Risk of developing psychiatric disease among adult patients with skin disease: A 9-year national register follow-up study in Norway.

Background: The existing association between skin disease and psychiatric comorbidity has gained attention during the last decades. Stress and mental illness can directly or indirectly affect skin disease, while dermatological conditions, known to impair life quality and mental well-being, can promote psychiatric conditions. Objectives: The aim of this study was to assess the risk of developing psychiatric disease among adult dermatological patients over a period of time. The secondary objective was to see which psychiatric disorders developed most commonly, and which skin diseases posed the greatest risk for later mental health issues. Methods: Adult dermatological patients were followed for 9 years (2008-2016) using the Norwegian Patient Registry, for both outpatient and inpatient specialist healthcare services. Dermatological patients were identified during the first 2 years and were then followed for psychiatric comorbidity prospectively for the next 7 years.Cox regression models were applied to estimate the risks of psychiatric disorders among patients with skin diseases. Estimates were adjusted for age and gender differences. Hazard risk ratios (HR) with 95% CI are reported. Results: Dermatological patients developed depressive disorders most frequently (4.1% vs. 2.3% in non-dermatological participants), followed by anxiety disorders (3.3% vs. 1.8%), and adjustment disorders (2.6% vs. 1.5%). Developing depressive disorders showed the highest HR among dermatological patients, HR (95% CI) = 2.5 (2.4-2.5), followed by disorders related to alcohol use, HR (95% CI) = 2.2 (2.1-2.5), and anxiety disorders, HR (95% CI) = 2.1 (2.1-2.2). Papulosquamous disorders were the skin conditions with the highest HR for developing a mental health condition, with depressive disorder having HR (95% CI) = 2.6 (2.5-2.9); anxiety disorders at HR (95% CI) = 2.9 (2.7-3.1); and disorders related to alcohol use at HR (95% CI) = 3.2 (2.8-3.6). Conclusions: The study demonstrates that having a skin disease doubles to triples the risk of developing a psychiatric illness within 7 years, especially depression, anxiety, and alcohol use compared with the general population.

Undernutrition and associated factors among adults with mental and neurological disorders in public health hospitals, Eastern Ethiopia, 2019: a cross-sectional study.

BACKGROUND: Poor nutritional status can be consequence of impaired mental health that may lead to involuntary weight gain, weight loss, or deficiency of essential nutrients. However, little has been documented about the nutritional status of adults with mental disorders and the contributing factors in low-income countries like Ethiopia. The aim of this study was to assess the magnitude of undernutrition and associated factors among adults with mental disorders in public hospitals of Eastern Ethiopia. METHODS: Institution-based, cross-sectional study was conducted among 507 adults with mental disorders from March 1, 2019 to April 1, 2019. Interviewer administered pretested structured questionnaire was used to collect data. Anthropometric data were collected using calibrated weighing scale and height measuring board. Descriptive statistics was computed to describe the data. Bivariable and multivariable logistic regression analyses were applied to identify factors associated with the undernutrition. Odds ratio alongside 95% confidence interval (CI) were estimated to measure the strength of the association. Level of statistical significance was declared at p-value less than 0.05. RESULTS: Undernutrition affected 62.7%; 95% CI: (58.3%, 67.7%) of the patients. Undernutrition was associated with meal frequency < 3 per day (adjusted odds ratio [(AOR = 2.07, 95% CI: (1.18, 3.63)], use of multiple medication (adjusted odds ratio [(AOR = 3.02, 95% CI: (1.88, 4.84)], being non-smoker [(AOR = 0.50, 95%CI: (0.25, 0.91)], and use of prescribed diet [(AOR = 0.45, 95%CI: (0.26, 0.78)]. CONCLUSIONS: The magnitude of undernutrition was high among the study participants. Multiple medication, cigarette smoking, frequency of meal and taking prescribed diet were significantly associated with undernutrition. Nutrition education for patients with mental disorders and their caregivers about the impact of taking multiple medication and substance use needs to be emphasized alongside nutritional screening and support to improve their nutritional status.

