Lars Lien

• Lien, Lars & Malkomsen, Anders (2024). Eksistensiell krise i den biopsykososiale modellen. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 144(4). doi: 10.4045/tidsskr.23.0839.
• Stea, Tonje Holte; Bonsaksen, Tore; Smith, Pierre; Kleppang, Annette Løvheim; Steigen, Anne Mari & Leonhardt, Marja [Vis alle 8 forfattere av denne artikkelen] (2024). Are social pressure, bullying and low social support associated with depressive symptoms, self-harm and self-directed violence among adolescents? A cross-sectional study using a structural equation modeling approach. BMC Psychiatry. ISSN 1471-244X. 24(1). doi: 10.1186/s12888-024-05696-1.
• Bramness, Jørgen Gustav; Lien, Lars; Moe, Jenny Skumsnes; Toft, Helge; Pandey, Susmita & Lid, Torgeir Gilje [Vis alle 9 forfattere av denne artikkelen] (2024). Bariatric surgery patients in AUD treatment in Norway—an exploratory cross-sectional study. Alcohol and Alcoholism. ISSN 0735-0414. 59(2). doi: 10.1093/alcalc/agae007.
• Sandvik, Miriam Kristine; Nesvåg, Ragnar; Jorem, Jacob & Lien, Lars (2024). Which factors affect job satisfaction of doctors in psychiatry? Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2024.2303314.
• Lien, Lars; Shaygani, Shahram & Reitan, Solveig Klæbo (2023). Hva innebærer en medisinsk forståelse av psykiatrisk sykdom? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 143(18), s. 1–5. doi: 10.4045/tidsskr.23.0660.
• Kalman, Janos L.; Burkhardt, Gerrit; Samochowiec, Jerzy; Gebhard, Christian; Dom, Geert & John, Miriam [Vis alle 15 forfattere av denne artikkelen] (2023). Digitalising mental health care: practical recommendations from the European Psychiatric Association. European psychiatry. ISSN 0924-9338. 67(1). doi: 10.1192/j.eurpsy.2023.2466. Fulltekst i vitenarkiv Vis sammendrag

  Thedigitalisationofmentalhealthcareisexpectedtoimprovetheaccessibilityandqualityof specialisedtreatmentservicesandintroduceinnovativemethodstostudy,assess,andmonitor mentalhealthdisorders.InthisnarrativereviewandpracticalrecommendationoftheEuropean PsychiatricAssociation(EPA),weaimtohelphealthcareprovidersandpolicymakerstonavigate thisrapidlyevolvingfield.Weprovideanoverviewofthecurrentscientificandimplementation statusacrosstwomajordomainsofdigitalisation: i)digitalmentalhealthinterventionsandii) digital phenotyping, discuss thepotential of eachdomain to improve the accessibility and outcomes ofmental healthservices, andhighlight current challenges facedby researchers, clinicians,andserviceusers.Furthermore,wemakeseveral recommendationsmeant tofoster thewidespreadadoptionofevidence-baseddigitalsolutionsformentalhealthcareinthemember statesoftheEPA.Torealisethevisionofadigitalised,patient-centred,anddata-drivenmental healthecosystem,anumberof implementationchallengesmustbeconsideredandaddressed, spanningfromhuman,technical,ethical–legal,andeconomicbarriers.Thelistofpriorityareas andactionpointsourexpertpanelhasidentifiedcouldserveasaplaybookforthisprocess.

• Vaishnav, Mrugesh; Javed, Afzal; Gupta, Snehil; Kumar, Vinay; Vaishnav, Parth & Kumar, Akash [Vis alle 46 forfattere av denne artikkelen] (2023). Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications. Indian Journal of Psychiatry. ISSN 0019-5545. 65(10), s. 995–1011. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_667_23. Fulltekst i vitenarkiv
• Lien, Lars; Bonsaksen, Tore; Stea, Tonje Holte; Kleppang, Annette Løvheim; Steigen, Anne Mari & Leonhardt, Marja (2023). Time trends in self-reported depressive symptoms, prescription of antidepressants, sedatives and hypnotics and the emergence of social media among Norwegian adolescents. PLOS ONE. ISSN 1932-6203. 18(12). doi: 10.1371/journal.pone.0295384. Fulltekst i vitenarkiv Vis sammendrag

  Background Research has shown increased mental health problems and use of prescription drugs among adolescents in recent years and social media use has been linked to poorer mental health. However, trend studies concerning these topics are scarce. The purpose of this study was to analyze gender-specific trends in a) symptoms of depression and loneliness, and b) prescription of antidepressants, hypnotics and sedatives, in relation to the emergence of social media among adolescents in Norway. Methods This is an ecological study using data from the ‘Young in Oslo’ surveys from 1996 to 2021. The surveys included approximately 110 000 students, 14–17 years of age, and yielded a response rate varying from 95% in 1996 to 64% in 2021. A self-report questionnaire was used to collect information on symptoms of depression and loneliness. Information on antidepressant and sleep medication prescription was retrieved from the Norwegian Prescription Database for the age group 15 to 19 years. A graphical approach and logistic regression models were used to examine gender-specific time-trends between 1996 to 2021. Results We found a doubling in self-reported symptoms of depression and loneliness among girls between 1996 and 2021, with the steepest increase in the period from 2006 to 2012, when Facebook and other social media were introduced. A similar trend was observed in the prescription of antidepressants among girls, with the steepest increase between 2011 and 2013. Among both boys and girls, ‘worried too much about things’ and ‘had sleep problems’ were the two symptoms with the greatest changes. Conclusion A significant upward trend in self-reported depressive symptoms and medication use was observed over the past 25 years, with variations in the rate of increase, including a steeper trajectory during certain periods immediately after the introduction of social media platforms in Norway.

• Bakken, Regine; Lien, Lars; Fauske, Halvor & Landheim, Anne Signe (2023). Education and employment status among young adults three years after entering residential substance use treatment. A longitudinal data-linkage study. Journal of Substance Use. ISSN 1465-9891. doi: 10.1080/14659891.2023.2281966. Fulltekst i vitenarkiv Vis sammendrag

  Aims This study aims to investigate three-year follow-up among young adults who entered residential substance use disorder (SUD) treatment with regard to outcomes related to education, work and mortality. Methods Participants who entered residential SUD treatment between 2011 and 2016 aged 16–29 years were included in the study. In this study, we used data from the electronic health records of the treatment facility of the participants and linked these with data from nationwide registries. The data included de-identified, person-level information on patient demographics, crime, treatment use and socioeconomic factors. The primary outcome was education and employment status, analyzed using logistic regression. Results At the follow-up, two-fifths of the sample were in education or employment, half were receiving welfare benefits and the annual income level was low. 3.6% of the sample had died. Those who were in education or work were less likely to have post-treatment convictions and to use residential SUD treatment services than those who were not. Conclusion Being in education or employment and not engaging in crime or severe substance use can create a life situation that helps to sustain recovery. There is a need to establish SUD treatment for young adults that includes education- and employment-focused interventions.

• Leonhardt, Marja; Bramness, Jørgen Gustav & Lien, Lars (2023). Incidence of SARS-CoV-2 and all-cause mortality in persons with co-occurring substance use disorder and mental illness during the pandemic: a Norwegian cohort study. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. s. 1–9. doi: 10.1007/s00127-023-02599-6. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Most people were affected by the COVID-19 pandemic. Persons with co-occurring substance use disorder (SUD) and mental illness (MI) are already a marginalized group, with above average mortality. Thus, the study aim was to investigate SARS-CoV-2 incidence and mortality among persons with SUD/MI during the first two years of the pandemic. Methods This historical cohort study merged data from the Norwegian Patient Register, the Norwegian Surveillance System for Communicable Diseases and census data from Statistics Norway. We calculated crude mortality rates for persons with SUD and mild/moderate vs. severe MI and compared them to persons with physical illnesses or healthy controls. The incidence rate ratios for SARS-CoV-2 infection and mortality were estimated using Poisson regression models. Results Compared to healthy controls, the SARS-Cov-2-infection rate was marginally lower in persons with SUD and mild/moderate MI (IRR,1.19 [95%CI,1.09–1.30]) as in persons with physical illness (IRR,1.35 [95%CI, 1.23–1.47]), whereas persons with SUD and severe MI showed a lower rate compared to healthy controls. Crude mortality rates for persons with SUD/MI were substantially higher and increased much more during the pandemic than for persons with physical illnesses or healthy controls. The IRR for mortality in persons with SUD and mild/moderate MI was 10.61 (95%CI,7.19–15.67) and 11.44 (95%CI,7.50-17.45) for SUD and severe MI, compared to 5.03 (3.34–7.57]) for persons with physical illnesses only. Conclusion The analysis showed excess mortality during COVID-19-pandemic for SUD/MI, but without higher SARS-CoV-2 infection rates in this group. Consequently, excess mortality among persons with SUD/MI was not due to SARS-CoV-2 infection.

• Bramness, Jørgen Gustav; Pandey, Susmita; Moe, Jenny Skumsnes; Toft, Helge; Lien, Lars & Walby, Fredrik A [Vis alle 8 forfattere av denne artikkelen] (2023). Levels of IL-6 are Associated with Lifetime Attempted Suicide in Alcohol Use Disorder Patients. Neuropsychiatric Disease and Treatment. ISSN 1176-6328. 19, s. 2141–2148. doi: 10.2147/NDT.S413101. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with alcohol use disorder (AUD) have an increased risk of suicide. Neuroimmunological measures, such as cytokines, are shown to deviate in people with attempted suicide. Few studies have investigated this among AUD patients. Patients and Methods: One-hundred and fourteen patients undergoing residential treatment for AUD were interviewed on lifetime suicide attempts (SA) along with several other background variables and clinical characteristics. Serum blood samples were drawn for analysis of cytokines. Results: Thirty-one patients (27%) reported at least one SA. These patients had more symptoms of current affective disorders and more severe dependence. In bivariate analysis only IL-6 and IL-10 appeared to be associated with lifetime SA but without reaching statistical significance. In multivariate linear regression, adjusting for sex, nicotine use, somatic illness, and the use of anti- inflammatory drugs, IL-6 was associated to SA (p = 0.033). Conclusion: The cytokine IL-6 has repeatedly been found to be associated with suicidality. The present study concurs with this role of IL-6 in a naturalistic observational study of AUD patients.

• Balieva, Flora Nicol; Abebe, Dawit Shawel; Dalgard, Florence & Lien, Lars (2023). Risk of developing psychiatric disease among adult patients with skin disease: A 9-year national register follow-up study in Norway. Skin Health and Disease (SHD). ISSN 2690-442X. 3(6). doi: 10.1002/ski2.294. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Pant, Sagun Ballav; Thapa, Suraj Bahadur; Howard, John; Ojha, Saroj Prasad & Lien, Lars (2023). Internalized Stigma and its Correlates Among Opioid Agonist Treatment Service Users in Nepal. Journal of Psychosocial Rehabilitation and Mental Health. ISSN 2198-9834. doi: 10.1007/s40737-023-00353-4. Fulltekst i vitenarkiv Vis sammendrag

  Opioid use disorder is associated with high levels of stigma and discrimination, which impact treatment seeking and compliance. Despite extensive evidence as an optimal intervention for opioid use disorder, enrollment in Opioid Agonist Treatment (OAT) in settings like Nepal, is accompanied by moral judgements and stigma with a broad narrative of it being merely a replacement of ‘one addiction with another’. Stigma is eventually internalized by many service users impacting enrollment and maintenance in OAT, and quality of life. This study aimed to assess internalized stigma among OAT service users in Nepal and to explore its association with sociodemographic characteristics, lifetime mental disorders and quality of life. A cross-sectional study was conducted among 231 OAT service users, the survey instrument included the Mini-International Neuropsychiatric Interview for DSM-5, Internalized Stigma of Mental Illness Inventory (ISMI) and the World Health Organization Quality of Life –BREF. Factors associated with quality of life and internalized stigma were investigated using bivariate and multivariate analyses. More than half (56.28%) of respondents reported having high internalized stigma with a mean ISMI score of 2.71 ± 0.64. All 29 ISMI items were found to have a mean score greater than 2.5 indicating a high burden of internalized stigma. Service users reporting higher internalized stigma had significantly lower quality of life across all domains, greater medical co-morbidity, lifetime anxiety and depressive disorder and alcohol use disorder. To lessen stigma and its impacts, our findings recommend a national initiative targeting stigma reduction interventions for existing OAT services and beneficiaries.

• Heltne, Unni Marie; Sarkadi, Anna; Lien, Lars & Dybdahl, Ragnhild (2023). Training non-specialists in teaching recovery techniques (TRT) to help traumatised children in humanitarian settings: a qualitative analysis of experiences gained from 20 years of practice. International Journal for Equity in Health. ISSN 1475-9276. 22. doi: 10.1186/s12939-023-01999-z.
• Olstad, Kjersti; Sørensen, Torgeir; Lien, Lars & Danbolt, Lars Johan (2023). Meaning in life in adolescents with developmental trauma: A qualitative study. Archive for the Psychology of Religion/ Archiv für Religionspsychologie. ISSN 0084-6724. 46(1), s. 16–34. doi: 10.1177/00846724221150027. Vis sammendrag

  Aim:The purpose of this study was to explore how adolescent patients displaying developmental trauma experience and describe meaning in life. Schnell’s model of meaning in life is applied to explore meaningfulness, crises of meaning and sources of meaning. Method: The study has a qualitative design based on individual interviews with eight adolescents aged 14–18 years in treatment in an outpatient clinic for mental health care for children and adolescents. The interviews were transcribed and analyzed using systematic text condensation. Results: The adolescents related meaning in life to the experience of coherence, intrinsic values, progress and belonging, or the absence of these. Examples of sources of meaning among the informants were positive relations with meaningful others, structure and routines, moments of well-being, achieving goals related to education, work and family, and seeking something else outside oneself such as playing computer games, being engaged in politics, being with animals, having a belief in a god or being outdoors in natural surroundings. Conclusion: Although the topic of meaning in life was unknown to this group, they used sources of meaning intuitively. This group seems to have similar preferences to the general population. More knowledge is needed on how the topic of meaning in life can be useful in therapy for adolescents with development trauma.

• Van Beugen, Sylvia; Schut, Christina; Kupfer, Jörg; Bewley, Antony P.; Finlay, Andrew Y. & Gieler, Uwe [Vis alle 31 forfattere av denne artikkelen] (2023). Perceived Stigmatization among Dermatological Outpatients Compared with Controls: An Observational Multicentre Study in 17 European Countries. Acta Dermato-Venereologica. ISSN 0001-5555. 103. doi: 10.2340/actadv.v103.6485. Fulltekst i vitenarkiv Vis sammendrag

  Perceived stigmatization places a large psychosocial burden on patients with some skin conditions. Little is known about the experience of stigmatization across a wide range of skin diseases. This observational cross-sectional study aimed to quantify perceived stigmatization and identify its predictors among patients with a broad spectrum of skin diseases across 17 European countries. Self-report questionnaires assessing perceived stigmatization and its potential predictors were completed by 5,487 dermatology outpatients and 2,808 skin-healthy controls. Dermatological diagnosis, severity, and comorbidity were clinician-assessed. Patients experienced higher levels of perceived stigmatization than controls (p < 0.001, d = 0.26); patients with psoriasis, atopic dermatitis, alopecia, and bullous disorders were particularly affected. Multivariate regression analyses showed that perceived stigmatization was related to sociodemographic (lower age, male sex, being single), general health-related (higher body mass index, lower overall health), disease-related (higher clinician-assessed disease severity, presence of itch, longer disease duration), and psychological (greater distress, presence of suicidal ideation, greater body dysmorphic concerns, lower appearance satisfaction) variables. To conclude, perceived stigmatization is common in patients with skin diseases. Factors have been identified that will help clinicians and policymakers to target vulnerable patient groups, offer adequate patient management, and to ultimately develop evidence-based interventions.

