Mental distress among young adults - gender differences in the role of social support.

BACKGROUND: The aim of the present study was to examine to what extent observed gender differences in mental health are associated with the protective factors social support, sense of coherence and participation in regular physical activity and more generally, engagement in organized or unorganized activity with other people. METHODS: This study was based upon a cross-sectional regional health survey in Norway, conducted during the winter of 2015-2016, in three southern counties; Aust-Agder, Vest-Agder and Vestfold. The study focused on young adults, comparing three age groups; 18-24 years old (n = 624), 25-31 (n = 582), and 32-38 years old (n = 795). RESULTS: Sense of coherence was strongly associated with low mental distress in all age groups and for both genders, while the association between low social support and mental distress was significant for young women only. Regular physical activity was not positively associated with low mental distress when sense of coherence and social support were included in the analysis. CONCLUSION: Social support appears to have a stronger role as a protective factor for mental distress among young women, compared to young men and older persons. This has implications for health promoting activities that target young women. Sense of coherence showed a strong association with low mental distress scores for all ages studied.

Trust Buffers Against Reduced Life Satisfaction When Faced With Financial Crisis.

Background: In light of the coronavirus disease 2019 (COVID-19) pandemic and its large economic consequences, we used a three-layer nested structural model (individual, community, and country), each with a corresponding measure of income, trust, and satisfaction, to assess change in their interrelationships following a global crisis; which, in this study, is the 2008/2009 financial crisis. Methods: With multilevel techniques, we analyzed data from two waves (2006 and 2012) of the European Social Survey (ESS) in 19 countries (weighted N = 73,636) grouped according to their levels of trust. Results: In high trust countries, personal life satisfaction (LS) was not related to personal, community, or national income before or after the crisis. In contrast, in low trust countries, LS was strongly related to all three forms of income, especially after the crisis. In all country groups, personal, social, and political trust moderated their respective effects of income on LS ("the buffer hypothesis"). Political trust moderated the effects of income more strongly in low trust countries. The moderating effect of political trust increased sharply after the crisis. After the crisis, national-level factors (e.g., political trust, national income) increased their importance for LS more than the factors at the local and individual levels. However, the relative importance of all the three forms of income to LS increased after the crisis, to the detriment of trust. Conclusion: Economic crises seem to influence personal LS less in high trust countries compared with low trust countries. Hence, high trust at a national level appears to buffer the negative impact of a financial crisis on personal satisfaction. Overall, the factors at the national level increased their impact during the financial crisis. When facing a global crisis, the actions taken by institutions at the country level may, thus, become even more important than those taken before the crisis.

Political Trust Influences the Relationship Between Income and Life Satisfaction in Europe: Differential Associations With Trust at National, Community, and Individual Level.

Background: A high level of well-being is associated with personal, community and national income, as well as personal, social and political trust. How these measures relate to each other within and between countries and within and across structural levels of society is largely unknown. To study this, we propose a three-layer nested socio-structural model. Each layer (individual, community, country) contains a measure of income, trust and satisfaction. Method: With this model, we analyzed data from two waves of the European Social Survey (ESS, 2006, 2012) in 19 countries (N = 72,461; weighted N = 73,307) with multilevel techniques. Indicators were personal, community, and national income; personal, social and political trust; and personal life satisfaction, social and political satisfaction. Results: Personal life satisfaction was associated with all income and trust variables. Greatest effect on personal life satisfaction, came from the national level, including political trust and income. However, 2/3 of the variance in personal life satisfaction came from income, that is personal, community and national. Within each socio-structural level, satisfaction was associated with income, but significantly modified by trust. When income and trust at all three levels were included, there was a significant association of the national layer on the social layer, and of the social layer on the individual layer as to the income-personal life satisfaction relationship. Consistent with the "the buffer hypothesis," all three forms of trust acted as a buffer against the effect of personal income on life satisfaction. Low-trust countries had strong income-personal life satisfaction associations and the moderating role of trust was also stronger. High- and medium-trust countries had no such associations. Likewise, direct associations between political and personal trust were much stronger in the low-trust countries. Conclusion: The model presented in this study provides authorities with a framework for policies that will improve the general well-being of their population. Trust and income strongly influence personal life satisfaction. Money is the most important. However, trust forcefully dampens the effect of income. Politicians who want to enhance their population's personal life satisfaction, should raise the levels of trust in their electorate.