The impact of PTSD on risk of cardiometabolic diseases: a national patient cohort study in Norway.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with cardiometabolic diseases, concurrent anxiety, alcohol use disorder and depression. The relationship between PTSD and cardiometabolic diseases are still unclear, and less is known about the effects of socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression. The study, therefore, aims to examine the risk of developing cardiometabolic diseases including type 2 diabetes mellitus over time in PTSD patients, and to what extent socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression attenuate associations between PTSD and risk of developing cardiometabolic diseases. METHOD: A retrospective, register-based cohort study with 6-years follow-up of adult (> 18 years) PTSD patients (N = 7 852) compared with the general population (N = 4 041 366), was performed. Data were acquired from the Norwegian Patient Registry and Statistic Norway. Cox proportional regression models were applied to estimate hazard ratios (HRs) (99% confidence intervals) of cardiometabolic diseases among PTSD patients. RESULTS: Significantly (p < 0.001) higher age and gender adjusted HRs were disclosed for all cardiometabolic diseases among PTSD patients compared to the population without PTSD, with a variation in HR from 3.5 (99% CI 3.1-3.9) for hypertensive diseases to HR = 6.5 (5.7-7.5) for obesity. When adjusted for socioeconomic status and comorbid mental disorders, reductions were observed, especially for comorbid depression, for which the adjustment resulted in HR reduction of about 48.6% for hypertensive diseases and 67.7% for obesity. CONCLUSIONS: PTSD was associated with increased risk of developing cardiometabolic diseases, though attenuated by socioeconomic status and comorbid mental disorders. Health care professionals should be attentive towards the burden and increased risk that low socioeconomic status and comorbid mental disorders may represent for PTSD patients' cardiometabolic health.

The burden of somatic diseases among people with alcohol- and drug use disorders are influenced by mental illness and low socioeconomic status. A registry-based cohort study in Norway.

OBJECTIVES: Persons with alcohol use disorder (AUD) and drug use disorder (DUD) have a lower life expectancy than the general population. We examined the burden of somatic diseases among persons with AUD or DUD and investigated impact of socioeconomic status (SES) and mental health disorders on the co-occurrence of somatic diseases in these groups. METHODS: We performed a retrospective, register-based cohort study with a 6-year follow-up of persons (aged ≥18 y) with AUD (13,478) or DUD (16,659). Cox regression analyses were used to estimate hazard ratios (HRs) of somatic diseases. RESULTS: Patients with DUD were, on average, 10 years younger at the point of diagnosis than patients with AUD. Mental illnesses were prominent in both groups (AUD: 40.5%, and DUD: 46.9% vs 3.5% in controls). Adjusting for mental disorders, the risk of all somatic diseases among the AUD and DUD groups was reduced by 30%. Some of the elevated risk of somatic diseases among persons with AUD and DUD is explained by low SES, though less than that explained by the presence of mental disorders. The diseases with highest risk among AUD patients were metabolic disorders (16.9-fold) and hypertension (14.8-fold), and among AUD patients, viral hepatitis (23.3-fold), after adjusting for low SES and mental disorders. CONCLUSIONS: Persons with AUD had a higher risk of most somatic diseases, while those with DUD had specific risks for infections and viral hepatitis. Mental health disorders and SES adjusted the associations regarding most somatic diseases. In general, improvement of socio-economic conditions, preferably in combination with professional support to self-manage mental health problems, will reduce the risk of somatic illness in both groups. For DUD patients, available sterile user equipment will reduce the risk of viral hepatis.

The association between early marriage and mental disorder among young migrant and non-migrant women: a Norwegian register-based study.

BACKGROUND: Marriage is considered beneficial for mental health when stable and of high quality. Yet, it is unclear whether marriage is equally advantageous for everyone regardless of marital timing or migrant background. This study aimed to investigate the association between early marriage and mental disorder, defined by outpatient mental healthcare (OPMH) service use, and whether the association varies between migrant and non-migrant women. METHODS: Using data from four Norwegian national registers, we applied discrete-time logistic regression analyses to study the aims of interest, among 602 473 young women aged 17-35 years. All women were followed from 2006 or the year they turned 17, and until first OPMH consultation, 2015 (study end), the year they turned 35, when emigrated, died, or changed marital status from married to separated, divorced, or widowed. RESULTS: Results show that unmarried and early married women had increased odds of mental disorder when compared to on-time married women. However, the differences between the early and on-time married women were explained by differences in educational level. There was no significant interaction between marital status and migrant background. CONCLUSIONS: Differences in mental health between early- and on time married women are attributed to poorer educational attainment of women who marry early. Furthermore, migrant background seems to have a limited role in the association between marital timing and mental disorder. The promotion of formal education among young women could contribute to the accumulation of socioeconomic and psychosocial resources, thus, reducing the risk of mental disorder, also among early married women.