• Bedane, Haji Kedir; Lien, Lars; Holsen, Maria; Bale, Marte; Osvoll, Knut Ivar & Thoresen, Christian [Vis alle 7 forfattere av denne artikkelen] (2023). Geographic variation in the utilisation of specialist healthcare for patients with severe mental illness in Norway: a population‑based registry study. Research in Health Services and Regions. s. 1–10. doi: 10.1007/s43999-023-00025-7. Fulltekst i vitenarkiv Vis sammendrag

  Purpose The aim of this study is to measure geographic variations in mental healthcare service utilisation among patients with severe mental illness in Norway. Method We analysed data from the Norwegian patient registry for 2014–2018 for patients with severe mental illness. The outcomes measured in this study were: outpatient contact, admission, bed days and total contact rates. Total contacts were calculated as the sum of observed outpatient contacts plus four times the hospital bed days for each hospital catchment area based on the Norwegian health director’s report on clinical activity and patient treatment cost. Geographic variations were measured using extreme quotient (EQ), coefficient of variation (CV) and systematic component of variation (SCV). Maps, figures, and tables were used to visualise geographic variation. Results The geographic variations saw a six-fold increase in the outpatient contact rate and a three-fold increase in the admission rate between the areas with lowest rate and areas with the highest rate. However, there was low geographic variation in calculated total contact rates (Eqs. 5 − 95 =1.77). The low-level geographic variation in the total calculated contact rate was also confirmed with an SCV of less than three. Conclusion The levels of geographic variations in the utilisation of outpatient and inpatient mental healthcare services among patients with severe mental illness are high. However, the geographic variation in total services provided by hospital catchment areas calculating the two service modalities together using their treatment cost ratio, is low. This may reflect the relatively equal performance of hospital catchment areas in terms of resource utilisation regardless which service modality they prioritise. Factors contributing to high geographic variation in individual service modalities need further investigation.

• Holsen, Maria; Holman, Per Arne; Solbakken, Ole Andre & Lien, Lars (2023). Geografisk variasjon i vaksnes bruk av avtalespesialistar og DPS i psykisk helsevern. Tidsskrift for Norsk Psykologforening. ISSN 0332-6470. doi: 10.52734/IHAK9103. Fulltekst i vitenarkiv Vis sammendrag

  Background: Equitable mental healthcare regardless of area of residence is a political aim in Norway. The purpose of this study is to evaluate geographical variation in private practitioner coverage and explore differences between private practitioners with public reimbursement and local community mental health centers (CMHCs) in terms of diagnoses and scope of outpatient treatment, with a focus on mood and neurotic disorders. Method: Cross-sectional registry-based study of adults in outpatient mental healthcare at private practitioners or CMHCs in Norway in 2014–2018. We calculated distribution of diagnoses, geographical variation in rates of private practitioners, and analyzed scope of treatment for patients with mood and neurotic disorders (ICD-10 disorders F3, F4). We estimate cost per treated patient and report geographic variation for hospital catchment areas. Results: Patients with F3, F4 disorders accounted for 64.7 % at private practitioners, and 41.5 % at CMHCs, and received more treatment at private practitioners, five more consultations in a 42 day longer period. There is considerable geographical variation in private practitioner coverage, highest in South-Eastern Norway and lowest in Northern Norway. Implications: As long as management and priority setting are differently organized for CMHCs and private practitioners in mental health care, we must expect geographical variation in access and use. It appears as an equity paradox that a group of patients, rejected by or not referred to CMHC, receive more treatment by private practitioners.

• Bolstad, Ingeborg; Lien, Lars; Moe, Jenny Skumsnes; Pandey, Susmita; Toft, Helge & Bramness, Jørgen Gustav (2023). Inflammatory cytokines in alcohol use disorder patients are lower in smokers and users of smokeless tobacco. Alcoholism: Clinical and Experimental Research. ISSN 0145-6008. 47(7), s. 1352–1363. doi: 10.1111/acer.15103. Fulltekst i vitenarkiv Vis sammendrag

  Background: Smoking and alcohol use often co-occur, and the use of nicotine-containing products is particularly common among persons with alcohol use disorder (AUD). Recent evidence shows that chronic alcohol use leads to inflammation through increased gut permeability and dysregulated cytokine levels. While cigarette smoking also has detrimental health effects, nicotine has immune dampening effects in some settings. Preclinical evidence demonstrates that nicotine can dampen alcohol-induced inflammation, but inflammatory responses after nicotine use has not been studied in persons with AUD. This study compared the level of circulating cytokines in abstinent AUD inpatients who were non-tobacco users, smokers, users of Swedish snus, or dual tobacco users. Methods: We collected blood samples and information about somatic and mental health and tobacco habits from 111 patients in residential treatment for AUD and 69 healthy controls. Levels of interferon (IFN)-γ, interleukin (IL)-10, tumor necrosis factor (TNF)-α, IL-17a, IL-1β, IL-6, IL-8, IL-1 receptor antagonist (ra), and monocyte chemoattractant protein (MCP)-1 were examined using a multiplex assay. Results: Patients with AUD had higher levels of seven cytokines than healthy controls. Among the AUD patients, nicotine users had lower levels of IL-10, TNF-α, IL-17a, IL-1β, IL-8, and MCP-1 (all p < 0.05). Conclusions: Our findings may indicate that nicotine has anti-inflammatory effects in patients with AUD. Nonetheless, nicotine use cannot be recommended as a viable therapeutic option to reduce alcohol-induced inflammation because of its other adverse effects. Additional studies of the effects of tobacco or nicotine products on cytokine patterns in relation to mental or somatic health conditions are warranted. Keywords: alcohol; alcohol use disorder; cytokines; inflammation; nicotine. © 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.

• Olstad, Kjersti; Sørensen, Torgeir; Lien, Lars & Danbolt, Lars Johan (2023). Adolescents with developmental traumas in therapy in a child and adolescent mental health service, outpatient unit: experiences of daily living and expectations for therapy – a qualitative study. Frontiers in Psychology. ISSN 1664-1078. 14. doi: 10.3389/fpsyg.2023.946394. Fulltekst i vitenarkiv Vis sammendrag

  Background: Developmental trauma has a profound effect on people's lives. There are few studies of the perceived difficulties and treatment needs of adolescents with developmental trauma. More studies are called for to explore the perspectives and experiences of these patients, especially adolescents. Method: Semi-structured interviews were conducted with eight adolescents with developmental trauma aged 14-18 years in a Child and Adolescent Mental Health Service, Outpatient Unit. The interviews were analyzed using systematic text condensation. Results: A main finding in this study regards the participants' understanding of why they needed therapy: symptom alleviation and coping tools. They expressed a need for talking with a safe and reliable adult who understood their situation. Their stories of daily functioning and bodily sensations align mainly with symptoms described for adolescents with developmental trauma. The study also shows that the participants' experiences of trauma affected their lives to a greater or lesser extent, in the form of ambivalence, avoidance, regulation, and coping strategies. They also described various physical problems, especially insomnia and inner restlessness. Their subjective stories revealed insights into their experiences. Conclusion: Based on the results, we recommend that adolescents with developmental trauma be allowed to express their understandings of their difficulties and their treatment expectations at an early stage of their therapy. An emphasis on patient involvement and the therapeutic relationship can increase their autonomy and control over their own lives and treatment. Keywords: adolescents; developmental trauma disorder; self-understandings; systematic text condensation; therapy. Copyright © 2023 Olstad, Sørensen, Lien and Danbolt.

• Bakken, Regine; Lien, Lars; Fauske, Halvor; Saltyte Benth, Jurate & Landheim, Anne Signe (2023). Criminal thinking and psychosocial characteristics among young adults entering residential substance use treatment. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 40(4), s. 339–354. doi: 10.1177/14550725231160337. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim: Young adults with substance use (SU) problems face a high risk of co-occurring problems, including criminality. The aim of the present study was to assess the psychosocial characteristics, SU problems, and criminal thinking young adults entering SU treatment have, and whether the SU characteristics, sex and age are associated with criminal thinking scores. Methods: The sample was 407 young adults aged 16–29 years who underwent an entry assessment between January 2011 and December 2016 at a residential SU treatment institution in Norway. All study data were extracted from electronic health records, including survey information from the Achenbach System of Empirically Based Assessment and the Psychological Inventory of Criminal Thinking Styles. Results: In the present sample, severe SU, high rates of psychosocial problems, and criminal thinking were reported. Almost three-quarters (72.67%) of young adults reported high levels of criminal thinking (≥60). However, male participants were more likely to report high levels of criminal thinking compared to female participants (p=0.031). In bivariate regression models, only sex and having stimulants/opioids as primary drug were associated with mean levels of criminal thinking. The same was true in the multiple regression model. Conclusion: Young adults in residential SU treatment are a multi-problem high-risk/high-need group of people. Due to the elevated levels of criminal thinking, we recommend that young adults in SU treatment should be screened for criminogenic treatment needs, such as criminal thinking, regardless of justice involvement.

• Berger, Endre; Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen Gustav (2023). The Association Between Regular Physical Activity and Depressive Symptoms Among Patients in Treatment of Alcohol and Substance Use Disorders. Substance Abuse: Research and Treatment. ISSN 1178-2218. 17. doi: 10.1177/11782218231175813. Fulltekst i vitenarkiv Vis sammendrag

  Background: Alcohol and other substance use disorders and major depression often co-occur. A sedentary lifestyle is related to major depression and even moderate exercise may prevent and contribute to the treatment of depression. Studies have found an effect of physical activity on depression in alcohol and other substance use disorder patients even in clinical settings. Aim: To investigate the relationship between level of physical activity and depressive symptoms over time in alcohol and substance use disorder inpatients. Methods: Eighty-nine substance use disorder inpatients were followed for 6 months during treatment. The International Physical Activity Questionnaire was used to categorize 3 groups of low, moderate, or high level of physical activity. In addition to background variables and alcohol and drug use measures, data on biometric measures and on sleep were gathered. Becks Depression Inventory version II (BDI-II) measured depressive symptoms. A multilevel logistic regression was used to analyze the longitudinal relationship between physical activity and depressive symptoms. Results: Most patients (57%) reported low activity, while 24% reported moderate and 19% high activity. Few changed their activity level during treatment. Moderate physical activity was related to lower score on BDI-II (P = .029). Level of physical activity was closely related to insomnia (P = .024). In the multivariate analysis the relationship between depressive symptoms and physical activity did not withstand the adjustment for insomnia. However, in the multilevel logistic regression higher physical activity was related to lower BDI-II score in a dose dependent manner. Conclusions: Among these alcohol and other substance use disorders patients in treatment, there was a relationship between depressive symptoms and physical activity. The low level of physical activity identified among these patients was related to a high level of depressive symptoms. The level of depressive symptoms declined over time; but this change was not related to an increase in physical activity.

• Roer, Grethe Emilie; Lien, Lars; Bolstad, Ingeborg; Aaseth, Jan Olav & Abebe, Dawit Shawel (2023). The impact of PTSD on risk of cardiometabolic diseases: a national patient cohort study in Norway. BMC Psychiatry. ISSN 1471-244X. 23. doi: 10.1186/s12888-023-04866-x. Fulltekst i vitenarkiv Vis sammendrag

  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. Keywords: Alcohol use disorder; Cardiovascular diseases; Cohort study; Comorbidity; Depression; Diabetes mellitus; Epidemiology; Metabolic diseases; Posttraumatic stress disorder; Register data. © 2023. The Author(s).

• Aasen, Jan; Galaaen, Kari; Nilsson, Fredrik; Sørensen, Torgeir; Lien, Lars & Leonhardt, Marja (2023). Promoting Social Participation and Recovery Using Virtual Reality–Based Interventions Among People With Mental Health and Substance Use Disorders: Qualitative Study. JMIR Formative Research. ISSN 2561-326X. 7. doi: 10.2196/46136. Fulltekst i vitenarkiv Vis sammendrag

  Background: People with mental health disorders (MHDs) and substance use disorders (SUDs) are a highly vulnerable group, particularly affected by social exclusion, marginalization, and disconnectedness. Virtual reality technology holds a potential for simulating social environments and interactions to mitigate the social barriers and marginalization faced by people recovering from MHDs and SUDs. However, it is still unclear how we can harness the greater ecological validity of virtual reality-based interventions targeting social and functional impairments in individuals with MHDs and SUDs. Objective: The aim of this paper was to explore how service providers in community-based MHD and SUD health care services perceive the barriers to social participation among adults recovering from MHDs and SUDs to provide a broader understanding of how learning experiences can be modeled to promote social participation in virtual reality environments. Methods: Two semistructured, open-ended, and dual-moderator focus group interviews were conducted with participants representing different community-based MHD and SUD health care services. Service providers were recruited from their MHD and SUD services in our collaborating municipality in Eastern Norway. We recruited the first participant group at a municipal MHD and SUD assisted living facility for service users with ongoing excessive substance use and severe social dysfunctionality. We recruited the second participant group at a community-based follow-up care service aimed at clients with a broad range of MHDs and SUDs and various levels of social functioning. The qualitative data extracted in the interviews were analyzed, using reflexive thematic analysis. Results: The analysis of the service providers' perceptions of the barriers to social participation among clients with MHDs and SUDs revealed the following five main themes: challenging or lacking social connections, impaired cognitive functions, negative self-perception, impaired personal functioning, and insufficient social security. The barriers identified are interrelated in a cluster of cognitive, socioemotional, and functional impairments, leading to a severe and diverse complex of barriers to social participation. Conclusions: Social participation relies on people's capability to use their present social opportunities. Promoting basic human functioning is key to promoting social participation among people with MHDs and SUDs. The findings in this study indicate a need to address cognitive functioning, socioemotional learning, instrumental skills, and complex social functions to meet the complexity and diversity of the identified barriers to social functioning in our target group. Virtual reality-based interventions for promoting social participation should be sequenced into distinct scenarios dedicated to specific learning goals to build complex learning in a step-by-step process based on successively more complex levels of human and social functioning. Keywords: MHD; SUD; VRI; mental health disorders and substance use disorders; qualitative study; recovery; reflexive thematic analysis; social functioning impairments; social participation; virtual reality–based interventions. ©Jan Aasen, Kari Galaaen, Fredrik Nilsson, Torgeir Sørensen, Lars Lien, Marja Leonhardt. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.04.2023.

• Pant, Sagun Ballav; Thapa, Suraj Bahadur; Howard, John; Ojha, Saroj Prasad & Lien, Lars (2023). Psychological distress and quality of life among Opioid Agonist Treatment service users with a history of injecting and non-injecting drug use: A cross-sectional study in Kathmandu, Nepal. PLOS ONE. ISSN 1932-6203. 18(2). doi: 10.1371/journal.pone.0281437. Fulltekst i vitenarkiv Vis sammendrag

  Background: Opioid use disorder is a serious public health problem in Nepal. People who use opioids often experience psychological distress and poor quality of life. Opioid agonist Treatment (OAT) is central in managing opioid dependence. This study aimed to examine factors associated with quality of life and serious psychological distress among OAT service users in the Kathmandu Valley, Nepal and compare those who had injected opioids prior to OAT and those who had not. Methods: A cross-sectional study with 231 was conducted using a semi-structured questionnaire, the Nepalese versions of the Kessler 6 psychological distress scale and World Health Organization Quality of Life scale (WHOQOL-BREF). Bivariate and multivariate analyses were undertaken to examine factors associated with quality of life and serious psychological distress. Results: Most participants were males (92%) and about half had injected opioids before initiating OAT. Serious psychological distress in the past four weeks was significantly more prevalent among participants with a history of injecting (32.2%) than those who did not inject (15.9%). In the adjusted linear regression model, those who had history of injecting were likely to have lower physical quality of life compared to non-injectors. Those self-reporting a past history of mental illness were more than seven times and those with medical comorbidity twice more likely to have serious psychological distress over last four weeks. Lower socioeconomic status and a history of self-reported mental illness in the past were found to be significantly associated with lower quality of life on all four domains. Conclusion: Those who had history of injecting were younger, had frequent quit attempts, higher medical comorbidity, lower socioeconomic status and remained longer in OAT services. Alongside OAT, the complex and entangled needs of service users, especially those with a history of injecting drugs, need to be addressed to improve quality of life and lessen psychological distress. Copyright: © 2023 Pant et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

• Bonsaksen, Tore; Steigen, Anne Mari; Stea, Tonje Holte; Kleppang, Annette Løvheim; Lien, Lars & Leonhardt, Marja (2023). Negative social media-related experiences and lower general self-efficacy are associated with depressive symptoms in adolescents . Frontiers in Public Health. ISSN 2296-2565. 10, s. 1–13. doi: 10.3389/fpubh.2022.1037375. Fulltekst i vitenarkiv Vis sammendrag

  Social media are an integral part of adolescents' daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use in a time use perspective, rendering nuances in adolescents' social media experience less well explored. Thus, studies of relationships between social media use and mental health problems need also examine the nature of the events taking place on social media. This study aimed to examine depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-efficacy. Data collected in a national survey, Ungdata 2021 (n = 139,841), was used. Multivariate linear regression analyses showed that time spent on social media was associated with depressive symptoms (β = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (β ranging 0.09–0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-efficacy was directly associated with lower symptom levels (β = −0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms. The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-efficacy is an important resource for adolescents' mental health.