Measures that increase social equality are effective in improving life satisfaction in times of economic crisis.

BACKGROUND: The financial crisis of 2008/2009, for some also in 2011, was accompanied by increasing social inequality and unemployment, which strained the welfare generosity systems in many countries. Welfare generosity redistributes internal resources to decrease poverty and increase equal opportunities. This was used by many countries to combat the crisis. We investigated the effects of increased social inequality, unemployment and welfare generosity on life satisfaction (LS) before and after the crisis. METHODS: A representative sample from the European Social Survey (2002 to 2014) with data from 26 countries was used (N = 301,559). Time from start of crisis (either 2008 or 2010-2012) was determined separately for each case. LS was measured with a single question with 11 response alternatives. Social inequality was measured using the Gini index. Unemployment was measured by a single question (No/Yes). Welfare generosity was measured using expenditure on social protection (PPS) per inhabitant (Eurostat). Data were analyzed by multilevel analysis and multilevel mediation analysis. RESULTS: Welfare generosity was associated with decreased levels of social inequality. The negative relationship between social inequality and LS was weakened when controlling for welfare generosity after the financial crisis. This effect of welfare generosity was not seen for the negative impact of unemployment on LS. CONCLUSION: The financial crisis stimulated the use of welfare generosity in Europe and strengthened the positive relationship between welfare generosity and LS. Social inequality, unemployment and welfare generosity played significant mediator roles between the crisis and LS, with increased welfare generosity far more strongly associated with increased LS. Measures that increase social equality in a country and thereby increase equal opportunity for all social classes, may be assumed to be effective in improving the general LS of the population in a country in times of economic crisis.

Observed to expected or logistic regression to identify hospitals with high or low 30-day mortality?

INTRODUCTION: A common quality indicator for monitoring and comparing hospitals is based on death within 30 days of admission. An important use is to determine whether a hospital has higher or lower mortality than other hospitals. Thus, the ability to identify such outliers correctly is essential. Two approaches for detection are: 1) calculating the ratio of observed to expected number of deaths (OE) per hospital and 2) including all hospitals in a logistic regression (LR) comparing each hospital to a form of average over all hospitals. The aim of this study was to compare OE and LR with respect to correctly identifying 30-day mortality outliers. Modifications of the methods, i.e., variance corrected approach of OE (OE-Faris), bias corrected LR (LR-Firth), and trimmed mean variants of LR and LR-Firth were also studied. MATERIALS AND METHODS: To study the properties of OE and LR and their variants, we performed a simulation study by generating patient data from hospitals with known outlier status (low mortality, high mortality, non-outlier). Data from simulated scenarios with varying number of hospitals, hospital volume, and mortality outlier status, were analysed by the different methods and compared by level of significance (ability to falsely claim an outlier) and power (ability to reveal an outlier). Moreover, administrative data for patients with acute myocardial infarction (AMI), stroke, and hip fracture from Norwegian hospitals for 2012-2014 were analysed. RESULTS: None of the methods achieved the nominal (test) level of significance for both low and high mortality outliers. For low mortality outliers, the levels of significance were increased four- to fivefold for OE and OE-Faris. For high mortality outliers, OE and OE-Faris, LR 25% trimmed and LR-Firth 10% and 25% trimmed maintained approximately the nominal level. The methods agreed with respect to outlier status for 94.1% of the AMI hospitals, 98.0% of the stroke, and 97.8% of the hip fracture hospitals. CONCLUSION: We recommend, on the balance, LR-Firth 10% or 25% trimmed for detection of both low and high mortality outliers.

The relationship between physical functional limitations, and psychological distress: Considering a possible mediating role of pain, social support and sense of mastery.