The association between persistent low parental income during preschool age and mental disorder in adolescence and early adulthood: a Norwegian register-based study of migrants and non-migrants.

BACKGROUND: Low socioeconomic status during childhood is associated with increased risk of mental disorders later in life. Yet, there is limited research on whether this association varies by migrant background, despite an overrepresentation of migrants among the economically disadvantaged. METHODS: Using national register data on a study population of 577,072 individuals, we investigated the association between persistent low parental income during preschool, measured at age 3-5 years and mental disorder during adolescence and early adulthood, measured between ages 16-25. Outpatient mental healthcare (OPMH) service use was a proxy for mental disorder and was measured between 2006 and 2015. We applied discrete-time logistic regression analyses with interaction terms to study differences in the relationship between persistent low parental income and OPMH service use by migrant background and gender. RESULTS: Persistent low parental income during preschool age was associated with increased odds of OPMH service use in adolescence and early adulthood (aOR = 1.99, 95% CI 1.90-2.08), even after adjusting for gender, migrant background, parental education and persistent lower income at later ages (aOR = 1.33, 95% CI 1.27-1.40). Statistically significant interactions between migrant background and persistent low parental income were recalculated and presented as marginal yearly probabilities. These results showed that the association was in the opposite direction for migrants; those in the higher income group had higher probability of OPMH service use, although the differences were non-significant for some groups. The relationship did not vary by gender. CONCLUSIONS: Social inequalities in mental health, as measured by OPMH service use, may have an onset already in childhood. Interventions to reduce inequalities should therefore start early in the life course. Since the association differed for migrants, future research should aim to investigate the mechanisms behind these disparities.

Effects of age and gender on the relationship between alcohol use disorder and somatic diseases: a national register study in Norway.

OBJECTIVE: This study aimed to examine how age and gender moderate the associations between alcohol use disorders (AUD) and several somatic diseases. DESIGN AND SETTING: We performed a retrospective, register-based cohort study with 6-year follow-up of patients with AUD and the general population. Data were acquired from the Norwegian Patient Registry. Cox regressions were used to estimate HRs of somatic diseases. PARTICIPANTS: Patients with AUD (17 023; 0.4%) were compared with the population without AUD (4 271 559; 99.6%), with adults aged 18 years or older who were registered residents of Norway on 1 January 2008. MAIN OUTCOMES: Dichotomous variables of 12 specific somatic diseases (cardiovascular diseases, endocrine, nutritional, and metabolic diseases, cancer, and infectious diseases) were assessed. Diagnoses were set in specialist healthcare services. RESULTS: Patients with AUD, compared with a population without AUD, experienced a significantly greater burden of all studied somatic diseases. Middle-aged adults with AUD had increased risks (p<0.05) for hypertension; ischaemic diseases; pulmonary diseases; cerebrovascular diseases; malnutrition; metabolic disorders; cancer; and influenza and pneumonia than younger and older adults with AUD. For most somatic diseases, we found no differences between younger versus older adults with AUD, and between females versus males with AUD (p>0.05). Males with AUD had significantly higher risks for pulmonary heart diseases (HR=3.9, 95% CI 3.3 to 4.6) and metabolic disorders (HR 4.7, 95% CI 4.5 to 5.0), while females with AUD had a significantly higher risk for viral hepatitis (HR=4.4, 95% CI 3.8 to 5.1). CONCLUSIONS: Age moderated the associations between AUD and most somatic diseases, with middle-aged adults with AUD having a greater increased risk of somatic diseases compared with younger and older adults with AUD. Gender only moderated associations between AUD and pulmonary heart diseases, metabolic disorders and viral hepatitis. This has implications for the prioritisation of somatic resources among patients with AUD.

Inpatients experiences about the impact of traumatic stress on eating behaviors: an exploratory focus group study.