• Pant, Sagun Ballav; Thapa, Suraj Bahadur; Howard, J.; Ojha, SP & Lien, Lars (2022). Mental disorders and Suicidality among Opioid Agonist Treatment service users in Nepal: a cross sectional study. . SSM - Mental Health (SSM-MH). ISSN 2666-5603. 2. doi: 10.1016/j.ssmmh.2022.100165. Fulltekst i vitenarkiv
• Skarstein, Siv; Lien, Lars & Abebe, Dawit Shawel (2022). 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. Journal of Psychosomatic Research. ISSN 0022-3999. 165. doi: 10.1016/j.jpsychores.2022.111137. Fulltekst i vitenarkiv Vis sammendrag

  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. Keywords: Alcohol use; Diseases; Drug use; Mental illness; Socioeconomic status; Somatic © 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

• Mthoko, Ndahambelela Frederika Nepando; Pazvakawambwa, Lilian; Leonhardt, Marja & Lien, Lars (2022). Risk factors for cardiovascular disease among people with mental illness in Namibia. Ghana Medical Journal. ISSN 0016-9560. 56(4), s. 285–294. doi: 10.4314/gmj.v56i4.7.
• Kour, Prabhjot; Lien, Lars; Hjelde, Karin Harsløf; Pettersen, Henning & Kumar, Bernadette. N (2022). The Use of Substances at an Early Age: A Qualitative Study among Young Men Living with Substance Use Disorders in Punjab. Journal of Addiction & Addictive Disorders. ISSN 2578-7276. doi: 10.24966/AAD-7276/100061. Vis sammendrag

  Substance Use Disorders (SUDs) among young people are a major health problem. The magnitude of the problem is increasing in India, especially in Punjab, where the menace of SUDs is debilitating the physical and mental welfare of young people. This qualitative study therefore aims to explore the reasons for initiating substance use at an early age among young people with SUDs. Individual interviews were conducted with young people. A thematic analysis of the data was performed. The analysis yielded four main themes, including adolescent behaviour, peer group influence, family influence, and social and cultural contextual factors. Peer pressure was reported to be the key factor in early substance use leading to SUDs. This study provides an enhanced understanding of the experiences of young people with SUDs, including reasons for early substance use. Further, these experiences may enhance the knowledge required for an integrated approach to prevent early substance use.

• Kuzman, Martina Rojnic; Slade, Michael; Puschner, Bernd; Scanferla, Elisabetta; Bajic, Zarko & Courtet, Philippe [Vis alle 41 forfattere av denne artikkelen] (2022). Clinical decision-making style preferences of European psychiatrists: Results from the Ambassadors survey in 38 countries. European psychiatry. ISSN 0924-9338. 65(1). doi: 10.1192/j.eurpsy.2022.2330. Fulltekst i vitenarkiv Vis sammendrag

  Background: While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods: We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style - Staff questionnaire and a set of questions regarding clinicians' expertise, training, and practice. Results: SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions: The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe. Keywords: Clinical decision-making; Europe; mental health; professional-patient relations; psychiatry; shared decision-making. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

• Bolstad, Ingeborg; Toft, Helge; Lien, Lars; Moe, Jenny Skumsnes; Rolland, Benjamin & Bramness, Jørgen Gustav (2022). Longitudinal determinants of insomnia among patients with alcohol use disorder. Alcohol. ISSN 0741-8329. doi: 10.1016/j.alcohol.2022.11.002. Fulltekst i vitenarkiv
• Bramness, Jørgen Gustav; Pandey, Susmita; Moe, Jenny Skumsnes; Toft, Helge Prytz; Lien, Lars & Bolstad, Ingeborg (2022). History of Delirium Tremens in AUD Patients in Treatment: Relationship to AUD Severity and Other Factors. Substance Abuse and Rehabilitation. ISSN 1179-8467. 13, s. 65–72. doi: 10.2147/SAR.S361810. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Delirium tremens (DT) occurs after stopping prolonged, high alcohol intake and may be life-threatening if untreated. We need to know about clinical correlates of DT in order to provide the best clinical care. Methods: At admission to inpatient treatment a cohort of 114 alcohol use disorder (AUD) patients were interviewed and examined concerning psychiatric diagnosis and symptoms, trauma experiences and alcohol related measures and if they had experienced DT. Results: Twenty-four percent of the patients reported a life-time experience of DT. These patients were predominantly males and had lower educational level. More of the patients in the DT than the non-DT group reported at least one suicide attempt, were diagnosed with PTSD, and dropped out of treatment. Also, having parents with alcohol problems was more common among these patients, and they reported a longer duration of problematic drinking and a higher number of drinks needed to feel an effect of drinking. In the multivariable adjusted analysis only a diagnosis of PTSD (OR=5.71; 95% confidence interval (CI): 1.34– 24.31) and duration of problematic drinking with a 6% increase in risk for every year (OR=1.06; 95% CI: 1.01– 1.11) remained significant risk factors for having DT experience. Discussion and conclusion: Having experienced DT was more prevalent in the current investigation than in earlier studies. Patients that had experienced DT seemed to have more serious AUD, especially signified by a longer duration of drinking. These patients seemed to have many clinical disadvantages including more drop-out and higher suicide rate. PTSD could be a risk factor for DT but may also follow the DT experience. Keywords: alcohol use disorder, delirium tremens, treatment, PTSD

• Leonhardt, Marja; Granrud, Marie Dahlen; Bonsaksen, Tore & Lien, Lars (2022). Associations between Mental Health, Lifestyle Factors and Worries about Climate Change in Norwegian Adolescents. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(19). doi: 10.3390/ijerph191912826. Fulltekst i vitenarkiv Vis sammendrag

  Climate change is a serious global health threat that has an impact on young people’s lives and may influence their mental health. Since the global climate strike movement, many adolescents have expressed worries about climate change. Thus, the aim of this study is to examine the prevalence of worries about climate change, and factors associated with worries about climate change, in a representative sample of Norwegian adolescents. Data were retrieved from Ungdata, an annual nationwide online youth survey. Adolescents (n = 128,484) from lower and upper secondary school participated in the study. Data were analysed descriptively and with logistic regression. Most of the adolescents were not worried or a little worried about climate change. Girls, pupils who had at least one parent with higher education and pupils from urban areas were more inclined to worry about the climate. Adolescents who worried about the climate had more symptoms of depression than those who were less worried. While worry about climate change may constitute an additional burden for adolescents experiencing depressive symptoms, such worry can also be seen to reflect climate-friendly values.

• Leonhardt, Marja; Kyrdalen, Ellen; Holstad, Atle; Hurlen-Solbakken, Heidi; Chiu, Marcus Y.-L. & Lien, Lars (2022). Norwegian Cross-Cultural Adaptation of the Social and Communities Opportunities Profile-Mini for Persons with Concurrent Mental Health and Substance Use Disorders. Journal of Psychosocial Rehabilitation and Mental Health. ISSN 2198-9834. doi: 10.1007/s40737-022-00309-0. Fulltekst i vitenarkiv Vis sammendrag

  Persons with concurrent mental health and substance use disorders often do not participate actively in society and remain marginalized. The promotion of social inclusion is important for the care of persons with concurrent disorders. To measure social inclusion, the Social and Communities Opportunities Profile (SCOPE) was developed, followed by its mini version for English-speaking people in Singapore. In Norway, there is no instrument available to measure social inclusion. Thus, the aim was crosscultural adaptation of SCOPE Mini for persons with concurrent disorders. The Norwegian adaptation was performed using the systematic approach recommended by Beaton et al. After a forward–backward translation, the Norwegian SCOPE-Mini was pretested among 30 persons with a concurrent mental health and substance use disorder in three areas to check its psychometric properties. To evaluate comprehensibility and applicability, participants were asked five open questions. The Norwegian crosscultural adaptation of SCOPE Mini showed acceptable psychometric properties and was considered comparable to the original version. The results of the pre-test showed no linguistic inconsistency, but some indications of the necessity of semantic adaptation regarding the cultural context and persons with concurrent disorders. The Norwegian SCOPE Mini may be a practical tool for health professionals, social workers, and researchers to measure social inclusion among a vulnerable group such as persons with a concurrent mental health and substance use disorder. However, given the relatively small sample size in our study, further research on the validity and reliability of the instrument is recommended. The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

• Ghetti, Claire; Chen, Xi-Jing; Brenner, Annette; Hakvoort, Laurien G; Lien, Lars & Fachner, Jorg [Vis alle 7 forfattere av denne artikkelen] (2022). Music therapy for people with substance use disorders. Cochrane Database of Systematic Reviews. ISSN 1469-493X. 2022(5). doi: 10.1002/14651858.CD012576.pub3. Fulltekst i vitenarkiv Vis sammendrag

  Background Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving. Objectives To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. Search methods We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews. Selection criteria We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD. Data collection and analysis We used standard Cochrane methodology.

• Pandey, Susmita; Bolstad, Ingeborg; Lien, Lars; Walby, Fredrik A; Myhre, Martin Øverlien & Bramness, Jørgen Gustav (2022). Sex-specific factors associated with lifetime suicide attempt among patients with alcohol use disorders. BJPsych Open. ISSN 2056-4724. 8(4), s. 1–7. doi: 10.1192/bjo.2022.545. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with alcohol use disorder (AUD) are at high risk for suicide attempts. Mental health problems along with AUD-related factors may contribute to this increased risk. Studies have shown sex differences in rates and correlates of suicide attempts. Aims: The purpose of the study was to examine mental-health-related and AUD-related factors associated with suicide attempt separately in female and male AUD patients. Method: We collected information about lifetime suicide attempt and mental-health- and AUD-related factors for AUD in-patients (n = 114; 32 females) receiving rehabilitative treatment. Results: The prevalence of lifetime suicide attempt was 27%, and the rate was similar in both sexes. Among females, current depressive symptoms and current post-traumatic stress disorder diagnosis were associated with suicide attempt. In male AUD patients, among the mental-health-related factors, lifetime major depression, panic disorder, social phobia, childhood sexual abuse and antisocial personality disorder were associated with suicide attempt. In addition, AUD-related factors including longer duration of drinking, history of delirium tremens, greater severity of AUD and lower levels of prolactin were associated with suicide attempt in males. Conclusions: Our results indicate that suicide attempts in female AUD patients were more mental-health-related, whereas those in males were also related to the severity of AUD. This suggests that a suicide prevention programme for AUD patients would benefit from a sex-based understanding of the risk factors.

• Balieva, Flora Nicol; Schut, Christina; Kupfer, Jörg; Lien, Lars; Misery, Laurent & Sampogna, Francesca [Vis alle 8 forfattere av denne artikkelen] (2022). Perceived stress in patients with inflammatory and non-inflammatory skin conditions. An observational controlled study among 255 Norwegian dermatological outpatients. Skin Health and Disease (SHD). ISSN 2690-442X. 2(4). doi: 10.1002/ski2.162. Fulltekst i vitenarkiv Vis sammendrag

  Background Inflammation may increase stress, while stress may promote inflammation. Most dermatological conditions are chronic and inflammatory, while some, such as cancer, naevi and tumours are non-inflammatory, but may cause stress because of the fear of malignancy and the necessity for surgical and other invasive treatments. Stress among patients with skin diseases is little explored. Objectives To assess perceived stress in patients with inflammatory and non-inflammatory skin conditions compared to healthy controls. Methods Observational cross-sectional study. Consecutive outpatients (N = 255) visiting the Department of Dermatology, Stavanger University Hospital, Norway and 148 skin-healthy controls contributed by answering questionnaires on sociodemographics, stressful life events, economic difficulties, self-rated health and perceived stress. The validated Perceived Stress Scale10 was used to evaluate stress. A dermatologist examined patients and registered their diagnoses and comorbidities. Controls included in this study were not examined by a dermatologist and self-reported their comorbidities. Results Patients with an inflammatory skin disease or psoriasis have a tripled risk of reporting moderate to high stress compared with controls when adjusted for relevant confounders, including having experienced a stressful life event recently or having a comorbidity. Patients with a purely non-inflammatory skin disease perceived stress no differently than controls. Conclusion Patients with inflammatory skin disease perceived higher stress than controls and patients with non-inflammatory skin conditions. Dermatologists may play a role in awareness of the importance of stress in skin disease.

• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2022). Association of daily hassles, daily uplifts, coping styles and stress-related symptoms among women exposed to sexual abuse — A cross-sectional study. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. s. 1–14. doi: 10.1111/scs.13107. Fulltekst i vitenarkiv Vis sammendrag

  Background: Women who experience physical or sexual violence report poor self-perceived health. Knowledge of daily hassles, daily uplifts and coping styles, as well as how these factors can affect health and well-being among survivors of sexual abuse, is important for healthcare professionals to understand and target their needs. Aim: The aim of the current study was to explore the association of daily hassles, daily uplifts, coping strategies and stress-related symptoms among female survivors of sexual abuse. Methods: A group of women (n = 57), exposed to sexual abuse, were recruited from nine support centres in Norway. Participants completed a questionnaire that addressed demographics, socioeconomic conditions, trauma history, daily hassles, daily uplifts, coping styles and stress-related symptoms. Two groups of participants were compared: one group that had above-median scores on uplifts and adaptive coping styles and one group that had above-median scores on daily hassles and maladaptive coping styles. Results: Results indicate that women who experienced more daily hassles and used maladaptive coping styles reported significantly more stress-related symptoms, and particularly emotional symptoms, than women who experienced more daily uplifts and used adaptive coping styles. There were few differences between the two groups related to socioeconomic conditions and trauma history. Conclusion: The results indicate that women in both groups struggle with stress-related physical, emotional, cognitive and target group-specific symptoms. However, high incidence of daily hassles and the use of maladaptive coping styles were associated with an increase in stress-related symptoms. Novell's findings indicate that despite severe traumatic experiences, adaptive coping styles and favourable perceptions of stress in everyday life were associated with a lower frequency of stress-related symptoms. It may therefore be helpful to focus on altering maladaptive coping styles to reduce stress-related symptoms among sexual abuse survivors. Keywords: coping styles; cross-sectional; daily hassles; daily uplifts; sexual abuse; stress-related symptoms; women.