The aim of this study was to examine associations between selected physical functional limitations related to performing daily activities and psychological distress. We also aimed to investigate if these associations vary across age (moderation), and to explore pain, sense of mastery and social support as potential moderators and mediators. The study was based on pooled data from two rounds (2008 and 2012) of a Norwegian nationally representative cross-sectional health survey (N = 8520) including individuals aged ≥ 16 years (Age groups = 16-44 and ≥ 45 years). Physical functional limitations comprised decreased ability to: i) climb stairs, ii) carry objects, or iii) both. Psychological distress was measured as anxiety and depressive symptoms occurring separately or in combination (CAD). Of respondents reporting physical functional limitations, 8-14% reported depressive symptoms, 5-7% anxiety symptoms, and 13-28% reported CAD. Physical functional limitations were significantly associated with all three forms of psychological distress, particularly among individuals 16-44 years, and were more strongly related to CAD than to anxiety or depression occurring separately. The association with CAD was twice as strong when both types of physical functional limitations were present. Pain, sense of mastery and social support were significant modifiers of depression, whereas all three were significant mediators of the relationship between physical functional limitations and anxiety, depression and CAD. Sense of mastery mediated the relationship between physical functional limitations and CAD, but most strongly among those 16-44 years. Social support was only a significant mediator among those [Formula: see text] 45 years. Close associations between physical functional limitations and psychological distress highlight special needs among individuals experiencing daily functional limitations. The results also suggest that pain, low social support, and low sense of mastery may contribute to aggravate psychological distress.

The financial crisis in Europe: Impact on satisfaction with life.

BACKGROUND: The 2008 financial crisis in Europe came abruptly and surprisingly. Many countries also suffered a second recession during the period 2010-2012. We examined the impact of the crisis on life satisfaction (LS) by country and individual socioeconomic level. METHOD: We used a representative sample from the European Social Survey (2002-2014) with data from 26 countries ( N = 294,407). LS was measured with a single question with 11 response alternatives. Time from start of crisis (either 2008 or 2010-2012) was determined separately for each interview. Data were analyzed by multilevel analysis Results: There was a sharp decrease in LS in the beginning of the crisis in 2008, and another, but not so severe, decline in 2011, each of them of short duration. However, there was also a slight and progressive yearly decrease in LS that continued one to at least 3 years after either financial crisis that was independent of the effect of being unemployed. Associations varied considerably between countries. A negative decline after the financial crisis was especially evident among those in the most educated groups, and in those in the higher occupational levels. CONCLUSIONS: The 2008 financial crisis had a double effect on LS: (1) a sharp short-term decrease consistent with the Easterlin paradox; (2) a slighter long-term progressive decrease that was over and above the strong negative relationship with unemployment that lasted several years. The long-term decline in LS after the start of the financial crisis tended to occur especially in the higher socioeconomic groups.

The association between adolescent and parental use of non-prescription analgesics for headache and other somatic pain - A cross-sectional study.

BACKGROUND AND PURPOSE: Over the last years, concern has been expressed about adolescents' possible liberal attitude towards - and use of - non-prescription analgesics. A high consumption of analgesics is unfortunate as it may lead to various harmful effects and worsening of headache. In order to address this challenge, it is necessary to achieve a more extensive knowledge about adolescent consumption. The main aim of this study was to examine the association between adolescent and parental use of non-prescription analgesics, taking into account headache as well as other somatic pain. The effects of parental prescription analgesics use was a secondary aim. METHODS: The study is based on data from two cross-sectional health studies conducted in 2005 and 2012 in Norway, including 646 adolescents and an accompanying parent. By using sample weights, the final weighted sample used in the analysis was 1326. Data was collected through postal questionnaires to parents and adolescents as well as parental telephone interviews. Questionnaires included questions on different pain locations and the pain for each location was graded according to how troubling the pain was. Medication data on prescription and non-prescription analgesics was from telephone interviews and was quantified based on the pattern over the past 4 weeks. Multivariate logistic regression models and complex samples analyses were used. RESULTS: 20% of adolescents were reported as using non-prescription analgesics during the previous 4 weeks. Girls were more often reported to use non-prescription analgesics than boys. Headache and all other somatic pain locations except back pain were reported more frequently among girls while boys more frequently reported back pain. There was a clear association between the use of non-prescription analgesics and headache with 34% of adolescents with headache using non-prescription analgesics versus 19% of adolescents with other somatic pain and 14% of adolescents not reporting pain. Among adolescents reporting headache, 9% were reported to use non-prescription analgesics daily or almost daily versus 3% and 2% among those reporting other somatic pain and reporting no pain respectively. In addition, parental use of non-prescription analgesics was a strong independent predictor of adolescent use (adjusted OR 1.69 for boys, 1.54 for girls). This relationship increased when the adolescents were less bothered by headache themselves. CONCLUSION: Headache is the dominant medication-driving pain for non-prescription analgesics among adolescents but parental medication use of non-prescription analgesics also strongly influences adolescent use. IMPLICATIONS: There is a need for health services to improve information to parents and adolescents about risks associated with use of analgesics and also to work on prophylactic strategies focusing on adolescents. Parents should be made aware that their medicine use strongly influences that of their children.

