Psychological distress among Afghan refugees in Norway as a function of their integration.

Background: Often, refugees are susceptible to mental health problems due to adversities experienced before, during, and after the flight. Through a cross-sectional study, the present study examines the relationship between different aspects of integration and psychological distress among Afghans living in Norway. Methods: The participants were recruited through e-mail invitations, refugee-related organizations, and social media platforms. The participants (N = 114) answered questions about integration across multiple dimensions (psychological, social, navigational, economic, and linguistic) in line with the Immigration Policy Lab index (IPL -12/24). Hopkins symptoms checklist (HSCL-25) was used to assess psychological distress. Results: Based on hierarchical multiple regression analysis, both the psychological dimension (0.269 p < 0.01) and the navigational dimension (0.358 p < 0.05) of integration predicted psychological distress. Discussion/Conclusion: The results suggest that the psychological aspects of integration, such as being part of a community, having feelings of security, and a sense of belonging, are beneficial for the mental health and well-being of the Afghans in Norway and contribute further to other aspects of integration.

"Of course, you get depression in this situation": Explanatory Models (EMs) among Afghan refugees in camps in Northern Greece.

BACKGROUND: Afghan refugees and asylum seekers constitute one of the largest groups that live in camp settings in Greece. While they experience psychological distress, they are facing significant barriers in accessing appropriate mental health care. Explanatory Models (EMs) provide a context-sensitive framework for understanding the differences between health professionals, refugees and NGOs that operate on the field. This study aims at further understanding how Afghan refugees perceive and explain depression and largely psychological distress, and how this influences their choices for coping strategies and help-seeking. METHODS: This qualitative study included six vignette-based semi-structured focus-group discussions with Afghan refugees and asylum-seekers (total N = 19, 12 female and 7 male) residing largely in camp settings in Northern Greece. The vignette describes a fictional person with symptoms of depression in line with DSM-5 and ICD-10 criteria. The interviews were recorded, transcribed, and analysed through template analysis. RESULTS: EMs for depression are explained through Pre-migration Traumatic Experiences (PMTE) and Post-migration Living Difficulties (PMLD) relating to camp settings. Female participants identified gender-based and domestic violence as contributing to psychological distress while males highlighted conflict and persecution. Life in the camp with associated inactivity, and uncertainty for the future, was perceived as a significant risk factor for psychological distress among females and males. In terms of coping strategies, females tended to focus on mobilizing collective resources within the camp (e.g. safe space for women facilitating emotional support), while males advocated for self-empowerment and solution-oriented coping. The value of engagement in peer helper-roles was highlighted. CONCLUSIONS: The results highlight the potential value of community-based psychosocial approaches to support and promote mental health within camp settings. Additionally, they may inform policies and practices regarding access to appropriate mental health care for Afghan refugees. Further research is needed to establish the efficiency of such interventions in this context.

Emotional Eating and Changes in High-Sugar Food and Drink Consumption Linked to Psychological Distress and Worries: A Cohort Study from Norway.

Psychological distress is linked to unhealthy eating behaviors such as emotional eating and consumption of high-sugar food and drinks. Cross-sectional studies from early in the COVID-19 pandemic showed a high occurrence of worries and psychological distress, and this was associated with emotional eating. Few larger studies have examined how this coping pattern develops over time. This cohort study with 24,968 participants assessed changes over time in emotional eating, consumption of sugary foods as an example of unhealthy food choices, and consumption of fruits and vegetables as an example of healthy food choices. Further, associations between these and psychological distress, worries, and socio-demographic factors were assessed. Data were collected at three time points (April 2020, initially in the COVID-19 pandemic, then one and two years later). Emotional eating and intake of sugary foods and drinks were high at the start of the pandemic, followed by a reduction over time. High psychological distress was strongly associated with higher levels of emotional eating and high-sugar food intake, and lower levels of healthy eating habits. The strength of this association reduced over time. Our findings indicate the high frequency in unhealthy food choices seen early in the COVID-19 pandemic improved over time.

Parental stress during the COVID-19 pandemic: A one-year follow-up.

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

Increased Gaming During COVID-19 Predicts Physical Inactivity Among Youth in Norway-A Two-Wave Longitudinal Cohort Study.