• Sørensen, Torgeir & Lien, Lars (2022). Significance of Self-Transcendence for Rehabilitation and Relapse Prevention among Patients with Substance Use Disorder: A Qualitative Study. Religions. ISSN 2077-1444. 13(6), s. 1–13. doi: 10.3390/rel13060491. Fulltekst i vitenarkiv Vis sammendrag

  A complex variety of restrictive and promoting factors are in play when people with substance use disorder face challenges concerning rehabilitation and relapse prevention. Selftranscendence sources are strongly associated with meaningfulness, and meaningfulness is found to be associated with less alcohol and drug use severity and relapse prevention. The aim of the present qualitative study was to investigate self-transcendence among patients with substance use disorders and to discuss its significance for treatment and relapse prevention. An exploratory qualitative research design was employed, with individual interviews in a strategic sample of four patients with substance use disorder recruited from a religiously founded rehabilitation clinic in Southeast Norway. The transcribed material was analysed through systematic text condensation. A search for objects beyond immediate needs through self-transcendence was revealed, related to generativity and an unselfish prosocial commitment to family and the surroundings, strengthening the participants’ elfefficacy, confidence, and safety. Spirituality and confidence in a higher power or destiny generated order in life. The use of rituals contributed to tranquillity. Values gave new directions, and private confession helped to start over in life. For patients in rehabilitation aiming at relapse prevention, self-transcendence seems to be significant as part of the recovery process. Possible implications for rehabilitation and relapse prevention are discussed. Keywords: relapse prevention; substance use disorder; meaning-making; self-transcendence; values; generativity; religion; spirituality © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

• Sanhori, Zeinat Balla Mohamed Ahmed; Lien, Lars; Hauff, Edvard; Ayazi, Touraj; Mdala, Ibrahimu & Eide, Arne Henning (2022). Change in Disability Associated with Psychological Distress among Internally Displaced Persons in Central Sudan. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(9). doi: 10.3390/ijerph19095347. Fulltekst i vitenarkiv Vis sammendrag

  Individuals with disabilities are particularly vulnerable in conflict settings, and a high rate of psychopathology is well documented among persons with disabilities. The objective of this study was to explore the change in disability prevalence among IDPs in two settlement areas in central Sudan and the association between disability and psychological distress. In this one-year follow-up study, 1549 IDPs were interviewed twice using the General Health Questionnaire (GHQ) to investigate emotional distress. Disability was measured using the Washington Group Short Set. Households were randomly selected using the community health center as the starting point. All household members above eighteen years of age in the sampled households were interviewed. There is an increase in disability prevalence among internally displaced persons over time, associated with rural residency and poverty, low education, unemployment, IDP status, originating from western Sudan, young age, male gender, and being married. Disability was further found to be associated with psychological distress. Disability among displaced persons should be considered as a risk factor for increase in psychopathological disorders and is closely related to poverty. The study is limited to individual-level data and does not incorporate relevant environmental variables that may have influenced the changes in disability rates.

• Toft, Helge; Bramness, Jørgen Gustav & Lien, Lars (2022). Levels of Peripheral Circulating IL-6 and IL-10 Decrease Over Time Despite High Depression Burden in PTSD Patients. Neuropsychiatric Disease and Treatment. ISSN 1176-6328. 18, s. 737–747. doi: 10.2147/NDT.S357797. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with combined depression symptoms and post-traumatic stress disorder (PTSD) often exhibit high levels of circulating inflammatory biomarkers as either a cause or consequence of their disease. We aimed to investigate how cytokines and depression symptoms develop with one-year follow-up and compare them with non-PTSD patients. Methods: The study had a longitudinal design with one-year follow-up measurements in an inpatient treatment setting at a psychiatric center in Norway. PTSD diagnoses were set using the Mini International Neuropsychiatric Interview (MINI). The first three measurements were at baseline (T0), halfway (T1) and at discharge (T2) from a 12-week main stay, followed by a final measurement one year after discharge (T3). Serum blood samples were collected on all four occasions. The Beck Depression Inventory-II (BDI-II) was administered at T0, T2 and T3. Results: Levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) in PTSD patients were higher than in patients without PTSD at T0 (p = 0.005 and 0.042). The PTSD patients had a higher average level of IL-10 across all four measurements (B = 1.62, Standard Error (SE) = 0.78, p = 0.037). The IL-10 levels in PTSD patients declined from T0 to T3 (p = 0.039). The PTSD patients were more depressed than non-PTSD patients at T3 (p = 0.019). Conclusions: The levels of IL-10 and IL-6 in PTSD patients more closely resembled the levels in non-PTSD patients at one-year follow-up, despite level of depression being unchanged in the PTSD patients. This calls into question the close relationship between level of circulating cytokines and depressive symptoms, at least in PTSD patients. Further research is needed to investigate what appears to be a complex relationship between immune markers and depression in patients with PTSD.

• Mæland, Ragnhild; Lien, Lars & Leonhardt, Marja (2022). Association between cannabis use and physical health problems in Norwegian adolescents: a cross-sectional study from the youth survey Ungdata. BMC Public Health. ISSN 1471-2458. 22. doi: 10.1186/s12889-022-13136-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Cannabis use is increasing among young Norwegians and several studies show a high incidence of common physical health problems. An association has previously been found between cannabis use and mental health problems. Since physical and mental health problems often co-occur, the aim of this study is to explore the relationship between cannabis use and physical health problems. Methods In 2017–2019, the Norwegian youth survey Ungdata collected data from 249,100 Norwegian adolescents, which equalled around 80% of all lower secondary school pupils (13–15 years) and about 50% of upper secondary pupils (16–19 years) in Norway. Descriptive analysis was used to calculate the prevalence of cannabis use and bi- and multivariate logistic regression analysis to examine the association between cannabis use and physical health problems, controlled for sociodemographics and mental health problems. Results Almost 10% of Norwegian adolescents had used cannabis once or more in the previous 12 months. The use of cannabis increased with age and it was more prevalent among boys. There is a clear connection between physical health problems and cannabis use (OR = 1.582 (CI: 1.527–1.638)) even after adjusting for sociodemographic variables and mental health problems (OR = 1.366 (CI: 1.312–1.423)). Conclusion More studies are needed to explore if there might a bidirectional relationship between cannabis use and physical health problems where physical problems increase cannabis use and cannabis use increases the risk of physical health problems. More knowledge on the effect of and motivation for cannabis use are important for policy makers and health care professionals involved in young people. Keywords: Cannabis, Adolescence, Physical health, Survey, Norway

• Kaldenbach, Siri; Leonhardt, Marja; Lien, Lars; Bjertnæs, Asborg Sine Aanstad; Strand, Tor Arne & Holten-Andersen, Mads Nikolaj (2022). Sleep and energy drink consumption among Norwegian adolescents – a cross-sectional study. BMC Public Health. ISSN 1471-2458. 22. doi: 10.1186/s12889-022-12972-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Adolescents are recommended to get 8–10 h of sleep at night, yet more than 80% fail to obtain this goal. Energy drink (ED) consumption has been linked to later bedtime in adolescents. Therefore, we aimed to investigate the potential association between ED consumption and sleep duration, and shuteye latency among adolescents in Norway. Methods This study was based on data from 15- to 16-year-old adolescents living in Oppland County in 2017. In total, 1353 adolescents were included in the analysis. Multiple regression models were used to estimate the associations between the frequency of ED consumption with sleep duration, shuteye latency, and getting 8 h of sleep. Results Forty-six point five percent of the adolescents reported sleeping more than 8 h at night. Those who reported ED consumption at any frequency had significantly shorter sleep duration than those who did not. On average, high consumers of ED (consuming ED ≥ 4 times a week) had 0.95 (95% CI: 0.61, 1.28) hours (i.e., 57 min) less sleep than those who never consumed ED. In addition, high consumers had more than 25 min (95% CI: 13.95, 36.92) longer shuteye period than those who never consumed ED. Conclusion Most ED consumers fail to obtain the recommended 8 h of sleep at night, which could be a consequence of shorter sleep duration and longer shuteye latency. We found a dose-response relationship between frequency of ED consumption and reduced sleep. Yet, the potential long-term effects of both ED consumption and insufficient sleep among adolescents remain unclear.

• Olstad, Kjersti; Lien, Lars; Leonhardt, Marja; Sørensen, Torgeir & Danbolt, Lars Johan (2022). Therapists and the Topic of Meaning in Life in Their Encounters With Adolescents With Developmental Trauma: A Qualitative Study. Frontiers in Psychiatry. ISSN 1664-0640. 13. doi: 10.3389/fpsyt.2022.835491. Fulltekst i vitenarkiv Vis sammendrag

  Background: Meaning in life is important to achieve quality of life, psychological well-being and good mental health. Existential issues such as meaning in life have limited attention in mental health care and treatment for children and young people in Norway. People in crisis often ponder existential questions. We find little research on this topic in relation to therapists who work with adolescents with developmental trauma. The purpose of this study was to examine how meaning in life is understood and addressed from the perspectives of therapists working with adolescents struggling with trauma. Method: The study has a qualitative design, based on focus groups with therapists in mental health care for children and adolescents. The interviews were transcribed and analyzed using systematic text condensation. Results: Therapists had limited professional experience and competence to address and explore meaning as a topic in therapy. Yet there was interest in the topic and they thought that young people with trauma experience may benefit from the incorporation of meaning perspectives into therapy. Conclusion: Therapists at a mental health outpatient clinic for children and adolescents found the topic of meaning important but challenging to involve in the treatment of adolescents with developmental trauma. There is a need for more research to enhance understanding of what it means to include meaning as a topic in child and adolescent psychiatry, and what may be the specific benefit and challenges involved. Keywords: adolescents; developmental trauma; meaning in life; systematic text condensation; therapists. Copyright © 2022 Olstad, Lien, Leonhardt, Sørensen and Danbolt.

• Leonhardt, Marja; Brodahl, Morten; Cogan, Nicola & Lien, Lars (2022). How did the first COVID-19 lockdown affect persons with concurrent mental health and substance use disorders in Norway? A qualitative study. BMC Psychiatry. ISSN 1471-244X. 22(1). doi: 10.1186/s12888-022-03812-7. Fulltekst i vitenarkiv Vis sammendrag

  Background: The outbreak of COVID-19 with its severe social restrictions touched the daily life of most people. While everyday social life becomes difficult for citizens with economic and cultural capital, it becomes even worse for vulnerable groups such as persons with mental health and substance use disorders, who are particularly vulnerable to social exclusion. The aim of this study is to investigate how the first COVID-19 lockdown affected the everyday life and health of persons with co-occurring mental health and substance use disorders. Methods: This qualitative study reports data from 17 individual interviews and one focus group of five participants, all with a self-reported mental health and substance use disorder. Interviews were conducted based on a semi-structured interview guide in September and October 2020 in a medium-sized local authority in Norway. Data were analysed using thematic analysis. A reference group of people with varied knowledge and experiences of the phenomenon were involved in study design, recruitment, data generation and analysis. Results: The analysis identified four interrelated main themes, describing how the first lockdown affected the everyday life and health of persons suffering from a mental health and substance use disorder: (1) The COVID-19 outbreak as a perceived challenge, (2) A decline in mental health and well-being, (3) Increased substance use challenges, and (4) Diverse experiences with health and social services. The results show that people with a co-occurring disorder have challenges with digital tools and/or do not have the appropriate equipment. Further, participants were not concerned about becoming infected themselves, but infecting others. Conclusions: Persons with a mental health and substance use disorder face major challenges during the COVID-19 pandemic. There is a need to maintain continuous low-threshold services especially directed towards persons with co-occurring disorders during the pandemic. Furthermore, it is important to improve the digital skills of every service user or offer alternatives to digital consultations and meetings.

• Schut, Christina; Dalgard, Florence J.; Bewley, Anthony; Evers, Andrea Walburga Maria; Gieler, Uwe & Lien, Lars [Vis alle 31 forfattere av denne artikkelen] (2022). Body dysmorphia in common skin diseases: results of an observational, cross-sectional multicentre study among dermatological outpatients in 17 European countries. British Journal of Dermatology. ISSN 0007-0963. 187(1), s. 115–125. doi: 10.1111/bjd.21021. Fulltekst i vitenarkiv Vis sammendrag

  Background: Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. Objectives: To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. Methods: This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. Results: The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. Conclusions: This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management

• Lien, Ingebjørg Aspeland; Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen Gustav (2021). Screening for depression in patients in treatment for alcohol use disorder using the Beck Depression Inventory-II and the Hopkins Symptom Checklist-10 . Psychiatry Research. ISSN 0165-1781. 308, s. 1–8. doi: 10.1016/j.psychres.2021.114363. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Alcohol use disorder (AUD) and major depressive disorder (MDD) are prevalent disorders that often co-occur. The aim of the study was to investigate how the Beck Depression Inventory (BDI-II) and Hopkins Symptom Checklist (HSCL-10) perform as screening instruments for MDD in AUD patients in treatment. The study included 127 mainly AUD inpatients currently in treatment at rehabilitation clinics in Norway. Demographic and clinical variables were examined using questionnaires and clinical interviews. The factor structures of the BDI-II and HCSL-10 were examined, as well as internal consistency and receiver operating characteristic (ROC) curve analyses. The Mini International Neuropsychiatric Interview (M.I.N.I.) was used as standard for diagnosing MDD. In total, 14% of the participants were diagnosed with MDD. BDI-II factor analysis retrieved three factors; cognition, somatic complaints and affect, and factor analysis for the HSCL-10 retrieved two factors; depression and anxiety. The optimal cut-off for the BDI-II was 24.5 with sensitivity of 80% and specificity of 78%. For HSCL-10 the optimal cut-off was 2.35, giving sensitivity of 80% and specificity of 69%. Both the BDI-II and HSCL-10 may be clinically useful screening instruments for MDD in AUD patients. There was a tendency that the affect factor of the BDI-II and the depression factor of the HSCL-10 were slightly more suitable for identifying MDD than the other factors. Optimal cut-offs for both the BDI-II and the HSCL-10 in this patient group were higher than cut-offs commonly used in the general population. Keywords: Alcohol use disorders (AUD); Beck Depression Inventory (BDI-II); Hopkins Symptom Checklist (HSCL-10); Major depressive disorder (MDD). Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

• Aye, Win Thuzar; Lien, Lars; Stigum, Hein & Bjertness, Espen (2021). Childhood abuse and its association with adults’ mental health problems: A cross-sectional study among men and women in the Yangon Region of Myanmar. BMJ Open. ISSN 2044-6055. 11(11). doi: 10.1136/bmjopen-2020-045870. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms. Design A community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale—Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively. Setting Urban and rural areas of the Yangon Region, Myanmar. Participants A total of 2377 men and women aged 18–49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. Results Overall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men. Conclusions Childhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.

• Abebe, Dawit Shawel; Lien, Lars & Bramness, Jørgen Gustav (2021). Effects of age and gender on the relationship between alcohol use disorder and somatic diseases: a national register study in Norway. BMJ Open. ISSN 2044-6055. 11(11). doi: 10.1136/bmjopen-2021-050608. Fulltekst i vitenarkiv Vis sammendrag

  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-years follow-up of AUD patients and the general population. Data were acquired from the Norwegian Patient Registry. Cox regressions were used to estimate hazard ratios (HRs) of somatic diseases. Participants: AUD patients (17,023; 0.4%) were compared to the population without AUD (4,271,559; 99.6%), with adults aged 18 years or older who were registered residents of Norway on January 1, 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 health care services. Results: AUD patients, compared with a population without AUD, experienced a significantly greater burden of all studied somatic diseases. Middle-aged adults with AUD had increased risks (p0.05). Males with AUD had significantly higher risks for pulmonary heart diseases (HR= 3.9, 95% CI 3.3-4.6) and metabolic disorders (HR 4.7, 95% CI 4.5-5.0), while females with AUD had a significantly higher risk for viral hepatitis (HR = 4.4, 95% CI 3.8-5.1). 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 to 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 prioritization of somatic resources among patients with AUD.

• Pandey, Susmita; Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen Gustav (2021). Factors associated with the level of prolactin in patients under remission from Alcohol Use Disorder: A gender perspective. Neuropsychopharmacology Reports. ISSN 2574-173X. 41(3), s. 352–361. doi: 10.1002/npr2.12182. Fulltekst i vitenarkiv Vis sammendrag

  Background: Prolactin mirrors the dopaminergic activity in the brain which is key to understanding alcohol use disorders (AUD). Still, patients with AUD are a heterogenous group and there seem to be gender differences in the relationship between alcohol use and the level of prolactin. In this study, we examined gender-wise relationship of alcohol use trait- and state-related factors with the level of prolactin among AUD inpatients in remission. Methods: This cross-sectional study examined the level of prolactin along with general patient characteristics and alcohol use trait- and state-related factors that could influence the level of prolactin in 112 AUD inpatients at three rehabilitation clinics in Norway. Logistic regression was performed to identify the gender-specific predictors of level of prolactin. Results: Male and female AUD patients had similar level of prolactin. Among females, younger age, early alcohol debut, and absence of parental drinking problem predicted higher level of prolactin. In males, presence of other substance dependence predicted a lower level of prolactin. Conclusions: There were gender differences in the factors associated with the level of prolactin among the AUD patients. Especially in the female AUD patients under remission, alcohol use trait-related factors were better predictors of the level of prolactin than the alcohol use state-related factors, indicating that individuals might characteristically have varying degree of dopamine reactivity. Keywords: alcohol use disorder; gender; prolactin; state factors; trait factors. © 2021 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Society of Neuropsychopharmacology.