The perceived constraints subscale of the Sense of Mastery Scale: dimensionality and measurement invariance.

PURPOSE: A number of studies have reported differences in sense of mastery and perceived control across different subgroups. Yet, few have examined measurement invariance, an important prerequisite for valid comparisons. This study examines the factorial structure and measurement invariance of the perceived constraints (PC) facet of Pearlin and Schooler's (1981) Sense of Mastery Scale (SM) which is a commonly used short form of the widely used SM scale. METHODS: Confirmatory factor analyses using AMOS and Mplus were conducted to explore dimensionality and test for measurement invariance in factor structure, factor loadings, intercepts, and residual variances across gender, age, education, income, and employment status in a large (N = 19,858), nationally representative sample of Norwegian males and females aged 16-100. RESULTS: The data supported a modified unidimensional model specifying correlations between the error terms of items 4 and 5, or possibly two highly correlated dimensions (r = 0.90). Metric invariance of the scale was shown for age, education, and employment, whereas invariance at the strong and strict levels was shown for gender and income. Partial invariance at the strong level was shown for age. CONCLUSIONS: This Norwegian study supported a modified unidimensional structure for the abbreviated SM scale. Invariance testing indicated that comparisons across genders and income levels are unproblematic, whilst comparing mean scores across education and employment status is not justified. Latent, but not sum score means are comparable across age. Future studies using all 7 items of SM scale should provide more information on dimensionality and measurement invariance.

The Relationship Between Violence and Psychological Distress Among Men and Women: Do Sense of Mastery and Social Support Matter?

The aims of this study were to examine associations between reported exposure to psychological and physical violence and psychological distress (PD) among men and women, and to explore the possible mediating or moderating roles of sense of mastery and social support. We used data from the nationally representative Norwegian Health and Level of Living Survey in 2005 and 2012 (Weighted N = 19,386). PD was measured with the Hopkins Symptom Checklist-25, using the subscales for anxiety and depression separately and in combination. Analyses were conducted using hierarchical logistic regression with complex sample adjustment. Altogether, 3.8% of men and 5.4% of women reported psychological violence during the last 12 months, while 2.3% and 1.6% reported physical violence, respectively. Both forms of violence were associated with excess risk of comorbid anxiety and depressive symptoms above clinical cut-point (CAD) in men and women alike, and CAD occurred more frequently than anxiety or depressive problems separately. Sense of mastery, but not social support, partly mediated the association between both forms of violence and CAD in men, whereas both partly mediated the association between psychological violence and CAD in women. No moderator role was indicated. Overall, the results provide evidence for excess risk of PD, particularly CAD, in men and women reporting exposure to violence. Sense of mastery and to a lesser degree social support were shown to constitute significant mediators, underscoring the importance of systems for strengthening coping strategies and social support among violence victims, such as psychological and practical support by the health services.

Sense of mastery as mediator buffering psychological distress among people with diabetes.

AIMS: The purpose of this study was to examine the association between diabetes with or without other comorbid somatic diseases and depression and anxiety, and to explore the mediating role of sense of mastery and social support. METHODS: Data were obtained from a cross-sectional health survey conducted in Norway (n=6827). People with diabetes alone or with simultaneous comorbid somatic diseases were compared to a group with no known somatic diseases. RESULTS: Among people with diabetes alone, 16.3% reported having depression and anxiety. Having diabetes was associated with 3 times greater odds for anxiety compared to the control group, and 2 times greater odds for depression. Among individuals with diabetes and comorbid somatic diseases, 17.4% reported depression and 11.6% reported symptoms of anxiety. The odds for both were approximately 2 times greater than in the control group. Sense of mastery, but not social support, protected against depression in both groups and against anxiety in the diabetes with comorbidity group. CONCLUSIONS: Comorbidity between diabetes and other somatic diseases seems to be related to depression to a larger degree, whereas having diabetes alone relates more to anxiety. This can possibly be explained by the overall burden in the comorbidity group and the related absence of sense of mastery.