BACKGROUND: Unhealthy changes in eating behavior among people experiencing trauma have been observed. There is, however, a lack of in-depth knowledge regarding the impact of the after effects of traumatic life experiences on eating behavior. Because eating behavior represents important components for promotion and maintenance of good health throughout life, this study aimed to explore inpatients' lived experiences of the impact of traumatic stress on eating behavior. METHOD: Thirteen female and two male inpatients (age range 28-62 years), recruited from a psychiatric clinic in Norway, participated in this qualitative explorative focus group study. The data analysis was performed using systematic text condensation. RESULTS: The results in the present study describe the participants' experiences about the impact of traumatic stress on their eating behavior. Their discussions and descriptions disclosed problems that could be summarized into four main themes: "experiencing eating behaviors as coping strategies"; "experiencing being addicted to food and sweets"; "experiencing eating behaviors controlled by stress and emotions"; and "experiencing lack of appetite and reduced capacity to plan and prepare meals". CONCLUSION: Traumatic stress can impact eating behavior in several complex ways that over time may cause adverse health consequences. The results add to an important understanding of changes in eating behavior that might appear in people struggling to cope with the after effects of traumatic life experiences to the existing literature. To better understand the complexity of how traumatic experiences may impact eating behavior, this knowledge is important and useful for health professionals offering support to those who experience struggling with eating behavior after traumatic experiences.

This study aimed to explore trauma-exposed inpatients experiences about the impact of traumatic stress on eating behavior. Thirteen female and two male inpatients with a history of trauma, recruited from a psychiatric clinic in Norway, participated in this qualitative explorative focus group study. The results in the present study describe the participants' experiences about the impact of after effects of traumatic experiences on eating behaviors. The findings are summarized into four main themes: "experiencing eating behaviors as coping strategies"; "experiencing being addicted to food and sweets"; "experiencing eating behaviors controlled by stress and emotions"; and "experiencing lack of appetite and reduced capacity to plan and prepare meals". The results contribute to the existing literature and provide an important understanding of changes in eating behavior that might appear in people struggling with traumatic stress after traumatic experiences. This knowledge is important and useful for health professionals offering help to those struggling with their eating behavior after traumatic experiences.

Cultural adaptation and validation of the Children's Eating Behaviour Questionnaire in Ethiopia.

Eating behaviours have been associated both with being underweight or overweight and poor growth. The Children's Eating Behaviour Questionnaire (CEBQ) is a widely used measure of child eating behaviours. The instrument is, however, mostly validated in high-income countries, with a scarcity of evidence among developing countries such as Ethiopia. The present study aims to assess the cultural adaptability and validity of the CEBQ to be used in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged 3-6 years in selected preschools. Tests of factorial validity, convergent validity and reliability were performed. The Confirmatory Factor Analysis model indicated that eight subscales provided the best fit (root-mean-square error of approximation = 0⋅05 (90 % CI 0⋅045, 0⋅055); Comparative Fit Index = 0⋅92 and Tucker-Lewis Index = 0⋅90) after seven items from the original CEBQ were removed. Convergent validity with child's weight status was found for emotional overeating, food fussiness, satiety responsiveness and slowness in eating subscales. Reliability, measured using Cronbach's α, provided values between 0⋅50 and 0⋅79. The eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity among preschool children. Further replication of the study among low-income countries is essential to improve the literature on children's eating behaviours.

Mental disorders among young adults of immigrant background: a nationwide register study in Norway.

PURPOSE: Previous research indicates increased risk of various mental disorders in immigrant populations, particularly for schizophrenia and PTSD. However, findings are inconclusive due to variations in contextual factors, characteristics of immigrant groups and study design. Our study aims to investigate prevalence differences of receiving an ICD-10 psychiatric diagnosis between 2008 and 2016 among four first-generation immigrant groups and one second-generation immigrant group compared to ethnic Norwegians. METHODS: Linked register data from the Norwegian Patient Registry and Statistics Norway were utilised. The sample (age 18-35) comprises 758,774 ethnic Norwegians, 61,124 immigrants originating from Poland, Somalia, Iran and Pakistan and 4630 s-generation Pakistani immigrants. Age- and gender-adjusted binary logistic regression models were applied. RESULTS: The odds of schizophrenia were significantly elevated for all groups except for Poles. The highest odds were observed for second-generation Pakistani immigrants (adjusted OR 2.72, 95% CI 2.21-3.35). For PTSD, the odds were significantly increased for Somalis (aOR 1.31, 95% CI 1.11-1.54), second-generation Pakistani immigrants (aOR 1.37, 95% CI 1.11-1.70), and in particular for Iranians (aOR 3.99, 95% CI 3.51-4.54). While Iranians showed similar or higher odds of receiving the vast majority of psychiatric diagnoses, the remaining groups showed lower or similar odds compared to ethnic Norwegians. CONCLUSION: Our findings suggest considerable prevalence differences in receiving a psychiatric diagnosis according to country of origin and generational status compared to ethnic Norwegian controls. The general pattern was lower prevalence of most ICD-10 mental disorders for the majority of immigrant groups compared to ethnic Norwegians, except for schizophrenia and PTSD.

