significant interaction effect of time and hardiness. The high hardiness group experienced less insomnia symptoms before and towards the end of the mission., Conclusions: The results indicate that high levels of hardiness may be a protective factor between the stressors of a naval mission and symptoms of insomnia.

The present study investigated psychological capital (PsyCap) as a protective factor in the relationship between worries about accidents and sleepiness among seafarers. The hypothesis that strong PsyCap weakens the relationship between worries about accidents and sleepiness was tested in a cross-sectional sample of 397 maritime workers. In contrast to expectations, the findings indicated a reverse buffering effect in that PsyCap only had a protective impact on sleepiness when worries about accidents were low. For workers that were highly worried, a strong PsyCap was associated with increased levels of sleepiness. The established associations remained consistent after controlling for workers' years of experience as seafarers, and their ratings of psychological safety climate. An interpretation of this finding is that seafarers with high levels of PsyCap will be attentive when the threat level is serious, but will not be bothered when exposed to everyday strain and hassles associated with their work situation.

Background: Seafaring is an inherently stressful environment. Because working time and leisure time is spent in the same confined environment for a prolonged period of time, many stressors present in seafaring can also be conceived of as chronic. We explored the effects of duration at sea, seafaring experience, environmental stressors, and psychological capital (PsyCap) on the sleep quality and fatigue of seafarers. PsyCap is a construct that draws upon ideas from positive psychology and positive organizational behavior, and is intended to capture an individual's psychological capacities that can be developed and utilized for performance improvements., Methods: We collected survey data from a sample of seafarers working in the offshore re-supply industry ( n  = 402) and a sample of seafarers working on board combined passenger and cargo ships ( n  = 340)., Results: PsyCap emerged as a robust predictor with statistically significant relations to fatigue and sleep quality in both samples. PsyCap also interacted with duration at sea in explaining fatigue in seafarers working on board the passenger and cargo ships. Seafarers on passenger and cargo ships also reported significantly higher levels of fatigue than those working in the offshore re-supply industry., Conclusion: Coupled with emerging research showing that PsyCap is trainable, our results suggest that maritime organizations could have much to gain by being cognizant of and developing routines for continually developing the PsyCap of their employees.

A large number of studies have shown that hardiness and cohesion are associated with mental health in a military context. However, most of them are presented without controlling for baseline mental health symptoms, which is their most significant source of error. The present study investigates the combined effect of hardiness and cohesion in a prospective design, controlling for baseline levels of symptoms among Norwegian personnel serving in a peacekeeping operation in Kosovo. Multivariate regression analyses were performed in which self-reported mental health complaints were regressed on our explanatory variables. Our findings suggest that both cohesion and hardiness contributed to increased stress resiliency, as measured by a lower level of reported mental health complaints. Our baseline measure of mental health accounted for a larger proportion of the variance than our other predictors. A significant interaction between cohesion and hardiness suggested a combined effect, over and above the individual contributions of the predictors. For individuals who scored high on hardiness, cohesion levels did not influence levels of mental health complaints. Individuals who scored low on hardiness, on the other hand, reported lower levels of mental health complaints when cohesion levels were high., (© 2015 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

This study provides empirical data about shipboard practices in bridge operations on board a selection of platform supply vessels (PSVs). Using the theoretical concept of distributed situation awareness, the study examines how situation awareness (SA)-related information is distributed and coordinated at the bridge. This study thus favours a systems approach to studying SA, viewing it not as a phenomenon that solely happens in each individual's mind but rather as something that happens between individuals and the tools that they use in a collaborative system. Thus, this study adds to our understanding of SA as a distributed phenomenon. Data were collected in four field studies that lasted between 8 and 14 days on PSVs that operate on the Norwegian continental shelf and UK continental shelf. The study revealed pronounced variations in shipboard practices regarding how the bridge team attended to operational planning, communication procedures, and distracting/interrupting factors during operations. These findings shed new light on how SA might decrease in bridge teams during platform supply operations. The findings from this study emphasize the need to assess and establish shipboard practices that support the bridge teams' SA needs in day-to-day operations., Practitioner Points: Provides insights into how shipboard practices that are relevant to planning, communication and the occurrence of distracting/interrupting factors are realized in bridge operations.Notes possible areas for improvement to enhance distributed SA in bridge operations.

This study is the first to our knowledge to examine the cross-language consistency across the original version of the Comprehensive Assessment of Psychopathy (CAPP) and a translated version. The CAPP is a lexically based construct map of psychopathy comprising 33 symptoms from 6 broad domains of personality functioning. English-language CAPP prototypicality ratings from 124 mental health workers were compared with ratings from 211 Norwegian mental health workers using the Norwegian translation. High agreement was found across languages in regard to which symptoms where perceived as central to psychopathy or not. Multigroup confirmatory factor analyses (MGCFA) indicated that, overall, the symptoms had similar associations with the 6 proposed underlying dimensions across the 2 language versions. Finally, in general, the probability for a given prototypicality rating on an individual symptom was similar across language version samples at the same level of the underlying trait, as analyzed with Item Response Theory (IRT). Together these findings lend support to the validity of the construct of psychopathy, the validity of the CAPP as a concept map of psychopathy, and the validity of the Norwegian translation of the CAPP., ((PsycINFO Database Record (c) 2014 APA, all rights reserved).)