Background: A concern for the COVID-19 measures and the potential long-term consequences the measures may have on physical inactivity and gaming among youth. Objectives: Examine the stability and change in internet and offline gaming and the association with physical inactivity among adolescents in Norway during the pandemic. Methods: A total of 2940 youth (58% girls) aged 12-19 years participated in an online longitudinal two-wave survey during the first Norwegian national lockdown in April 2020 (t1) and in December 2020 (t2). Gaming behavior and physical activity status were assessed at both time points. Age, gender, and socioeconomic status were included as covariates. Results: Among boys, 41% reported gaming a lot more and 35% a little more at t1 compared to before the national lockdown. The corresponding numbers for girls were 14 and 23%, respectively. In fully adjusted analysis, a pattern of increased gaming at t1 followed by an additional increase in gaming reported at t2 was associated with physical inactivity at t1 (OR = 2.10, p < 0.01) and t2 (OR = 2.45, p < 0.001). Participants gaming more at t1 followed by a reduction at t2 had higher odds of inactivity at t1 (OR = 1.88, p < 0.01). Youth reporting no gaming at t1 had lower odds for inactivity at this time point (OR = 0.67, p < 0.05). Conclusions: Increased gaming among many youths and a relationship with physical inactivity was observed during the first phase of the COVID-19 pandemic. To counteract the negative long-term impacts of COVID-19 restrictions, public health initiatives should emphasize the facilitation of physical activity in youth and develop effective strategies to prevent problematic gaming.

Explanatory models of post-traumatic stress disorder (PTSD) and depression among Afghan refugees in Norway.

BACKGROUND: The current situation in Afghanistan makes it likely that we are facing a new wave of Afghan refugees, warranting more knowledge about how to deal with mental health problems among them. This study aims to gain more knowledge on Explanatory Models (EM) of depression and post-traumatic stress disorders (PTSD) among Afghan refugees resettled in Norway. METHODS: We conducted six gender-separated, semi-structured focusgroup interviews based on vignettes with Afghan refugees (total N = 27). The vignettes described a fictional character with symptoms of either depression or PTSD symptoms in line with DSM-5 and ICD-10 criteria. RESULTS: The findings showed that EM varied with gender, age, generation, and migration stories. Participants suggested different potential causes, risk factors, and ways of managing symptoms of depression and PTSD depending on the context (e.g., in Norway vs. Afghanistan). In describing the causes of the depression/PTSD in the vignettes, females tended to emphasize domestic problems and gender issues while males focused more on acculturation challenges. The younger males discussed mostly traumatic experiences before and during flight as possible causes. CONCLUSION: The practice of condensing a single set of EMs within a group may not only be analytically challenging in a time-pressed clinical setting but also misleading. Rather, we advocate asking empathic questions and roughly mapping individual refugee patients' perceptions on causes and treatment as a better starting point for building trusting relationships and inviting patients to share and put into practice their expertise about their own lives.

How the Norwegian population was affected by non-pharmaceutical interventions during the first six weeks of the COVID-19 lockdown.

AIMS: The aim of this study was to examine how the Norwegian general adult population was affected by non-pharmaceutical interventions during the first six weeks of the COVID-19 lockdown. We assessed quarantine, symptoms, social distancing, home office/school, work status, social contact and health-care contact through digital access and knowledge. METHODS: A cross-sectional survey was performed of 29,535 adults (aged 18-99) in Norway after six weeks of non-pharmaceutical interventions in March/April 2020. RESULTS: Most participants found the non-pharmaceutical interventions to be manageable, with 20% of all adults and 30% of those aged <30 regarding them as acceptable only to some or a limited degree. Sixteen per cent had been quarantined, 6% had experienced symptoms that could be linked to COVID-19 and 84% practiced social distancing. Eleven per cent reported changes in the use of health and social services. Three-quarters (75%) of those who had mental health or physiotherapy sessions at least monthly before the pandemic reported a reduction in their use of these services. A substantial reduction was also seen for home nursing, hospital services and dentists compared to usage before the non-pharmaceutical interventions. Immigrants were more likely to experience a reduction in follow-up from psychologists and physiotherapy. With regard to the use of general practitioners, the proportions reporting an increase and a reduction were relatively equal. CONCLUSIONS: The non-pharmaceutical interventions were perceived as manageable by the majority of the adult general population in Norway at the beginning of the COVID-19 pandemic. A substantial proportion of adults <30 years old experienced difficulties with social distancing, and those >70 years old lacked the digital tools and knowledge. Further, immigrant access to health services needs monitoring and future attention.