The relationship between caregivers' feeding practices and children's eating behaviours among preschool children in Ethiopia.

Preschool age is a time when distinct eating behaviours are formed. Eating behaviours have been associated with underweight and poor growth as well as with overweight. However, the relationship between caregivers' feeding practices and children's eating behaviours remains poorly understood in developing countries. This study aims to evaluate the association between caregivers' feeding practices and eating behaviours among preschool children in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged between three and six years old. We used the Children Eating Behaviour Questionnaire and the Child Feeding Questionnaire to measure eating behaviour and caregivers' feeding practices respectively. A multiple linear regression was fitted to determine the association between caregivers' feeding practices and the multiple scales of children's eating behaviour while adjusting for potential confounders. Children whose caregivers practice food restriction tended to be more food responsive (ß = .23, p < .001), tend to emotionally overeat (ß = .09, p < .01), enjoy food more (ß = 0.23, p < .001) and have more desire to drink (ß = .24, p < .001). Meanwhile, children whose caregivers practiced pressure to eat were fussier about food (ß = .09, p < .001), were more satiety responsive (ß = .13, p < .001) and tended to eat slower (ß = .10, p < .01). In Ethiopia, where under- and over-nutrition coexist among pre-school children, the results from this study underscore the importance of investigating eating behaviours at an early age, as these eating styles may contribute to children's poor nutritional status. It is also essential to include appropriate child eating behaviour and specific feeding practices components, together with responsive feeding in national nutritional programmes to improve the nutritional status of children aged 24-59 months.

Use of outpatient mental healthcare services and upper-secondary school completion in young women with migrant background - A population-based study.

Mental disorders typically develop during adolescence, with young women being particularly at risk. Mental disorders during this period can negatively affect both current and future life prospects such as school completion. Migrants are at increased risk of developing mental disorders as a result of their experiences prior to, during and after migration. Additionally, they are less likely to complete upper-secondary school when compared to the majority population. Thus, being a young migrant woman with a mental disorder may have adverse consequences for school completion, which in turn can affect socioeconomic status later in life. In this study, we aimed to investigate the association between mental disorders, defined as having used outpatient mental healthcare services (OPMH), and completion of upper-secondary school among young women living in Norway, using national registry data. Additionally, we examined differences in probability of school completion between Norwegian majority, migrants and migrant descendants between those who used and did not use OPMH. The sample consisted of women born between 1990 and 1993 (N = 122,777). We conducted hierarchical, multivariable logistic regression analysis. In unadjusted analysis, we found that young women who used OPMH services had lower odds of school completion than those who did not, even after adjustment for migrant background and parental education. However, by calculating predictive margins, we found that descendant women, who had used OPMH services, had significantly higher probability of completing upper-secondary education than Norwegian majority women who had used services. None of the four migrant groups differed significantly from majority women. Use of OPMH services, had most adverse effect on majority, migrants from Nordic and Western countries and descendants, when compared to non-users. Future interventions should aim to increase school completion among young women with mental disorders.

Utilization of somatic specialist services among psychiatric immigrant patients: the Norwegian patient registry study.