• Dybdahl, Ragnhild; Sørensen, Torgeir; Hauge, Hans A.; Røsvik, Kjersti; Lien, Lars & Eide, Ketil (2021). Same but different: meaning-making among refugee and non-refugee youths. International Journal of Migration, Health and Social Care. ISSN 1747-9894. 17(4), s. 433–448. doi: 10.1108/IJMHSC-02-2021-0019. Fulltekst i vitenarkiv Vis sammendrag

  Purpose There is substantial research on the experiences, needs and well-being of unaccompanied refugee adolescents, but less is known about existential aspects of their lives. The purpose of the current study is to explore existential meaning-making among unaccompanied refugee children. Design/methodology/approach The informants in this study are young unaccompanied refugees (n = 30) living in Norway, and young Norwegians (n = 46). The authors undertook a secondary analysis of in-depth qualitative refugee interview data and a quantitative analysis of questionnaire data from Norwegian informants. Findings Both the refugee youths and the Norwegian youths expressed that social relationships and connections to others were most important for meaning. Moreover, both groups emphasized the importance of relatedness and generativity, i. e. commitment to worldly affairs beyond one’s immediate needs. The main differences between the two groups were related to the significance attached to religion and to loneliness. Research limitations/implications The comparison between the two groups is only possible to some degree. Secondary analyses have some limitations, as well as strengths. Practical implications The findings may be useful for supporting young refugees, as they provide insights into less-studied aspects of their lives. Originality/value The originality of this study lies in the focus on and broad interpretation of meaning, of secondary data analyses, and of comparisons between youths that are refugees versus non-refugees.

• Roer, Grethe Emilie; Solbakken, Heidi Hurlen; Abebe, Dawit Shawel; Aaseth, Jan; Bolstad, Ingeborg & Lien, Lars (2021). Inpatients experiences about the impact of traumatic stress on eating behaviors: an exploratory focus group study. Journal of Eating Disorders. ISSN 2050-2974. 9, s. 1–12. doi: 10.1186/s40337-021-00480-y. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Pandey, Susmita; Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen Gustav (2021). Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (AUD): Characteristics and Predictors of Early Relapse or Drop-Out. Substance Abuse and Rehabilitation. ISSN 1179-8467. 12, s. 11–22. doi: 10.2147/SAR.S296526. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with alcohol use disorders (AUD) vary significantly in many clinically important characteristics making them a heterogenous group. AUD patients with comorbid antisocial personality disorder (ASPD) form an important sub-group, and studies indicate that these patients may have poorer treatment outcomes. Therefore, we aimed to investigate the characteristics of AUD inpatients with comorbid ASPD and identify predictors of early relapse or treatment drop-out in these patients. Methods: In a longitudinal study of AUD patients (n = 113; 30 females; aged 27 to 72 years) in treatment at three residential rehabilitation clinics in Norway, we used interviews and self-report questionnaires to collect data on alcohol use, mental health, and trauma experience. In addition, we assessed biochemical parameters. The patients were followed up at 6 weeks to identify early relapse or drop-out. Results: Prevalence of ASPD among AUD patients was 15%. AUD patients with comorbid ASPD were exclusively male, of younger age, and reported more childhood trauma, and adult attention-deficit-hyperactivity-disorder symptoms. They reported more hazardous drinking behavior and more often had dependence on substances in addition to alcohol. The presence of ASPD did not predict early relapse or drop-out. However, early relapse or drop-out in ASPD patients was associated with childhood and adult trauma, younger age of drinking debut, and higher baseline prolactin levels. Conclusion: AUD patients with ASPD had different clinical characteristics to other AUD patients and they had specific predictors of early relapse or drop-out. Our findings indicate that the early relapse or drop-out among AUD patients with ASPD may be attributed to environmental and possibly biological vulnerability. However, further studies with larger sample size are warranted to confirm these preliminary associations. Keywords: alcohol use disorder, antisocial personality disorder, relapse, drop-out

• Kour, Prabhjot; Lien, Lars; Kumar, Bernadette N; Nordaunet, Ole Martin; Biong, Stian & Pettersen, Henning (2021). Health Professionals’ Experiences with Treatment Engagement Among Immigrants with Co-occurring Substance Use- and Mental Health Disorders in Norway. Substance Abuse: Research and Treatment. ISSN 1178-2218. 15, s. 1–11. doi: 10.1177/11782218211028667. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Immigrants face barriers in seeking and accessing mental health and addiction services. Health professionals are crucial in providing and promoting healthcare and it is important to understand their experiences in order to enhance the access of mental healthcare. The aim of this paper is to explore and describe health professionals’ experiences with treatment engagement among immigrants with co-occurring substance use disorders (SUD) and mental health disorders (MHD) in Norwegian mental health and addiction services. Within a collaborative approach, 3 focus group interviews were conducted with health professionals, who had provided various mental health and addiction care services to immigrants with co-occurring SUD and MHD. The focus group interviews were transcribed verbatim and analyzed using systematic text condensation. The analysis resulted in 5 main categories: (1) difficulties due to language barriers, (2) difficulties due to lack of culturally competent services, (3) difficulties due to social factors, (4) being curious and flexible improves the user-provider relationship, and (5) increasing access to mental health and addiction services. This study provides an enhanced understanding of how health professionals’ experienced treatment engagement among immigrants with co-occurring SUD and MHD in the Norwegian context. Implications of the findings for clinical practice and future research are discussed. Keywords Co-occurring substance use and mental health disorders, immigrants, health professionals, mental health and addiction services, qualitative methods, lived experiences, Norway. © The Author(s) 2021 This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

• Lien, Lars; Bolstad, Ingeborg & Bramness, Jørgen G. (2021). Smoking among inpatients in treatment for substance use disorders: prevalence and effect on mental health and quality of life. BMC Psychiatry. ISSN 1471-244X. 21. doi: 10.1186/s12888-021-03252-9. Fulltekst i vitenarkiv Vis sammendrag

  Background: Smoking is still prevalent among people with substance use disorders. The objective of this study was to investigate the prevalence of smoking among patients in treatment for substance use disorders and to analyze the effect of smoking both at baseline and follow-up on drop-out, mental health and quality of life. Methods: One hundred and twenty-eight inpatients (26% female), mainly with alcohol use disorder, staying at three different rehabilitation clinics in Eastern Norway, were interviewed at admission, and at 6 weeks and 6 months follow-up. The interview contained mental health-related problems, trauma, questions on alcohol and other substances and quality of life. Non-parametric tests were used to test group differences and unadjusted and adjusted linear regression to test the associations between smoking and the main outcome variables, while logistic regression was used to test the association between smoking and drop-out. Results: At admission, 75% were daily smokers. Compared to non-smokers at baseline, the smokers had higher drop-out rates (37% vs. 13%), more mental distress, and lower quality of life from baseline up to 6 months followup. Those quitting smoking while admitted improved in mental distress and quality of life at the same rate as nonsmokers. Alcohol-related factors did not differ between smokers and non-smokers. Conclusions: Smoking was associated with mental distress, quality of life and treatment drop-out among patients in primary alcohol use disorder treatment. The results indicate that smoking cessation should be recommended as an integral part of alcohol use treatment both before and during inpatient treatment to reduce drop-out. Keywords: Mental health problems, Alcohol use disorder, Smoking, Drop-out © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

• Toft, Helge; Bramness, Jørgen Gustav; Tilden, Terje; Bolstad, Ingeborg & Lien, Lars (2021). Persistent level of mental distress in PTSD patients is not reflected in cytokine levels 1 year after the treatment. Acta Neuropsychiatrica. ISSN 0924-2708. 33(5), s. 254–260. doi: 10.1017/neu.2021.11. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Cross-sectional data show that post-traumatic stress disorder (PTSD) patients often have increased levels of circulating inflammatory markers. There is, however, still a paucity of longitudinal studies with long follow-up times on levels of cytokines in such patients. The current study assesses patients with and without PTSD diagnosis 1 year after discharge from inpatient treatment. Methods: Patients in treatment for serious non-psychotic mental disorders were recruited at the beginning of their treatment stay at a psychiatric centre in Norway. Ninety patients submitted serum samples and filled out the Hopkins Symptom Checklist-90 Revised Global Severity Index (HSCL-90R GSI) questionnaire during their mainstay and at a follow-up stay 1 year after discharge. Of these patients, 33 were diagnosed with PTSD, 48 with anxiety, depression, or eating disorder, while 9 patients had missing data. The patients were diagnosed using the Mini-International Neuropsychiatric Interview (MINI). Results: At the follow-up stay (T3), PTSD patients had higher levels of GSI scores than non-PTSD patients (p = 0.048). These levels were unchanged from the year before (T2) in both groups. The levels of circulating cytokines/chemokine did not differ between the PTSD and non-PTSD patients at T3. At T2, however, the PTSD and non-PTSD groups exhibited different levels of interleukin 1β (IL-1β) (p = 0.053), IL-1RA (p = 0.042), and TNF-α (p = 0.037), with the PTSD patients having the higher levels. Conclusion: Despite exhibiting different mental distress scores, the PTSD and non-PTSD patients did not differ regarding levels of circulating inflammatory markers at 1-year follow-up. © The Author(s), 2021. Published by Cambridge University Press in association with Scandinavian College of Neuropsychopharmacology.

• Abraham, Ruth; Leonhardt, Marja; Lien, Lars; Hanssen, Ingrid; Hauff, Edvard & Thapa, Suraj Bahadur (2021). The relationship between religiosity/spirituality and quality of life among female Eritrean refugees living in Norwegian asylum centres. International Journal of Social Psychiatry. ISSN 0020-7640. doi: 10.1177/00207640211010207. Fulltekst i vitenarkiv Vis sammendrag

  Background: Women are more vulnerable to mental health problems than men after migration, but little is known about the influence of religiosity/spirituality on their quality of life. The purpose of this study was to explore religiosity/spirituality, in relationships with various domains of quality of life, among female Eritrean refugees staying in Norwegian asylum centres. Method: A questionnaire assessing sociodemographic characteristics was used together with the World Health OrganizationQuality of Life – Spirituality, Religiosity and Personal Beliefs (WHOQOL-SRPB) questionnaire, which assesses religiosity/spirituality and domains of quality of life. A total of 63 adult female Eritrean refugees who had been granted asylum but were still living in asylum reception centres located in southern and central Norway participated. Results: Religiosity/spirituality was independently associated with psychological quality of life (B = 0.367, p < .001), level of independence (B = 0.184, p = .028), social quality of life (B = 0.500, p = .003), environmental quality of life (B = 0.323, p < .001) and overall quality of life (B = 0.213, p < .001), but not with physical quality of life (B = 0.056, p = .679). There were no significant differences between religious affiliations on religiosity/spirituality or quality of life measures. Conclusion: Consistent with previous research, this study highlights the correlation between religiosity/spirituality and overall quality of life. We recommend a longitudinal follow-up study of similar populations, after they are resettled and integrated into their host countries, to understand the associations between quality of life and religiosity/spirituality over time. Keywords Eritrea, refugees, religiosity, spirituality, quality of life, well-being

• Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen G. (2021). ADHD symptoms as risk factor for PTSD in inpatients treated for alcohol use disorder. Psychiatry Research. ISSN 0165-1781. 300, s. 1–6. doi: 10.1016/j.psychres.2021.113904. Fulltekst i vitenarkiv Vis sammendrag

  Attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are more common in alcohol use disorder (AUD) patients than in the general population. Still, there is a lack of knowledge about the relationship between the two conditions in these patients. The main objective of this study was to examine the prevalence of ADHD symptoms, and the relationship between ADHD symptoms and PTSD in AUD inpatients in treatment. Data from 85 AUD patients were collected. The Adult ADHD Self-Report Scale (ASRS) was used to measure ADHD symptoms in all patients. Differences between groups split by PTSD diagnosis and by ASRS clinical cut-off were described, and the relationship between ADHD symptom level and PTSD was tested in a multiple regression model. Almost half the patients scored above ASRS cut-off and 14% had PTSD. Of the patients whose score was above cut-off on the ASRS 23% had PTSD, versus 7% among those below cut-off. Higher ASRS score was associated with PTSD even when age, sex and trauma were adjusted for. This study confirms the high level of ADHD symptoms in AUD patients in treatment. Diagnostic evaluation of PTSD is recommended in patients with ADHD attending inpatient treatment programs for AUD.

• Oerbeck, Beate; Overgaard, Kristin Romvig; Hjellvik, Vidar; Lien, Lars & Bramness, Jørgen G (2021). The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care. Journal of child and adolescent psychopharmacology. ISSN 1044-5463. 31(5), s. 350–357. doi: 10.1089/cap.2020.0123. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Methods: Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age and gender adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age and gender. Results: 1856 children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥13 years. Among those, 423 or 23% used any of the three psychotropics, significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most. Polypharmacy was not frequent in RC, as only 26% used ≥ 2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and while the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6 to16 year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (CI: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (CI: 0.9-1.0). Conclusion: The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.

• Silwal, Sanju; Chudal, Roshan; Dybdahl, Ragnhild; Sillanmaki, Lauri; Lien, Lars & Sourander, A (2021). Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study. Child Psychiatry and Human Development. ISSN 0009-398X. doi: 10.1007/s10578-021-01136-3. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels. Keywords: Adolescent; Depression; Earthquake; Longitudinal study; Post-traumatic stress disorder. © The Author(s) 2021

• Sanhori, Zienat Balla Mohamed Ahmed; Hauff, Edvard; Eide, Arne Henning; Mdala, Ibrahimu; Abdelrahman, Abdullah & Brunborg, Cathrine [Vis alle 7 forfattere av denne artikkelen] (2020). Changes in prevalence of mental disorders among internally displaced persons in central Sudan: a 1-year follow-up study. Global Mental Health (GMH). ISSN 2054-4251. 7. doi: 10.1017/gmh.2020.16. Fulltekst i vitenarkiv Vis sammendrag

  Background Sudan has one of the largest numbers of internally displaced persons (IDPs) in the world, estimated at five million. The main cause of displacement was the civil war. Attention to the health and in particular the mental health of IDPs has been lacking. That includes limited population longitudinal data describing the “natural” fluctuations of mental morbidity among these groups. The aim of this study is to investigate the level and stability of mental disorders among IDPs over a 1-year period. Method In this 1-year follow-up of IDPs in two settlement areas in central Sudan, 1549 persons 18 years or older were interviewed twice using the MINI International Neuropsychiatric Interview. Trained psychologists collected the data in a random household survey in the selected IDP areas. Results We found overall high stability among those having and those free of mental disorders in this 1-year follow-up study. There were, however, discernible and statistically significant increases in overall new cases of mental disorders from T1 to T2 as major depression increased by 1.4%, generalized anxiety by 2.8% and social phobia by 1.4%. Conclusion The study revealed continued high levels and increases of mental disorders over time, although with a pattern of substantial persistence among those initially ill and limited recovery. This might be due to a complex set of factors such as unavailability of mental health services, poverty, low educational level and social exclusion.

• Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Win, Hla Hla; Oo, Tin & Bjertness, Espen (2020). The prevalence of mental distress and the association with education: a cross-sectional study of 18-49-year-old citizens of Yangon Region, Myanmar. BMC Public Health. ISSN 1471-2458. 20(1). doi: 10.1186/s12889-020-8209-8. Fulltekst i vitenarkiv Vis sammendrag

  Background: Poor mental health is an important contributor to the global burden of disease. Mental health problems are often neglected in communities, and are scarcely studied in developing countries, including Myanmar. This study estimates the prevalence of mental distress by socio-demographic and health related factors, and the association between education and mental distress. As far as the authors are aware, this is the first population-based study in Myanmar estimating the prevalence of mental distress. Methods: Between October and November 2016, a cross sectional study was conducted using a multi-stage sampling design with face-to-face interviews using the Hopkins Symptom Checklist (HSCL-10) for mental distress (symptoms of depression and anxiety). The multivariable analysis strategy was based on Directed Acyclic Graphs (DAGs), to identify confounders, mediators and colliders. Pearson's chi-square was used for testing differences between proportions and multiple linear regression analysis was applied to explore the association between education (years at school) and mental distress (HSCL score). Results: A random sample of 2391 (99.6% response) men and women aged 18-49 years participated in the study. The prevalence of mental distress was 18.0% (95% confidence interval (CI): 14.7-21.9), being higher among women (21.2%; 95% (CI): 16.6-26.6) than men (14.9%; 95% (CI): 11.4-19.2). Older-age, being separated or divorced and having a higher number of children were associated with increased mental distress. In linear regression analyses, adjusted for confounders (age, marital status and income), there was a significant negative association between years at school and mental distress among women and older men (> 30 years), but not among the youngest men. Conclusions: The prevalence of mental distress is high, and there is an association between HSCL-10 score and education. Due to the scarcity of mental health services in Myanmar, the findings indicate a need for a mental health policy to handle the burden of mental health problems in Yangon, a burden which is probably high within the country.