'We are unlikely to return to the same world, and I do not want it to destroy my future.' Young people's worries through the outbreak of the COVID-19 pandemic.

This study aims to explore what worries youth were having during the seventh to ninth week of the COVID-19 lockdown. Our findings build on the responses to an open-ended survey question from 1314 youths. The worries covered three main themes: 'That my mom dies, then I am left all alone': worries related to COVID-19 virus infection; 'To me, this is lost youth': worries about the consequences of measures for the present life and near future; and 'I will face a very difficult life in the future': worries about the consequences of measures for the outlook on life. Young people worried that the measures would have a huge impact on their present life and outlook on life. The costs of restriction measures were unevenly distributed and indicated that the measures affected their mental health. Listening to youth voices during the pandemic is important for practitioners, educators and policymakers. The results indicate that the threshold for closing schools also including the provision of distance learning should be kept high. Social and health services for youth should offer early intervention and be prepared for an escalation in mental health problems in the imminent future.

Perceived consequences and worries among youth in Norway during the COVID-19 pandemic lockdown.

Aims: To examine perceived consequences for everyday life, learning outcomes, family relations, sleep problems and worries for infection, for friends and their future, among youth aged 12-19 years during weeks 7 to 9 of the COVID-19 lockdown in Norway. We examine variations by age, gender, socioeconomic status and country of birth. Methods: Youth within the municipality of Bergen were invited via SMS to participate in a 15-minute online survey. A total of 2997 (40%) youths participated. The mean age was 17 years (standard deviation 1.7). Results: Overall, 28% reported feeling somewhat to a lot impacted by schools closing, 63% reported learning less. In total, 62% reported improvement of everyday life. The youth's situation in their family was worse for 13%. Regarding sleep problems, 19% reported difficulties initiating and maintaining sleep, 12% had more nightmares, while 90% reported later bedtime and rise time. Seven per cent worried about getting infected, while 53% worried about infection among family members. A total of 19% worried that the outbreak would lead to a more difficult future, and 32%worried that friends were facing a difficult situation at home. Perceived consequences and worries related to the lockdown varied across sociodemographic groups. Conclusions: The perceived consequences and degree of worries varied by age, gender, socioeconomic status and to a certain degree country of birth. Girls, older youth, youth with lower socioeconomic status and with a migrant background from developing countries seemed to experience the lockdown as more difficult, and thereby possibly accentuating the need for services in these groups.

General Practitioners' Experiences of Clinical Consultations With Refugees Suffering From Mental Health Problems.

Refugees suffer from higher rates of certain mental health problems than non-refugee migrants and the native population of their host country. General practitioners (GPs) in Norway and many other European countries are the first contact person for settled refugees in need of non-emergency medical support. This includes psychiatric support, although GPs are not typically specialists in psychiatry. The aim of this study is to investigate how GPs experience working with refugees suffering from mental health problems, with a specific focus on perceived challenges and facilitators. We conducted semi-structured interviews with 15 GPs working in Norway (7 females). Participants ages ranged from 29 to 67 (M = 41.7 years, SD = 11.1) with work experience ranging from 2 to 39 years (M = 13.6 years, SD = 12.1). Interviews were analysed thematically using the qualitative data analysis computer software package NVivo 12. The main challenges presented by GPs relate to language barriers, mismatched expectations, different understandings of health and illness, and the GP feeling unprepared to work with this patient group. The main facilitating themes related to establishing trust and finding the work meaningful. The themes presented in this study highlight areas of interest for future research, and should inform training programmes to improve health care for both clinicians and refugee patients.

Psychological Hibernation in Antarctica.