BACKGROUND: Amongst psychiatric patients, the leading causes of reduced quality of life and premature death are chronic viral infections and cardiovascular diseases. In spite of this, there are extremely high levels of disparity in somatic healthcare amongst such populations. Little research has explored patterns of healthcare utilisation and, therefore, this study aims to examine the use of somatic specialist healthcare for infectious diseases and diseases of circulatory system among psychiatric patients from different immigrant groups and ethnic Norwegians. METHODS: Register data from the Norwegian Patient Registry and Statistics Norway were used. The sample (ages 0-90+) consisted of 276,890 native-born Norwegians and 52,473 immigrants from five world regions - Western countries, East Europe, Africa, Asia, and Latin America, all of whom had contacts with specialist mental healthcare during the period 2008-2011. Statistical analyses were applied using logistic regression models. RESULTS: Rates of outpatient consultation for circulatory system diseases were significantly lower amongst patients from Africa, Asia and Latin America compared with ethnic Norwegian psychiatric patients. Only patients from Eastern Europeans had a higher rate. With regard to hospital admission, all psychiatric patients had a lower rate than ethnic Norwegians with the exception of those from Africa where the finding was non-significant. In terms of infectious diseases, patients from African countries had significantly higher outpatient and admission rates than ethnic Norwegians. Outpatient consultation rates were lower amongst those from Western and Latin America and hospital admission rates were lower amongst those from Eastern Europe and Asia. CONCLUSIONS: The findings suggest that the majority of immigrant psychiatric patients have lower hospitalization rates for circulatory system diseases than Norwegian psychiatric patients. This may suggest that poor access for immigrants is a contributing factor, though the findings were less pronounced for infectious diseases.

Eating behaviour disorders among adolescents in a middle school in Dongfanghong, China.

BACKGROUND: Disordered eating behaviours (DEB) are significant public health challenges among adolescents. DEB are prevalent among Chinese young people and replication epidemiological studies in DEB are needed due to ongoing rapid modernization and socio-economic change. In addition, there has been no prevention or intervention programs for DEB in most of rural areas in China and research in DEB in rural China is limited. More research in DEB in rural China is needed for increased awareness of prevention strategies. The objectives of the study are to examine the prevalence and associated factors of DEB among rural Chinese adolescents. METHODS: Four hundred and sixty-six students aged 11-18 years old from a middle school in rural China were invited to complete a self-reported questionnaire that included measures on DEB and psychosocial factors. The SCOFF questionnaire was applied to measure DEB (i.e., a score of > = 2 indicates a likely case of DEB). Logistic regression models were applied for data analyses. A p-value <0.05 was regarded as statistically significant. RESULTS: There were 389 adolescents (11-18 years) included in this study with the prevalence of DEB being 28.8%. No significant differences were found between male adolescents (30.5%) and female adolescents (27.1%). Independently, perceived overweight (OR = 2.80, 95% CI = 1.05-7.48), negative affect (OR = 1.07, 95% CI = 1.03-1.12), body dissatisfaction (OR = 0.96, 95% CI = 0.93-0.99), and watching TV (OR = 2.40, 95% CI = 1.11-5.18) were significantly (p < 0.05) associated with DEB. CONCLUSION: This study indicates a high prevalence rate of DEB among rural adolescents and associated factors of DEB from a school-based sample. Such findings imply that local public health systems should pay more attention to DEB and design prevention and intervention strategies for DEB.

Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

PURPOSE: As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. METHODS: Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. RESULTS: Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. CONCLUSION: Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

Mental health problems among individuals with persistent health challenges from adolescence to young adulthood: a population-based longitudinal study in Norway.

BACKGROUND: Persistent health challenges are increasing throughout the world. It has been shown that adolescents with persistent health challenges are at greater risk of having mental health problems than their healthy peers. However, these studies are mainly cross-sectional, and little is known about the transition to adulthood. Thus, the aim of this study was to examine how mental health problems in adolescents and young adults with persistent health challenges vary during adolescence and in the transition to young adulthood. METHODS: The study used longitudinal and time-series data from the "Young in Norway" study. A sample of adolescents was prospectively followed from adolescence to young adulthood with measures at four different time points (n = 3,087; T1-T4): 2921 adolescents (12-19 years) participated at T1 and T2, while 2448 young adults participated at T3 and T4. Persistent health challenges, age, gender, mental health problems and parental socio-economic status were measured in the longitudinal survey. Regression models were applied to estimate associations between persistent health challenges (understood as having a chronic health condition or disability) and mental health problems during adolescence and young adulthood. Different models were tested for chronic health conditions and disability. RESULTS: Adolescents with disability had higher scores for depressive and anxiety symptoms, loneliness and self-concept instability, and lower scores for self-worth, appearance satisfaction, scholastic competence and social acceptance compared with adolescents without disability. In young adulthood, there were also significant associations between disability and most mental health problems. The longitudinal associations between chronic health conditions and mental health problems during adolescence and young adulthood showed that significant associations between chronic health conditions and mental health problems were only found during adolescence. CONCLUSIONS: This longitudinal survey revealed that on average, adolescents with disability had more mental health problems than those with a chronic health condition. In addition, the problems followed into adulthood for adolescents with disability. Thus, disability seems to be a much higher risk factor for developing and maintaining mental health problems than having a chronic health condition. These findings need to be followed up in further studies.