Changes Over Time of Prescription and Nonprescription Analgesics for Headache With or Without Other Somatic Pain: Effects of Prescription Regulatory Changes.

UNLABELLED: The aim of this study was to examine the association and changes over time between headaches with or without somatic pain and the self-reported use of pain medication. The study further examined whether the law amendment in 2003 in Norway releasing the sale of nonprescription drugs to shops has changed these relationships. The study is on the basis of repeated self-report cross-sectional studies from 1998 to 2012 in Norway. A total of 27,247 adults were included. As expected, there was a strong association between headache, especially headache with comorbid somatic pain and consumption of prescription versus nonprescription analgesics, although the overall consumption decreased slightly after 2003. We conclude that the strong association between especially headache, whether complicated by somatic pain or not, and the consumption of prescription-free analgesics did not seem to be negatively affected by the prescription regulatory changes. The very high use of nonprescription medication among headache patients suggests the need for continued observation and information regarding the risk of medication-overuse headache. PERSPECTIVE: In Norway, headache was strongly associated with use of over-the-counter analgesics, for other somatic pain prescription analgesics were equally common. Between 1998 and 2012 headache and related analgesic consumption was reduced and other somatic pain increased. Making over-the-counter analgesics available outside pharmacies in 2003 did not increase the self-reported intake.

Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?

OBJECTIVES: Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors. METHODS: The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded. RESULTS: Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders. CONCLUSIONS: Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy.

Early sexual debut in Norwegian youth with epilepsy: A population-based study.

OBJECTIVES: In comparison with controls, youth with epilepsy (YWE) have greater psychosocial problems. However, information about their sexual behavior is sparse. We have performed a large, population-based questionnaire study to examine differences in sexual behavior between YWE and controls. METHODS: A randomly chosen cohort of youth (13-19 years) from Akershus county, Norway (n=19,995) was asked to complete a questionnaire anonymously with questions on epilepsy and sexual activity. RESULTS: The response rate was 85%. Two hundred forty-seven participants reported having or having had epilepsy, i.e., a lifetime epilepsy prevalence of 1.2%. Compared with controls, a higher proportion of YWE reported having had sexual intercourse (43.6% vs. 35.3%, p=0.009). The mean age at sexual debut was significantly lower in YWE than in controls (14.0 years vs. 15.0 years, p<0.001), and this was particularly marked among boys. A higher proportion of YWE reported not having used contraceptives at their last sexual intercourse compared with controls (31.6% vs. 22.3%, p=0.03). Ten percent of YWE, compared with 2% of the controls, reported that they had been forced into their first sexual intercourse. CONCLUSION: In YWE, some aspects of sexual behavior differ from those of their peers, with earlier sexual debut and less frequent use of contraceptives. More attention should be directed toward this subject, aiming at avoiding unwanted pregnancies and potential emotional traumas in this already vulnerable patient group.

Coping strategies among adolescents with chronic headache and mental health problems: a cross-sectional population-based study.

To examine prevalence of mental health problems among adolescents with chronic headache and compare internal and external coping strategies in young people with chronic headaches with and without mental health problems. This study is based on a cross-sectional survey undertaken in Akershus County in Norway. A total of 19,985 adolescents were included in the study, covering lower secondary and upper secondary students, aged 13-19 years. Chronic headache was measured with a single item question based on headache frequency. Mental health was assessed by using the strengths and difficulties questionnaire (SDQ). Internal and external coping strategies were assessed through seven options for answering the question: What do you do/what happens when you are burdened by painful thoughts and feelings? Adolescents with chronic headaches showed more frequent mental health problems overall (23 %) compared to those without chronic headache (6 %). Logistic regression analyses showed that those adolescents having both chronic headaches and comorbid mental health problems more frequently used internal coping strategies, such as keeping feelings inside (OR 2.05), using abusive substances (OR 1.79) and talking oneself out of problems (OR 1.55), compared to those without mental health problems. Groups with mental health problems, especially with chronic headache, less frequently used the external strategy of talking to others about their problem than controls (OR 0.7-0.8). Factor analyses revealed significant differences in profiles of coping strategies between groups. We suggest that attention should be paid towards the high risk group that has both chronic headaches and mental health problems and their tendency to use destructive internal coping strategies.