Human activity in Antarctica has increased sharply in recent years. In particular during the winter months, people are exposed to long periods of isolation and confinement and an extreme physical environment that poses risks to health, well-being and performance. The present study aimed to gain a better understanding of processes contributing to psychological resilience in this context. Specifically, the study examined how the use of coping strategies changed over time, and the extent to which changes coincided with alterations in mood and sleep. Two crews (N = 27) spending approximately 10 months at the Concordia station completed the Utrecht Coping List, the Positive and Negative Affect Schedule (PANAS), and a structured sleep diary at regular intervals (x 9). The results showed that several variables reached a minimum value during the midwinter period, which corresponded to the third quarter of the expedition. The effect was particularly noticeable for coping strategies (i.e., active problem solving, palliative reactions, avoidance, and comforting cognitions). The pattern of results could indicate that participants during Antarctic over-wintering enter a state of psychological hibernation as a stress coping mechanism.

International medical graduates' perceptions of entering the profession in Norway.

BACKGROUND: There is little knowledge available about how it feels for an international medical graduate arriving in Norway. We have investigated how the initial period as an employee of the Norwegian health services is perceived. MATERIAL AND METHOD: We conducted semi-structured interviews with 16 international medical graduates who had foreign training and citizenship. They had worked as doctors in Norway for less than two years. Transcriptions of the interviews were analysed using the Systematic Text Condensation method. RESULTS: Their background for working in Norway varied. Some had an affiliation to the country and a social network, which appeared to be a support during the initial period. Many perceived the authorisation process as bureaucratic and as throwing suspicion on them. The doctors felt that they could cope with most of their work assignments, but reported having faced challenges in terms of language, a lack of insight into systems and uncertainty regarding what was expected of the doctor's role in a Norwegian context. There was also uncertainty associated with a perceived absence of collegial support. Because of the availability of jobs, some had adjusted their career plans towards psychiatry, geriatrics or general practice. INTERPRETATION: It appears that preparatory measures such as training courses, tests and the authorisation process fail to provide the practice-related experience and local knowledge that many doctors feel that they need in their new job situation. Measures such as language training and introduction to systems would be likely to improve their general well-being as well as integration.

Individual, situational and lifestyle factors related to shift work tolerance among nurses who are new to and experienced in night work.

AIM: To identify individual, situational and lifestyle variables related to shift work tolerance among nurses who have worked night shifts for less than 1 year and nurses who have worked night shift for more than 6 years, all engaged in rotating shift work. BACKGROUND: Working shifts is related to negative health consequences. Factors related to shift work tolerance may differ between nurses with little experience and nurses with extensive experience in night work. DESIGN: Cross-sectional questionnaire study. METHODS: A questionnaire including established instruments measuring shift work tolerance, personality, work schedule and lifestyle factors was administered between November 2008-May 2010. Randomly selected Norwegian nurses (n = 749) participated in the study; 322 were new and 427 were experienced in night work. RESULTS: There were no statistically significant differences in shift work tolerance between the new to night work nurses and the nurses who were experienced in night work. Young age was related to higher shift work tolerance. Hardiness was positively related to shift work tolerance in both groups. For the new to night work nurses, morningness was positively related to shift work tolerance. For the experienced in night work nurses, languidity, work hours per week and caffeine consumption were negatively, but flexibility was positively, related to shift work tolerance. CONCLUSION: Several variables were related to shift work tolerance among rotating shift working nurses, especially hardiness. Somewhat different variables were related to shift work tolerance for nurses who were new to night work than for nurses with more experience in night work.

Communal proactive coping strategies among Tamil refugees in Norway: A case study in a naturalistic setting.

BACKGROUND: An exclusive focus on individual or family coping strategies may be inadequate for people whose major point of concern may be collective healing on a more communal level. METHODS: To our knowledge, the current study is the first to make use of ethnographic fieldwork methods to investigate this type of coping as a process in a natural setting over time. Participant observation was employed within a Tamil NGO in Norway between August 2006 and December 2008. RESULTS: Tamil refugees in Norway co-operated to appraise their shared life situation and accumulate resources communally to improve it in culturally meaningful ways. Long term aspirations were related to both the situation in the homeland and in exile. However, unforeseen social events created considerable challenges and forced them to modify and adapt their coping strategies. CONCLUSIONS: We describe a form of coping previously not described in the scientific literature: Communal proactive coping strategies, defined as the process by which group members feel collectively responsible for their future well-being and co-operate to promote desired outcomes and prevent undesired changes. The study shows that proactive coping efforts occur in a dynamic social setting which may force people to use their accumulated proactive coping resources in reactive coping efforts. Theoretical and clinical implications are explored.