Much research has now documented the substantial influence of safety climate on a range of important outcomes in safety critical organizations, but there has been scant attention to the question of what factors might be responsible for positive or negative safety climate. The present paper draws from positive organizational behavior theory to test workplace and individual factors that may affect safety climate. Specifically, we explore the potential influence of authentic leadership style and psychological capital on safety climate and risk outcomes. Across two samples of offshore oil-workers and seafarers working on oil platform supply ships, structural equation modeling yielded results that support a model in which authentic leadership exerts a direct effect on safety climate, as well as an indirect effect via psychological capital. This study shows the importance of leadership qualities as well as psychological factors in shaping a positive work safety climate and lowering the risk of accidents.

Psychological hardiness characterizes people who remain healthy under psychosocial stress. The present exploratory study investigates possible links between hardiness and several immune and neuroendocrine markers: IL-6, IL-12, IL-4, IL-10, & neuropeptide-Y. A total of 21 Norwegian navy cadets were studied in the context of a highly stressful military field exercise. Blood samples were collected midway, and again late in the exercise when stress levels were highest. Psychological hardiness (including commitment, control, and challenge) was measured two days before the exercise. While all subjects scored high in hardiness, some were high only in commitment and control, but relatively low in challenge. These "unbalanced" hardiness subjects were also more stress reactive, showing suppressed proinflammatory cytokines (IL-12), increased anti-inflammatory cytokines (IL-4, IL-10), and lower neuropeptide-Y levels as compared to the hardiness-balanced group. This study thus shows that being high in hardiness with a balanced profile is linked to more moderate and healthy immune and neuroendocrine responses to stress.

This study examined the influence of safety climate and psychosocial work environment on the reported fatigue of seafarers working in the offshore oil and gas re-supply industry (n = 402). We found that seafarers who reported high psychological demands and perceived the organisational-level safety climate negatively,reported significantly more mental fatigue, physical fatigue, and lack of energy. In addition, seafarers who reported having high levels of job control reported being significantly less mentally fatigued. We also found some combined effects of safety climate and shift arrangement. Organisational-level safety climate did not influence the levels of physical fatigue in seafarers working on the night shift. On the contrary, seafarers working during the days reported to be more physically fatigued when they perceived the organisational-level climate to be negative compared with the positive. The opposite effect was found for group-level safety climate: seafarers working during the nights reported to be more physically fatigued when they perceived the group-level climate to be negative compared with the positive. The results from this study point to the importance of taking into consideration aspects of the psychosocial work environment and safety climate,and their potential impact on fatigue and safety in the maritime organisations.

Organizational justice has attracted attention as a predictor of employees' mental and physical health as well as commitment and work outcomes. The lack of a Norwegian translation of an organizational justice scale has precluded its use in Norway. Four dimensions of the organizational justice construct were examined in a Norwegian military context, including facet measures of distributional, interpersonal, and informational justice developed by Colquitt in 2001, in addition to procedural justice developed by Moorman in 1991. Confirmatory factor analyses supported a four-dimensional structure with good internal consistency. Follow-up analyses have suggested that the four dimensions were nested beneath a general, latent organizational justice factor. A positive relationship between organizational justice and self-sacrificial behavior was found, indicating satisfactory construct validity. The results demonstrate that the Norwegian Organizational Justice Scale is a reliable and construct-valid measure of organizational justice in a Norwegian setting.

This study prospectively investigated the effects of psychological hardiness, job control, and job demands on medically certified sickness absence. Data from a questionnaire survey were combined with archival data for sickness absence among 7,239 civilian and military employees of the Norwegian Armed Forces (84.3% male, 69.8% military). A 2-component hurdle regression was used in the statistical analyses of the sickness absence data. After controlling for age, sex, and baseline absence, hardiness predicted both the likelihood of having any sickness absence (odds ratio = 0.97) and the number of absence spells (a 6.5% decrease in the expected count for 1 standard deviation change in hardiness). In addition, an interaction was found among hardiness, job control, and psychological demands. When demands were high, high job control was associated with more absence among employees with low levels of hardiness. Together, these findings point to hardiness as an important individual resource in relation to health, and that it is necessary to consider individual differences when examining the effects of work characteristics.

The present study explored sex and cultural differences in Emotional Intelligence scores in samples from Norway (n = 297) and the United States (n = 234). Significant main effects for sex were found in overall Emotional Intelligence scores and the Empathy factor. In addition, results revealed a small but significant effect for culture in the Self-control factor, as well as support for an interaction between sex and culture in the Handling Relationships factor. The results are discussed in light of cultural differences between U.S. and Norwegian societies.

In the 30 years that have elapsed since it was first introduced, the concept of hardiness has continued to attract the attention and interest of researchers from all over the world. The purpose of this study was to examine the reliability and factor structure of a revised Norwegian hardiness scale (Dispositional Resilience Scale 15; DRS-15). Using exploratory and confirmatory factor analytic strategies with a large sample of working adults (N = 7,280), support was found for a hierarchical structure comprising a general hardiness dimension and three sub-dimensions (commitment, control, and challenge). Overall, the results support the reliability and validity of the revised DRS-15 and underscore the importance of examining the psychometric properties and cultural appropriateness of translated scales.