The relationship between negative life events, psychological distress and life satisfaction: a population-based study.

PURPOSE: Negative life events may increase psychological distress and reduce life satisfaction (LS). This study investigates associations between negative life events and both positive and negative indicators of mental health and explores the extent to which these associations are buffered by sense of mastery and perceived social support. METHODS: Data were obtained from a large (N = 4,823), nationally representative sample of Norwegians aged 16 and older. Psychological distress was measured by The Hopkins Symptom Check List (HSCL-25), LS by a single question on overall satisfaction with life and negative life events by a 12-item list of threatening experiences. Moderating variables, sense of mastery and social support, were measured using standard instruments. RESULTS: Adjusting for age, sex, education and income, all of the negative life events were significantly associated with both psychological distress and LS, with the exception of events pertinent to bereavement. Of the life events examined, financial strain constituted the strongest predictor. Overall, negative life events were more closely associated with psychological distress than LS. Altogether, negative life events explained 22.3 and 11.4 % of the variance in psychological distress and LS, respectively. Sense of mastery, but not perceived social support, emerged as a moderating factor between financial strain and both psychological distress and LS. CONCLUSION: Negative life events are associated with higher psychological distress and lower LS, but the strength of the associations varies across events. The impact of financial strain and conflict appears particularly strong, but may be moderated by self-perceived mastery.

Comparing hospital mortality--how to count does matter for patients hospitalized for acute myocardial infarction (AMI), stroke and hip fracture.

BACKGROUND: Mortality is a widely used, but often criticised, quality indicator for hospitals. In many countries, mortality is calculated from in-hospital deaths, due to limited access to follow-up data on patients transferred between hospitals and on discharged patients. The objectives were to: i) summarize time, place and cause of death for first time acute myocardial infarction (AMI), stroke and hip fracture, ii) compare case-mix adjusted 30-day mortality measures based on in-hospital deaths and in-and-out-of hospital deaths, with and without patients transferred to other hospitals. METHODS: Norwegian hospital data within a 5-year period were merged with information from official registers. Mortality based on in-and-out-of-hospital deaths, weighted according to length of stay at each hospital for transferred patients (W30D), was compared to a) mortality based on in-and-out-of-hospital deaths excluding patients treated at two or more hospitals (S30D), and b) mortality based on in-hospital deaths (IH30D). Adjusted mortalities were estimated by logistic regression which, in addition to hospital, included age, sex and stage of disease. The hospitals were assigned outlier status according to the Z-values for hospitals in the models; low mortality: Z-values below the 5-percentile, high mortality: Z-values above the 95-percentile, medium mortality: remaining hospitals. RESULTS: The data included 48 048 AMI patients, 47 854 stroke patients and 40 142 hip fracture patients from 55, 59 and 58 hospitals, respectively. The overall relative frequencies of deaths within 30 days were 19.1% (AMI), 17.6% (stroke) and 7.8% (hip fracture). The cause of death diagnoses included the referral diagnosis for 73.8-89.6% of the deaths within 30 days. When comparing S30D versus W30D outlier status changed for 14.6% (AMI), 15.3% (stroke) and 36.2% (hip fracture) of the hospitals. For IH30D compared to W30D outlier status changed for 18.2% (AMI), 25.4% (stroke) and 27.6% (hip fracture) of the hospitals. CONCLUSIONS: Mortality measures based on in-hospital deaths alone, or measures excluding admissions for transferred patients, can be misleading as indicators of hospital performance. We propose to attribute the outcome to all hospitals by fraction of time spent in each hospital for patients transferred between hospitals to reduce bias due to double counting or exclusion of hospital stays.

Psychiatric symptoms in Norwegian children with epilepsy aged 8-13 years: effects of age and gender?