• Johnson, Sverre Urnes; Hoffart, Asle; Tilden, Terje; Toft, Helge Prytz; Neupane, Sudan & Lien, Lars [Vis alle 7 forfattere av denne artikkelen] (2020). Circulating cytokine levels in the treatment of comorbid anxiety disorders. Acta Neuropsychiatrica. ISSN 0924-2708. s. 1–7. doi: 10.1017/neu.2020.38. Fulltekst i vitenarkiv Vis sammendrag

  Psychotherapy research aims to investigate predictors and moderators of treatment outcome, but there are few consistent findings. This study aimed to investigate cytokines in patients undergoing treatment for anxiety disorders and whether the level of cytokines moderated the treatment outcome. Thirty-seven patients with comorbid and treatment-resistant anxiety disorders were investigated using multilevel modelling. Serum cytokine levels were measured three times: pretreatment, in the middle of treatment, and at the end of treatment. Anxiety and metacognitions were measured weekly throughout treatment by self-report. The levels of monocyte chemoattractant protein-1, tumour necrosis factor-alpha, and interleukin-1 receptor antagonist did not change during therapy or were not related to the level of anxiety. Metacognitive beliefs predicted anxiety, but the relationship between metacognitions and anxiety was not moderated by cytokines. Limitations of the study include that the patients were not fasting at blood sampling, and we did not assess body mass index, which may affect cytokine levels. The lack of significance for cytokines as a predictor or moderator may be due to a lack of power for testing moderation hypotheses, a problem associated with many psychotherapy studies. Cytokines did not predict the outcome in the treatment of comorbid anxiety disorders in our sample. Furthermore, cytokines did not moderate the relationship between metacognitions and anxiety. Keywords: anxiety; comorbidity; cytokines; metacognition; psychotherapy.

• Altunay, Ilknur K; Özkur, Ezgi; Dalgard, Florence; Gieler, Uwe; Aragones, Lucia Tomas & Lien, Lars [Vis alle 21 forfattere av denne artikkelen] (2020). Psychosocial Aspects of Adult Acne: Data from 13 European Countries. Acta Dermato-Venereologica. ISSN 0001-5555. 100(4). doi: 10.2340/00015555-3409. Fulltekst i vitenarkiv Vis sammendrag

  The link between acne and psychiatric morbidities has been demonstrated in many studies; however, large scale studies aiming to reveal the psychosocial impact of acne are rare. The aim of this study was to assess the psychological burden of adult acne patients. This analysis was based on a multicenter study including 213 acne patients and 213 controls from 13 European countries. The Hospital Anxiety and Depression Scale (HADS), Dermatology Life Quality Index, and EuroQol 5 dimensions 3 levels scores of the patients with acne were analyzed. Patients with acne (n = 213) had higher HADS scores for anxiety (mean ± standard deviation 6.70 ± 3.84) and depression (3.91 ± 3.43) than the controls (p < 0.001 for both). For patients with acne, 40.6% reported that they were very concerned about their skin disease, 12.3% had suicidal ideation, and, among those, 10 (4%) patients implied that acne was the cause of their suicidal thoughts. After adjusting for other variables, patients who had suicidal ideation (p = 0.007, and adjusted odds ratio 3.32 [95% confidence interval (CI): 1.39-7.93]) and stressful life events (p < 0.001, and adjusted OR 5.85 [95% CI: 2.65-12.86]) had a greater chance of fulfilling the HADS criteria for anxiety. This study highlights the need for a psychotherapeutic approach in order to recognize the concerns of acne patients and optimize their treatment. Keywords: anxiety; depression; health concerns; multicenter study; quality of life; acne vulgaris.

• Sampogna, Francesca; Abeni, Damiano; Gieler, Uwe; Tomas-Aragones, Lucia ; Lien, Lars & Poot, Françoise [Vis alle 21 forfattere av denne artikkelen] (2020). Exploring the EQ-5D Dimension of Pain/Discomfort in Dermatology Outpatients from a Multicentre Study in 13 European Countries. Acta Dermato-Venereologica. ISSN 0001-5555. 100(8). doi: 10.2340/00015555-3477. Fulltekst i vitenarkiv Vis sammendrag

  Pain and discomfort are important symptoms in dermatology. The aim of this cross-sectional, multicentre study was to describe the prevalence of pain/discomfort and its associations in patients with several dermatological conditions across 13 European countries. The outcome was the prevalence of pain/discomfort according to a question of the EQ-5D questionnaire. Data collected from November 2011 to February 2013 were complete for 3,509 consecutive outpatients. Moderate or extreme pain/discomfort was reported by 55.5% of patients and 31.5% of controls with no skin conditions. The highest proportions were reported by patients with hidradenitis suppurativa (92.9%), leg ulcer (81.4%), prurigo (80%) and lichen planus (75.6%). Pain/discomfort was associated with older age, low educational level, clinical severity, flare on scalp or hands, itch, depression, anxiety, low quality of life, and thoughts of suicide. It is important to enquire specifically about pain/discomfort during clinical consultations and to address it when planning a patient's care. Keywords: EQ-5D; discomfort; pain; dermatology.

• Kour, Prabhjot; Lien, Lars; Kumar, Bernadette N.; Biong, Stian & Pettersen, Henning (2020). Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders. Substance Abuse: Research and Treatment. ISSN 1178-2218. 14, s. 1–10. doi: 10.1177/1178221820970929. Fulltekst i vitenarkiv Vis sammendrag

  Immigrants are considered at risk of psychological distress and therefore involvement in substance abuse, due to a variety of pre- and post-migration factors. Further, there is lower treatment engagement, a higher dropout rate, and less frequent hospitalizations among this group compared to the general population. There are few studies on the subjective understanding of co-occurring substance use disorder (SUD) and mental health disorder (MHD) among immigrants in Norway. This qualitative study aims to explore the treatment experiences of immigrant men living with co-occurring SUD and MHD. Within a collaborative approach, individual interviews were conducted with 10 men of immigrant background, living with co-occurring SUD and MHD, who had treatment experiences from the Norwegian mental health and addiction services. Data were analyzed using a systematic text condensation. The analysis yielded 6 categories where participants described their treatment experiences in mental health and addiction services in Norway as: lack of connection, lack of individually tailored treatment, stigma and discrimination preventing access to treatment, health professionals with multi-cultural competence, care during and after treatment, and raising awareness and reducing stigma. A significant finding was the mention by participants of the value of being seen and treated as a “person” rather than their diagnosis, which may increase treatment engagement. They further mentioned aftercare as an important factor to prevent relapse. This study provides an enhanced understanding of how immigrant men living with co-occurring SUD and MHD experienced being treated in Norwegian healthcare settings. These experiences may add to the knowledge required to improve treatment engagement.

• Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Schei, Berit; Sundby, Johanne & Bjertness, Espen (2020). Domestic violence victimisation and its association with mental distress: A cross-sectional study of the Yangon Region, Myanmar. BMJ Open. ISSN 2044-6055. 10:e037936(9), s. 1–13. doi: 10.1136/bmjopen-2020-037936. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To estimate the prevalence of domestic violence, with subgroups of physical, sexual and emotional violence, among men and women and to assess the association between any lifetime domestic violence (DV) and mental distress among ever-married men and women. Design We conducted a cross-sectional study from October to November 2016 using a multistage sampling design. DV questionnaire was adopted from the Demographic and Health Survey programme. Mental distress was estimated using the Hopkins Symptom Checklist-10 (HSCL-10). HSCL-score and DV were the outcome and exposure variables, respectively, in multiple linear regression. Prevalence estimates and associations were presented with a 95% CI and the Wald test. Setting Urban and rural areas of the Yangon region, Myanmar. Participants Men and women ages 18 to 49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. Results A random sample of 2383 people was included in the analyses. Among ever-married participants, lifetime (LT) and past-12-month (12M) prevalence of any domestic violence victimisation was higher in women compared with men: LT women: 61.8% (95% CI: 54.3 to 68.9) versus LT men: 42.4% (95% CI: 37.5 to 47.5) and 12M women: 51.2% (95% CI: 44.9 to 57.5) versus 12M men: 37.7% (95% CI: 32.9 to 42.7). Among never-married participants, lifetime physical and sexual violence victimisation rates was higher in men (34.3% and 7.9%) compared with women (19.1% and 6.4%). Mental distress was significantly associated with lifetime DV in women who were afraid of their husbands and men who had wives who exhibited controlling behaviours. Conclusions Domestic violence is prevalent among both men and women and is associated with mental distress. The findings highlight an urgent need to prevent domestic violence in both sexes, including through legal and policy reform and improved mental health services for DV victims.

• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2020). Interrelationship of Posttraumatic Stress, Hassles, Uplifts, and Coping in Women With a History of Severe Sexual Abuse: A Cross-Sectional Study. Journal of Interpersonal Violence. ISSN 0886-2605. doi: 10.1177/0886260520935479. Fulltekst i vitenarkiv Vis sammendrag

  Experiencing trauma, such as sexual abuse, increases the risk of a negative health outcome. The aim of the present study was to compare two groups of female survivors of sexual abuse, one group with a lower indication of posttraumatic stress disorder (L-PTSD) and one with a higher indication of posttraumatic stress disorder (H-PTSD). We hypothesized that, with a history of sexual abuse, higher levels of PTSD symptoms would be associated with more daily hassles, fewer daily uplifts, and more maladaptive coping strategies, and that there would be more reporting of severe types of sexual victimization, less resourceful socioeconomic conditions and a lower level of emotional stability. A questionnaire, including measures of socioeconomic conditions, trauma experience, emotional stability (the Single-Item Measures of Personality), Posttraumatic Stress Disorder Checklist (PCL), daily hassles and uplifts (the Stress Profile), and coping strategies (the Brief Coping Orientation to Problems Experienced [COPE] questionnaire), was completed by 57 female users at nine support centers for survivors of incest and sexual abuse in Norway. The results show that the H-PTSD group reported significantly more daily hassles, fewer daily uplifts, and more use of maladaptive coping strategies. The L-PTSD group reported more emotional stability, fewer daily hassles, and more uplifts, and used more adaptive coping strategies. However, few differences were found between the H-PTSD and the L-PTSD groups with regard to severity of sexual abuse and socioeconomic conditions. The results on the hassle, uplift, and coping scales are potentially interesting from an interventional point of view. Major life events such as sexual abuse may be out of control for the afflicted victim. Appraisal of and coping with everyday events, however, can be affected and offer interesting possibilities for interventions directed at the survivor, her significant others, and professional helpers.

• Vattø, Ingvild E.; Haug, Sigrid H. K.; deMarinis, Valerie; Lien, Lars & Danbolt, Lars Johan (2020). The significance ascribed to contacting a diaconal suicide-prevention crisis line in Norway: a qualitative study. Mental Health, Religion & Culture. ISSN 1367-4676. 23(2), s. 113–126. doi: 10.1080/13674676.2020.1763281. Vis sammendrag

  Suicide-prevention crisis lines worldwide offer support to individuals in crisis, nonetheless, there is limited in-depth knowledge as to the significance of contacting these services from the service-users’ first-hand perspectives. This study aimed to provide a deeper understanding of the significance ascribed to contacting a diaconal suicide-prevention crisis line in Norway. In-depth qualitative interviews were conducted with nine callers. The material was analysed using systematic text condensation. The analysis revealed three main themes reflecting the crisis line’s emotional, relational and existential support functions in terms of providing: (i) immediate emotional availability, (ii) experiences of connectedness and acceptance, and (iii) a safe space for existential meaning-making processes. The findings point to the need for future research on the value of integrating biopsychosocio-existential perspectives into intervention models within the field of crisis support. KEYWORDS: Crisis lines, suicide prevention, diaconal, culture, existential meaning-making

• Vattø, Ingvild Engh; DeMarinis, Valerie; Haug, Sigrid H. K.; Lien, Lars & Danbolt, Lars Johan (2020). Emotional stressors among volunteers operating a diaconal suicide-prevention crisis line in Norway: a qualitative study. British Journal of Guidance and Counselling. ISSN 0306-9885. 48(4), s. 563–575. doi: 10.1080/03069885.2019.1646409. Vis sammendrag

  Despite the worldwide proliferation of suicide-prevention crisis-line networks, there is limited in-depth knowledge of how the volunteer call responders experience and manage emotional stressors. The study’s purpose was to explore emotional stressors related to operating a diaconal suicide-prevention crisis line, and how these are managed in daily operations. In this qualitative study, 27 volunteers were interviewed in four focus groups. The material was analysed using systematic text condensation. The participants experienced emotional stressors related to being unable to actively intervene, encountering traumatised callers and feeling uncertain about representing the Church. They used a combination of personal coping strategies and organisational support factors. Implications for training and practice are further discussed.

• Kour, Prabhjot; Lien, Lars; Kumar, Bernadette N.; Biong, Stian & Pettersen, Henning (2020). Coping and Negotiating a Sense of Self: Immigrant Men's Experiences of Living with Co-Occurring Substance Use and Mental Health Disorders in Norway. American Journal of Psychiatric Rehabilitation (AJPR). ISSN 1548-7768. 22(1-2), s. 43–63. Vis sammendrag

  Recent years have seen an increase in the immigrant population in Norway, and within this population, a considerable rise in substance use disorders (SUDs) and elevated odds of developing mental health disorders (MHDs). Immigrants are thus regarded as an at-risk group for both situations. No studies have been conducted on the subjective understanding of co-occurring SUDs and MHDs among this immigrant population; thus, there is limited knowledge of the field. This qualitative study aims to explore the lived experiences of being an immigrant and living with co-occurring SUDs and MHDs. Individual interviews with 10 persons of immigrant background with co-occurring SUDs and MHDs, and treatment experience in Norway, were conducted. Data were analyzed using a phenomenological approach and systematic text condensation. Analysis yielded three categories, each with two subcategories, of the immigrants’ experiences of living with cooccurring SUDs and MHDs. The overarching theme was how they coped and negotiated a sense of self within the self, within the surrounding culture, and within the structures of society. Subcategories revealed their experiences that necessitated coping and negotiating sense of self within each level. Participants experienced “living a double life” and a “culture clash” along with a sense of belonging to a marginalized group, thus, lacking a sense of belonging in mainstream society. This study provides enhanced understanding of how immigrants with co-occurring SUDs and MHDs experience being an immigrant and having the concurrent disorders.

• Brekke, Eva; Ness, Ottar & Lien, Lars (2020). Relational recovery in co-occurring conditions: a qualitative study of first-person experiences. Advances in Dual Diagnosis: Policy, practice and research in mental health and substance use. ISSN 1757-0972. 13(2), s. 89–100. doi: 10.1108/ADD-12-2019-0017. Vis sammendrag

  Purpose: The purpose of this study was to explore and describe first-person experiences of relational recovery in co-occurring mental health and substance use conditions. Design/methodology/approach: Within a phenomenological and collaborative approach, indepth individual interviews with eight persons with co-occurring conditions were analysed using systematic text condensation. Findings: Participants described interpersonal relationships as both supporting and hindering recovery in fundamental ways. Four categories of experiences of relational recovery were described: (1) Choosing one’s child; (2) Living with loneliness and a painful past; (3) Sacrificing everything for one’s partner; and (4) Regaining trust and support. Originality/value: This article provides an enhanced understanding of how interpersonal relationships may be experienced by persons who live with co-occurring conditions. The results generally support an understanding of recovery as a relational process.