Individual-level changes in self-rated health before and during the economic crisis in Europe.

BACKGROUND: Changes over time in self-rated health (SRH) are increasingly documented during the current economic crisis, though whether these are due to selection, causation, or methodological artefacts is unclear. This study accordingly investigates changes in SRH, and social inequalities in these changes, before and during the economic crisis in 23 European countries. METHODS: We used balanced panel data, 2005-2011, from the European Union Statistics on Income and Living Conditions (EU-SILC). We included the working-age population (25-60 years old) living in 23 European countries. The data cover 65,618 respondents, 2005-2007 (pre-recession cohort), and 43,188 respondents, 2008-2011 (recession cohort). The data analyses used mixed-effects ordinal logistic regression models considering the degree of recession (i.e., pre, mild, and severe). RESULTS: Individual-level changes in SRH over time indicted a stable trend during the pre-recession period, while a significant increasing trend in fair and poor SRH was found in the mild- and severe-recession cohorts. Micro-level demographic and socio-economic status (SES) factors (i.e., age, gender, education, and transitions to employment/unemployment), and macro-level factors such as welfare generosity are significantly associated with SRH trends across the degrees of recession. CONCLUSIONS: The current economic crisis accounts for an increasing trend in fair and poor SRH among the general working-age population of Europe. Despite the general SES inequalities in SRH, the health of vulnerable groups has been affected the same way before and during the current recession.

Municipal-level differences in depressive symptoms among adolescents in Norway: Results from the cross-national Ungdata study.

AIM: This study aimed to investigate municipal-level variations and individual- and municipal-level predictors of high levels of depressive symptoms among Norwegian adolescents. METHODS: We used data from the Norwegian cross-national Ungdata study. We included 77,424 adolescents from 171 municipalities attending junior high school (Grades 8-10; age 13-16 years) from 2011 to 2013. Multilevel (two-level) logistic regression models were applied for the data analyses. RESULTS: The study revealed that 11% of adolescents reported high levels of depressive symptoms. The median odds ratio without adjusting for any individual- or municipal-level predictors was 1.24, indicating a small between-municipalities variability for high levels of depressive symptoms. All individual-level factors, such as gender, school grade, family income, substance use behaviours, bullying and dissatisfaction with different aspects of life, were significantly associated with high levels of depressive symptoms (p < 0.05). As to municipal-level factors, a low annual budgets for municipal health services was the sole significant predictor of high levels of depressive symptoms between municipalities. Municipal-level factors and variables related to survey characteristics explained a moderate proportion of the variation in high levels of depressive symptoms between municipalities. CONCLUSIONS: The cluster heterogeneity in high levels of depressive symptoms was small between municipalities in Norway. Further research should examine the geographic clustering of mental health problems at the school and neighbourhood level.

What we know and don't know about mental health problems among immigrants in Norway.

Mental health problems have been regarded as one of the main public health challenges of immigrants in several countries. Understanding and generating research-based knowledge on immigrant health problems is highly relevant for planning preventive interventions, as well as guiding social and policy actions. This review aims to map the available knowledge on immigrants' mental health status and its associated risk factors in Norway. The reviewed literature about mental health problems among immigrant populations in Norway was found through databases, such as PUBMED, EMBASE, PsychINFO and MEDLINE. About 41 peer-reviewed original articles published since 1990s were included. In the majority of the studies, the immigrant populations, specifically adult immigrants from low and middle income countries, have been found with a higher degree of mental health problems compared to Norwegians and the general population. Increased risk for mental illness is primarily linked to a higher risk for acculturative stress, poor social support, deprived socioeconomic conditions, multiple negative life events, experiences of discrimination and traumatic pre-migration experiences. However, research in this field has been confronted by a number of gaps and methodological challenges. The available knowledge indicates a need for preventive interventions. Correspondingly, it strongly recommends a comprehensive research program that addresses gaps and methodological challenges.