PURPOSE: In this population-based study we wanted to assess the prevalence and impact of psychiatric symptoms in children with epilepsy compared to controls, and investigate possible age and gender differences. METHODS: Data were collected using the Strengths and Difficulties Questionnaire-Parent report (SDQ-P) as part of a more extensive questionnaire. A total of 14,699 parents of children aged 8-13 years (response rate 78%) participated. Associations between SDQ scores and epilepsy, other chronic disease, age, gender, and socioeconomic factors were explored using logistic regression analysis. KEY FINDINGS: Children with epilepsy (CWE) (n=110) had a significantly higher frequency of psychiatric symptoms (37.8% vs. 17.0% in controls, p<0.001). Gender differences were found in several subscales of the SDQ; girls had more emotional problems, whereas boys had higher scores regarding peer relationship and hyperactivity/inattention problems. Male gender, low socioeconomic status (family income below poverty limit and living in a single parent home), and other chronic disease (asthma/diabetes) were independent risk factors of developing psychiatric symptoms, along with epilepsy. Having or having had epilepsy was, however, a much stronger risk factor for developing psychiatric symptoms in girls than in boys [odds ratio (OR) 4.2 vs. OR 2.3]. A minor effect of age was seen only in girls with epilepsy, with an increased risk of psychiatric symptoms in age group 10-13 years (OR 1.28 for scoring borderline/abnormal on SDQ-total difficulties). Borderline/abnormal impact scores were found in 31.8% of CWE compared with 13.0% of controls (p<0.001). SIGNIFICANCE: Multiple risk factors contribute to the high prevalence of psychiatric symptoms in CWE, perhaps differently in boys and girls. Awareness of this complex interaction may help target intervention toward high risk groups and thus prevent more serious problems from arising.

Dimensionality and measurement invariance in the Satisfaction with Life Scale in Norway.

PURPOSE: Results from previous studies examining the dimensionality and factorial invariance of the Satisfaction with Life Scale (SWLS) are inconsistent and often based on small samples. This study examines the factorial structure and factorial invariance of the SWLS in a Norwegian sample. METHODS: Confirmatory factor analysis (AMOS) was conducted to explore dimensionality and test for measurement invariance in factor structure, factor loadings, intercepts, and residual variance across gender and four age groups in a large (N = 4,984), nationally representative sample of Norwegian men and women (15-79 years). RESULTS: The data supported a modified unidimensional structure. Factor loadings could be constrained to equality between the sexes, indicating metric invariance between genders. Further testing indicated invariance also at the strong and strict levels, thus allowing analyses involving group means. The SWLS was shown to be sensitive to age, however, at the strong and strict levels of invariance testing. CONCLUSION: In conclusion, the results in this Norwegian study seem to confirm that a unidimensional structure is acceptable, but that a modified single-factor model with correlations between error terms of items 4 and 5 is preferred. Additionally, comparisons may be made between the genders. Caution must be exerted when comparing age groups.

Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors.

BACKGROUND: Discrepancies between parents and children in their assessment of children's mental health affect the evaluation of need for services and must be taken seriously. This article presents the differences between parents' and children's reports of the children's symptoms and social impairment, based on the results of the Strengths and Difficulties Questionnaire (SDQ). The interrelationship between relational aspects and socio-demographic factors with patterns of disagreement are explored. METHODS: Differences in the prevalence and means of SDQ symptom and impact scores were obtained from 8,154 primary school children, aged between 10 and 13 years, and their parents. Agreement between matched pairs was measured using Pearson's and Spearman's rho correlations. Socio-demographic variables, communication patterns and parental engagement were analysed as possible correlates of informant discrepancies using bivariate and multivariate logistic regression models. RESULTS: In general, although children reported more symptoms, they reported less impact of perceived difficulties than parents. The parents were more consistent in their evaluation of symptoms and impact than were the children. Exploration of highly discrepant subgroups showed that, when children reported the most symptoms and impact, qualitative aspects of the parent-child relationship and family structure seemed to be more powerful predictors of disagreement than were gender of the child and socio-demographic variables. When parents reported the most symptoms and impact, low parental educational level, low income and male gender of the child played an additional role. CONCLUSIONS: Our findings underline the importance of paying attention to child reports of emotional-behavioural difficulties, particularly when parents do not identify these problems. Considerations on what meaning parent-child discrepancy might have in the context of the parent-child relationship or the family's psychosocial status should be integrated in the overall understanding of the child's situation and subsequent recommendations.