• Ørbeck, Beate; Øvergaard, Kristin Romvig; Hjellvik, Vidar; Bramness, Jørgen Gustav; Hansen, Berit M Hjelde & Lien, Lars (2020). The Use of Sleep Medication in Youth Residential Care. Journal of child and adolescent psychopharmacology. ISSN 1044-5463. 30(5), s. 335–341. doi: 10.1089/cap.2019.0172. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0–20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ‡ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5–2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3–1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylumseekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; Girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.

• Toft, Helge Prytz; Lien, Lars; Neupane, Sudan Prasad; Abebe, Dawit Shawel; Tilden, Terje & Wampold, Bruce E. [Vis alle 7 forfattere av denne artikkelen] (2020). Cytokine concentrations are related to level of mental distress in inpatients not using anti-inflammatory drugs. Acta Neuropsychiatrica. ISSN 0924-2708. 32(1). doi: 10.1017/neu.2019.36. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Cross-sectional data show elevated levels of circulating cytokines in psychiatric patients. The literature is divided concerning anti-inflammatory drugs' ability to relieve symptoms, questioning a causal link between inflammatory pathways and psychiatric conditions. We hypothesised that the development of circulating cytokine levels is related to mental distress, and that this relationship is affected by the use of anti-inflammatory drugs. Methods: The study was a longitudinal assessment of 12-week inpatient treatment at Modum Bad Psychiatric Center, Norway. Sera and self-reported Global Severity Index (GSI) scores, which measure psychological distress, were collected at admission (T0), halfway (T1) and before discharge (T2). Other variables known to distort the neuroimmune interplay were included. These were age, gender, diagnosis of PTSD, antidepressants and anti-inflammatory drugs. A total of 128 patients (92 women and 36 men) were included, and 28 were using anti-inflammatory medication. Multilevel modelling was used for data analysis. Results: Patients with higher levels of IL-1RA and MCP-1 had higher GSI scores (p = 0.005 and p = 0.020). PTSD patients scored higher on GSI than non-PTSD patients (p = 0.002). These relationships were mostly present among those not using anti-inflammatory drugs (n = 99), with higher levels of IL-1RA and MCP-1 being related to higher GSI score (p = 0.023 and 0.018, respectively). Again, PTSD patients showed higher GSI levels than non-PTSD patients (p = 0.014). Conclusions: Cytokine levels were associated with level of mental distress as measured by the GSI scores, but this relationship was not present among those using anti-inflammatory drugs. We found no association between cytokine levels and development of GSI score over time. Keywords: PTSD; anti-inflammatory agents; cytokines; depression; inflammation.

• Kour, Prabhjot; Lien, Lars; Kumar, Bernadette. N; Biong, Stian & Pettersen, Henning (2019). Coping and Negotiating a Sense of Self: Immigrant Men’s Experiences of Living with Co-Occurring Substance Use and Mental Health Disorders in Norway. American Journal of Psychiatric Rehabilitation (AJPR). ISSN 1548-7768. 22(1-2), s. 43–63.
• Dalgard, Florence; Svensson, Åke; Halvorsen, Jon Anders; Gieler, Uwe; Schut, Christina & Tomas-Aragones, Lucia [Vis alle 22 forfattere av denne artikkelen] (2019). Itch and mental health in dermatological patients across Europe: A cross-sectional study in 13 countries. Journal of Investigative Dermatology. ISSN 0022-202X. s. 1–6. doi: 10.1016/j.jid.2019.05.034. Vis sammendrag

  Abstract Itch is a highly prevalent and multidimensional symptom. We aimed to analyze the association between itch and mental health in dermatological patients. This multicenter study is observational and cross-sectional and was conducted in dermatological clinics across 13 European countries. A total of 3,530 patients and 1,094 healthy controls were included. Patients were examined clinically. Outcome measures were itch (presence, chronicity, and intensity), the Hospital Anxiety and Depression Scale, EQ-5D visual analogue scale, sociodemographics, suicidal ideation, and stress (negative life events and economic difficulties). Ethical approval was obtained. Results showed significant association between the presence of itch in patients and clinical depression (odds ratio, 1.53; 95% confidence interval, 1.15-2.02), suicidal ideation (odds ratio, 1.27; 95% confidence interval, 1.01-1.60), and economic difficulties (odds ratio, 1.24; 95% confidence interval, 1.10-1.50). The mean score of reported generic health status assessed by the EQ-5D visual analogue scale was 65.9 (standard deviation = 20.1) in patients with itch, compared with 74.7 (standard deviation = 18.0) in patients without itch (P < 0.001) and 74.9 (standard deviation = 15.7) in controls with itch compared with 82.9 (standard deviation = 15.6) in controls without itch (P < 0.001). Itch contributes substantially to the psychological disease burden in dermatological patients, and the management of patients should include access to multidisciplinary care. Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2019). First-line managers' experience of the use of audit and feedback cycle in specialist mental health care: A qualitative case study. Archives of Psychiatric Nursing. ISSN 0883-9417. 33(6), s. 103–109. doi: 10.1016/j.apnu.2019.10.009. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Audit and feedback was the main strategy to facilitate implementation of The National Guideline for Persons with Concurrent Substance Use Disorders and Mental Disorders in specialist mental health services. Studies have shown that leadership support contributes to implementation success. The aim of the study was to explore how first-line managers in a District Psychiatric Centre experienced using audit and feedback cycle. Method The study had a qualitative case study design with individual interviews with five first-line managers from a District Psychiatric Centre in Norway. Qualitative content analysis was conducted. Results First-line managers were positive to contribute to better practice for the patient group and apply available tools. Four themes emerged: 1) Lack of endurance, where first-line managers saw their role as being process leaders, but failed to persist, 2) Lack of support in the process, where first-line managers called for a stronger organisational focus 3) Lack of ownership, where first-line managers felt the process was imposed on them, and 4) Lack of leader autonomy, where first-line managers seemed insecure about their role between professional leadership and own management. Conclusion First-line managers were not sufficiently experienced or equipped to solve the implementation process satisfactorily. They were torn between different commitments, without the autonomy to act as process drivers or facilitators, and without taking the necessary leadership role. The potential impact of the use of audit and feedback may thus not be fully realized, in part, because of limited organisational support and capacity to respond effectively.

• Titeca, Géraldine; Goudetsidis, Laetitia; Francq, Bernard G.; Sampogna, Francesca; Gieler, Uwe & Tómas-Aragonés, Lucía [Vis alle 23 forfattere av denne artikkelen] (2019). 'The psychosocial burden of alopecia areata and androgenetica': a cross-sectional multicentre study among dermatological out-patients in 13 European countries. Journal of the European Academy of Dermatology and Venereology. ISSN 0926-9959. s. 1–6. doi: 10.1111/jdv.15927. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Hair diseases play an important burden on patients' lives, causing significant emotional and psychosocial distress. However, the impairment due to different hair conditions, such as alopecia areata (AA) and androgenetic alopecia (AGA), has rarely been compared. OBJECTIVE: The aim of this study was to assess the psychological burden of subgroups of patients with different hair diseases and to compare them to a healthy population. METHODS: In this study, we analysed a subgroup of patients with hair diseases from patients of a large multicentre study including 3635 dermatological patients and 1359 controls from 13 European countries. In the subgroup of patients with hair diseases, we analysed the socio-demographic characteristics, the stress level, and the impact of hair diseases on quality of life (QoL), anxiety, and depression and we compared them among patients with AA, AGA and healthy controls. RESULTS: The study population included 115 patients (77% women, 23% men) with hair diseases, 37 of whom with AA and 20 with AGA. Patients with hair diseases had a lower education level than healthy controls (medium educational level: 43% vs. 28%). Overall, 41% of the patients reported stressful life events during the last 6 months compared with 31% of the controls. Patients with the same age, sex, depression level and comorbidities had a worse QoL when suffering from AA than from AGA (Mean Dermatology Life Quality Index score: 5.8 vs. 2.5). CONCLUSION: Patients with hair diseases are more anxious, depressed and have a lower QoL than controls.

• Leonhardt, Marja & Lien, Lars (2019). Fargerikt og grønt - innvandrere og friluftsliv. I Tellnes, Gunnar (Red.), NaKuHel og folkehelse som bærekraft: Samspillet Natur-Kultur-Helse sett i lys av FNs bærekraftmål. Det norske medicinske Selskab. ISSN 978-82-92871-81-2. s. 64–69. Vis sammendrag

  Samfunnets helseutfordringer er nå, kanskje mer enn noen gang, knyttet til klima, miljø, matsikkerhet, migrasjon, økonomi, osv. Dette har aktualisert behovet for å styrke klodens bærekraft, blant annet for å sikre gode levekår og folkehelse for fremtidige generasjoner. Det er nå 25 år siden NaKuHel-senteret i Asker ble etablert. I den anledning vil vi synliggjøre betydningen av helsefremmende natur- og kulturaktiviteter sett i lys av FNs bærekraftsmål. Denne boken viser hvordan god samfunnshelse kan skapes på andre måter enn tradisjonell medisinsk tenkning, paradigme og ideologi. Det mangfold av perspektiv som presenteres i bokens 21 kapitler, skrevet av 24 forfattere, gir eksempler på helsefremmende tiltak som kan bidra til en salutogen samfunnsutvikling. Målet er å fremme helse, miljø, livskvalitet og velferd for alle. Inkluderende og helsefremmende fellesskap kan bidra til god folkehelse og bærekraftige samfunn. Et sentralt element ved NaKuHel-konseptet er at offentlige tjenester, frivillige organisasjoner og næringsliv skal samarbeide med utgangspunkt i felles mål for å bedre helse, miljø og velferd. På NaKuHel-senteret i Asker kan deltakere fra alle samfunnslag føle seg inkludert og får stor frihet til å realisere egne idéer i praksis. Senteret har dermed blitt et vitalt møtested for mangfold, kommunikasjon, solidaritet, økt livskvalitet, helse, mestring og miljøbevissthet.

• Aaseth, Jan; Roer, Grethe Emilie; Lien, Lars & Bjørklund, Geir (2019). Is there a relationship between PTSD and complicated obesity? A review of the literature. Biomedicine & Pharmacotherapy. ISSN 0753-3322. 117. doi: 10.1016/j.biopha.2019.108834. Fulltekst i vitenarkiv Vis sammendrag

  Recent research strongly supports the hypothesis that posttraumatic stress disorder (PTSD) can be accompanied by obesity and related metabolic disturbances. The mechanisms of these associations are however still not well defined, although disturbed functions in the sympathetic-adrenergic nervous system together with the disturbed release of hormones via the endocrine HPA (hypothalamic-pituitary-adrenal) axis apparently play a role. Leptin resistance and ghrelin excesses might contribute to a disturbed hypothalamic function, and also disturb other cerebral functions, leading to dysfunctional reward signaling and uncontrolled appetite combined with a tendency to alcohol abuse. Secondarily, cortisol stimulation will contribute to the development of central obesity which is known to facilitate the development of metabolic syndrome, including slightly increased levels of inflammatory biomarkers such as C-reactive protein and fibrinogen. While previous therapeutic strategies have focused on early psychotherapeutic interventions in PTSD, the present review emphasizes the importance of better therapeutic approaches regarding the somatic correlates of the syndrome. Strict regulation of dietary meals and food composition with minimal intake of sweets and saturated fat, as well as alcohol avoidance, can provide a basic therapeutic framework. A cognitive psychotherapeutic approach with graduated desensitization toward trigging factors, combined with pharmacotherapy, is discussed in the present review.

• Silwal, Sanju; Lehti, Venla; Chudal, Roshan; Suominen, Auli; Lien, Lars & Sourander, Andre (2019). Parental immigration and offspring post-traumatic stress disorder: A nationwide population-based register study. Journal of Affective Disorders. ISSN 0165-0327. 249, s. 294–300. doi: 10.1016/j.jad.2019.02.002. Vis sammendrag

  Objectives The aim of this study was to investigate the association between parental immigration status and a diagnosis of post-traumatic stress disorder (PTSD) in their offspring. Methods This nested matched case-control study was based on a Finnish national birth cohort for 1987–2010 and cases were diagnosed with PTSD by 2012 from the Care Register for Health Care. We identified 3639 cases and 14,434 controls individually matched for gender, place and date of birth (±30 days). Conditional logistic regression analyses were conducted to examine the association between parental immigration status, parents’ region of birth and time since paternal immigration, and PTSD after controlling for confounding factors. Results The likelihood of being diagnosed with PTSD was significantly increased among children with an immigrant father (OR 1.8, 95% CI 1.3 - 2.4) than those with two Finnish parents and one immigrant mother. There was no significant association between having an immigrant mother or two immigrant parents and receiving a diagnosis of PTSD. The likelihood of being diagnosed with PTSD was increased if the children's fathers had migrated less than five years before their birth (OR 1.4, 95% CI 1.03 - 1.9) and if their immigrant fathers had been born in North Africa or the Middle East (OR 2.1, 95% CI 1.4 - 3.3). Limitations The sample included a heterogeneous migrant group without information on the reason for migration. The cases were identified from hospital diagnosis that may have only included severe cases. Conclusion The increased likelihood of a diagnosis of PTSD underlines the need for psychosocial services among second-generation immigrants.

• Vattø, Ingvild Engh; Lien, Lars; deMarinis, Valerie; Haug, Sigrid Helene Kjørven & Danbolt, Lars Johan (2019). Caught between Expectations and the Practice Field: Experiences of This Dilemma among Volunteers Operating a Diaconal Crisis Line in Norway. Crisis. ISSN 0227-5910. doi: 10.1027/0227-5910/a000573.
• Sanhori, Zienat Balla Mohamed Ahmed; Eide, Arne Henning; Ayazi, Touraj; Mdala, Ibrahimu & Lien, Lars (2019). Change in Mental Health Stigma After a Brief Intervention Among Internally Displaced Persons in Central Sudan. Community mental health journal. ISSN 0010-3853. 55(3), s. 534–541. doi: 10.1007/s10597-019-00375-y. Fulltekst i vitenarkiv Vis sammendrag

  Stigmatizing attitudes towards people with mental illness is a worldwide phenomenon, This Longitudinal study aimed to determine the level of stigma, among the internal displaced persons in central Sudan and explore possible changes in stigma associated with an intervention. 1549 persons were interviewed using standardized stigma attitude tools. The study reveled high level of stigma among our respondents and there was no significant difference in attitudes towards mental illness observed after the intervention. The intervention was not associated with change in stigma. However, the findings can inform policy to create sustainable national mental health strategies to address the stigma.

• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2019). How women experience and cope with daily hassles after sexual abuse – a retrospective qualitative study. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. doi: 10.1111/scs.12649. Vis sammendrag

  The impact of stress on health can depend on factors such as frequency, heightening of stress during a given period or the presence of one or a few repeated hassles of psychological importance. The aim of this study was to gain a deeper understanding of how adult women experience and cope with daily hassles after sexual abuse. Ten interviews were analysed using the grounded theory method. The theoretical model of ‘protecting armor in daily life’ emerged. The aftermath of sexual abuse related coping with daily stress can be understood as a three-phase process: (1) avoiding and Introduction Violence against women is a common public health con- cern and one in three women worldwide, experiences physical or sexual violence in their lifetime (1). The World Health Organization (2) defines sexual violence as: Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed against a person’s sexu- ality using coercion, by any person regardless of their relationship to the victim, in any setting including but not limited to home and work. (p. 11) Sexual abuse may include everything from sexualised language/behaviour to more severe abuse like intimate touching and rape (3). According to the World Health Organization (4), one in five women reports having been sexually abused as a child and one in three women has been a victim of physical or sexual violence by an Correspondence to: Marianne Torp Stensvehagen, Inland Norway University of Applied Sciences, Postboks 400, 2418 Elverum, Norway. E-mail: marianne.stensvehagen@inn.no escaping—coping after experiencing sexual abuse; (2) accepting and disclosing—starting a process of recovery; and (3) reconciling and repossessing—living with the experience in the present. The model contributes to a deeper understanding of the everyday life of women who have experienced sexual abuse. Increased knowl- edge of coping behaviours that can be used to deal with daily hassles may also serve as a tool for health professionals, other helpers and family to help these women rebuild a good life. Keywords: sexual abuse, women, daily hassles, daily uplifts, coping strategies, stress reactions.

• Schut, Christina; Dalgard, Florence; Halvorsen, Jon Anders; Gieler, Uwe; Lien, Lars & Aragones, Lucia Tomas [Vis alle 21 forfattere av denne artikkelen] (2018). Occurrence, chronicity and intensity of itch in a clinical consecutive sample of patients with skin diseases: A multi-centre study in 13 european countries. Acta Dermato-Venereologica. ISSN 0001-5555. 99(2), s. 146–151. doi: 10.2340/00015555-3040. Fulltekst i vitenarkiv
• Brénaut, Émilie; Halvorsen, Jon Anders; Dalgard, Florence; Lien, Lars; Balieva, Flora Nicol & Sampogna, Francesca [Vis alle 21 forfattere av denne artikkelen] (2018). The self-assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries. Journal of the European Academy of Dermatology and Venereology. ISSN 0926-9959. 33(1), s. 157–162. doi: 10.1111/jdv.15145. Vis sammendrag

  Background Prurigo is defined by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions. Objective The aim of this study was to assess the psychological burden of prurigo in patients of European countries. Methods In this multicentre European study, 3635 general dermatology outpatients and 1359 controls were included. Socio‐demographic data and answers to questionnaires (regarding quality of life, general health, anxiety and depression and suicidal ideation) were collected. Results There were 27 patients with prurigo; of these, 63% were men, and the mean age was 58.6 years. Among patients with prurigo, 10 of 27 (37%) suffered from anxiety and 8 of 27 (29%) from depression. Suicidal ideation was reported in 5 of 27 (19%) patients, and for four of these five patients, suicidal ideation was related to their skin disease. These frequencies were higher in the 10 commonest dermatological diseases (including psoriasis, atopic dermatitis and leg ulcers). The impact on quality of life was severe, with a mean Dermatologic Life Quality Index (DLQI) of 12.4, with an extreme impact on quality of life for 23% of patients and a very large impact for 27% of patients. Conclusion The psychological comorbidities of prurigo are common, greater than those of other skin diseases, and their impact on quality of life is significant. Thus, it is important to study this condition and to find new treatments.

• Dalgard, Florence; Bewley, Anthony; Evers, Andrea W.; Gieler, Uwe; Lien, Lars & Sampogna, Francesca [Vis alle 10 forfattere av denne artikkelen] (2018). Stigmatisation and body image impairment in dermatological patients: Protocol for an observational multicentre study in 16 European countries. BMJ Open. ISSN 2044-6055. 8:e024877(12), s. 1–5. doi: 10.1136/bmjopen-2018-024877.
• Sørensen, Torgeir; la Cour, Peter; Danbolt, Lars Johan; Stifoss-Hanssen, Hans; Lien, Lars & deMarinis, Valerie [Vis alle 8 forfattere av denne artikkelen] (2018). The Sources of Meaning and Meaning in Life Questionnaire in the Norwegian Context: Relations to Mental Health, Quality of Life, and Self-Efficacy. The international journal for the psychology of religion. ISSN 1050-8619. s. 32–45. doi: 10.1080/10508619.2018.1547614.
• Søberg, Ane Inger Bondahl; Haug, Sigrid Helene Kjørven; Danbolt, Lars Johan; Lien, Lars & Sørensen, Torgeir (2018). Existential themes in the treatment of people at suicide risk. Understandings and practices of specialist healthcare professionals. Mental Health, Religion & Culture. ISSN 1367-4676. 21(6), s. 588–600. doi: 10.1080/13674676.2018.1524860. Vis sammendrag

  This qualitative study focuses on the ways in which existential themes were understood and addressed in therapeutic relationships with patients who had attempted suicide. Health care professionals (HCP) from Norway specialist healthcare participated in focus groups. The interviews were transcribed and analysed by systematic text-condensation through a four-step procedure. We found that the HCPs emphasised the context-specific functions of their departments. They considered these conversations essential but demanding. They indicated existential themes of hope/hopelessness, loneliness, meaning, life/death, shame, religion and suicide. The HCPs’ understandings of themes deemed to be existential and how they should be addressed were primarily based on clinical experience. This appeared to exacerbate the pressure on their personal involvement, leading to the question of whether patients’ existential needs are tackled or instead disappear into a conversational vacuum. The study suggests that HCPs' professional competence of existential themes pertaining to patients at suicide risk needs to be strengthened.

• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2018). Audit and feedback in mental healthcare: staff experiences. International Journal of Health Care Quality Assurance. ISSN 0952-6862. 31(7), s. 822–833. doi: 10.1108/IJHCQA-08-2017-0142. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Audit and feedback (A&F) often underlie implementation projects, described as a circular process; i.e. an A&F cycle. They are widely used, but effect varies with no apparent explanation. We need to understand how A&F work in real-life situations. The purpose of this paper, therefore, is to describe and explore mental healthcare full A&F cycle experiences. Design/methodology/approach This is a naturalistic qualitative study that uses four focus groups and qualitative content analysis. Findings Staff accepted the initial A&F stages, perceiving it to enhance awareness and reassure them about good practice. They were willing to participate in the full cycle and implement changes, but experienced poor follow-up and prioritization, not giving them a chance to own to the process. An important finding is the need for an A&F cycle facilitator. Practical implications Research teams cannot be expected to be involved in implementing clinical care. Guidelines will keep being produced to improve service quality and will be expected to be practiced. This study gives insights into planning and tailoring A&F cycles. Originality/value Tools to ease implementation are not enough, and the key seems to lie with facilitating a process using A&F. This study underscores leadership, designated responsibility and facilitation throughout a full audit cycle.

• Abebe, Dawit Shawel; Elstad, Jon Ivar & Lien, Lars (2018). Utilization of somatic specialist services among psychiatric immigrant patients: the Norwegian patient registry study. BMC Health Services Research. ISSN 1472-6963. 18:852, s. 1–7. doi: 10.1186/s12913-018-3672-y. Fulltekst i vitenarkiv
• Dalgard, Florence; Svensson, Åke; Gieler, Uwe; Tómas-Aragonés, Lucía; Lien, Lars & Poot, Françoise [Vis alle 21 forfattere av denne artikkelen] (2018). Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations. British Journal of Dermatology. ISSN 0007-0963. 179(2), s. 464–470. doi: 10.1111/bjd.16250. Fulltekst i vitenarkiv
• Toft, Helge Prytz; Bramness, Jørgen Gustav; Lien, Lars; Abebe, Dawit Shawel; Wampold, Bruce E. & Tilden, Terje [Vis alle 8 forfattere av denne artikkelen] (2018). PTSD patients show increasing cytokine levels during treatment despite reduced psychological distress. Neuropsychiatric Disease and Treatment. ISSN 1176-6328. 14, s. 2367–2378. doi: 10.2147/NDT.S173659. Fulltekst i vitenarkiv Vis sammendrag

  Background: A reciprocal relationship between activated innate immune system and changes in mood and behavior has been established. There is still a paucity of knowledge on how the immune system responds during psychiatric treatment. We aimed to explore circulating cytokines and assess psychiatric symptom severity scores during 12 weeks of inpatient psychiatric treatment. Methods: The study was a longitudinal assessment of 124 patients (88 women and 36 men) in treatment at Modum Psychiatric Center, Norway. The patient sample comprised a mixed psychiatric population of whom 39 were diagnosed with posttraumatic stress disorder (PTSD). Serum blood samples for cytokine analysis and measures of mental distress using Global Severity Index were collected at admission (T0), halfway (T1), and before discharge (T2). Other factors assessed were age, gender, and the use of antidepressants and anti-inflammatory drugs. Multilevel modeling was used for longitudinal analyses to assess the repeated cytokine samples within each patient. Results: Overall level of IL-1RA was higher in PTSD patients when compared to those without PTSD (P=0.021). The level of IL-1β, MCP-1, and TNF-α increased over time in PTSD compared to non-PTSD patients (P=0.025, P=0.011 and P=0.008, respectively). All patients experienced reduced mental distress as measured by self-reported Global Severity Index scores. Stratified analysis showed that PTSD patients who used anti-inflammatory drugs had higher levels of IL-1β (P=0.007) and TNF-α (P=0.049) than PTSD patients who did not use such drugs. Conclusion: The study indicates that traumatized patients may have a distinct neuroimmune development during recovery. Their activated immune system shows even further activation during their rehabilitation despite symptom reduction.

• Khalifa, Dina Mohammed Sami; Glavin, Kari; Bjertness, Espen & Lien, Lars (2018). Course of depression symptoms between 3 and 8 months after delivery using two screening tools (EPDS and HSCL-10) on a sample of Sudanese women in Khartoum state. BMC Pregnancy and Childbirth. ISSN 1471-2393. 18(324). doi: 10.1186/s12884-018-1948-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Effects of depression on parenting and on cognitive development of newborns are augmented when symptoms continue throughout the first postnatal year. Current classification systems recognize maternal depression as postnatal if symptoms commence within four to six weeks. Traditional cultural rituals in Sudan offer new mothers adequate family support in the first 6–8 weeks postpartum. The course of postnatal depression symptoms beyond that period is not explored in such settings. We therefore aim to investigate the change in screening status and in severity of depression and distress symptoms between three and eight months postpartum among a sample of Sudanese women using the Edinburgh Postnatal Depression Scale (EPDS) and a locally used tool: the 10-items Hopkins Symptoms Checklist (HSCL-10). Methods Three hundred pregnant women in their 2nd or 3rd trimester were recruited from two clinics in Khartoum state. They were followed up and screened for depression symptoms eight months after delivery by EPDS at ≥12, and by HSCL-10 at ≥1.85. The same sample was previously screened for depression at three months after birth. Results Prevalence of postnatal depression symptoms by EPDS was lower at eight months compared to three months after birth (3.6% at eight months (8/223) compared to 9.2% at three months (22/238), p <  0.001). Eight Mothers exhibited depression symptoms eight months after birth. Depressed mothers at three months had a 56% reduction in EPDS mean scores by eight months and 96.4% of participants either remained in the same EPDS category, or improved eight months after birth. Four participants with major depression symptoms at eight months were also depressed three months after birth and four participants had new onset depression symptoms. The HSCL-10 measured higher distress than EPDS across the two screening points (19.3% at three months, 9.1% at eight months postpartum, p <  0.001). Nonetheless, the two tests correlated positively at both points. Conclusions Repeated screenings by EPDS (depression surveillance) is recommended during the first postnatal year because a subset of mothers can have symptoms beyond the early postnatal period. Existing depression screening instruments can be assessed for their validity to detect PND.

• Marrón, Servando E.; Tómas-Aragonés, Lucía; Navarro-Lopez, Jorge; Gieler, Uwe; Kupfer, Jörg & Dalgard, Florence [Vis alle 22 forfattere av denne artikkelen] (2018). The psychosocial burden of hand eczema: Data from a European dermatological multicentre study. Contact Dermatitis. ISSN 0105-1873. 78(6), s. 406–412. doi: 10.1111/cod.12973. Fulltekst i vitenarkiv
• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2018). Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway. BMC Health Services Research. ISSN 1472-6963. 18(71). doi: 10.1186/s12913-018-2862-y. Fulltekst i vitenarkiv Vis sammendrag

  Background The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014. Methods This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings. Results The discussions provided health professionals with insight into their own and their colleagues’ practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working. Conclusion Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups

• Brekke, Eva; Lien, Lars; Nysveen, Kari & Biong, Stian (2018). Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: A qualitative study of staff experiences in Norway. International Journal of Mental Health Systems. ISSN 1752-4458. 12(30). doi: 10.1186/s13033-018-0211-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Recovery-oriented practice is recommended in services for people with co-occurring mental health and substance use disorders. Understanding practitioners’ perceptions of recovery-oriented services may be a key component of implementing recovery principles in day-to-day practice. This study explores and describes staff experiences with dilemmas in recovery-oriented practice to support people with co-occurring disorders. Methods Three focus group interviews were carried out over the course of 2 years with practitioners in a Norwegian community mental health and addictions team that was committed to developing recovery-oriented services. Thematic analysis was applied to yield descriptions of staff experiences with dilemmas in recovery-oriented practice. Results Three dilemmas were described: (1) balancing mastery and helplessness, (2) balancing directiveness and a non-judgmental attitude, and (3) balancing total abstinence and the acceptance of substance use. Conclusions Innovative approaches to practice development that address the inherent dilemmas in recovery-oriented practice to support people with co-occurring disorders are called for

• Belfrage, Anna; Grotmol, Kjersti Støen; Tyssen, Reidar; Moum, Torbjørn Åge & Lien, Lars (2018). Factors associated with low vs increased perceived mastery of clinical work over ten years of practice: a prospective study of Norwegian doctors. BMC Medical Education. ISSN 1472-6920. 18:116(116). doi: 10.1186/s12909-018-1236-9. Fulltekst i vitenarkiv Vis sammendrag

  Background A higher sense of mastery of doctors’ clinical work could benefit not only their own mental health but also their work performance and patient care. However, we know little about factors associated with perceived mastery of clinical work among physicians. Our aim was therefore to study characteristics of those with stable low levels and of those with increased levels of mastery over a period of ten years of medical practice. Methods N = 631 doctors were surveyed in their final year of medical school in 1993/94 (T1) and 10 (T2), 15 (T3) and 20 (T4) years later. Low and increased perceived mastery of clinical work were measured between T2, T3 and T4. Response rates for all items measuring low and increased mastery were 238/522 (46%) and 256/522 (49%) respectively. The following explanatory variables were included: demographics, medical school factors, personality and contextual work-related and non-work-related factors. Results N = 73 (31%) of the doctors reported stable low mastery from T2 to T4. The following variables were significantly associated with low mastery in the adjusted analyses: vulnerability (OR: 1.30, P < .000, CI: 1.12 to 1.50), drinking alcohol to cope with stress during medical school (OR: 2.66, P = .04, CI: 1.03 to 6.85) and social support (OR: 0.78, P = .002, CI: 0.66 to 0.91). N = 39 (15%) reported increased mastery during the ten-year period from T2 to T4. Perceived job demands (OR: 0.66, P = .02, CI: 0.45 to 0.98) and taking up a leading position (OR: 3.04, P = .01, CI: 1.31 to 7.07) were associated with increased mastery after adjustment. Conclusions Stable low sense of mastery over time is associated with having a vulnerable personality, a history of having used alcohol to cope with stress during medical school and lack of contemporary social support. Conversely, increased sense of mastery is associated with taking up a leading position and having the perception that job demands are decreasing over time. These findings indicate that perceived mastery of clinical work may not be a trait, but a state modifiable over time

• Toft, Helge Prytz; Neupane, Sudan Prasad; Bramness, Jørgen Gustav; Tilden, Terje; Wampold, Bruce E. & Lien, Lars (2018). The effect of trauma and alcohol on the relationship between level of cytokines and depression among patients entering psychiatric treatment. BMC Psychiatry. ISSN 1471-244X. 18(95). doi: 10.1186/s12888-018-1677-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Depression is associated with immunological responses as reflected by altered levels of circulating cytokines. Alcohol use and trauma may modulate immune activity, and few studies have investigated these factors in depressed patients. We aimed to explore the association between circulating peripheral cytokine levels and degree of depressive symptoms, taking trauma and alcohol into account. Methods The study was a cross-sectional assessment of patients at admission to a specialized psychiatric center in Norway. A total of 128 patients were included. Information was gathered using the self-administered questionnaires Beck Depression Inventory-II (BDI-II) and the Alcohol Use Disorders Identification Test (AUDIT), in addition to clinical interviews recording childhood or adult life trauma. Serum levels of the cytokines Interleukin-1β (IL-1β), Interleukin-1 Receptor Antagonist (IL-1RA), Tumor Necrosis Factor-α (TNF-α) and the chemokine Monocyte Chemoattractant Protein-1 (MCP-1) were assessed. A Luminex bead-based multiplex assay was used for cytokine measurements. Patient cytokine levels were compared to those of healthy volunteers by the Mann-Whitney U test. Results Levels of cytokines did not differ across patients with mild, moderate and severe depression. AUDIT score was not related to cytokine levels, but to level of depression. A history of trauma was related to higher levels of IL-1RA and TNF-α (p = 0.048 and p = 0.033, respectively), especially among the severely depressed. Serum levels of MCP-1 and TNF-α were significantly higher among psychiatric patients than in healthy volunteers. Conclusions Findings indicate that depression was not related to levels of circulating cytokines among patients in treatment, but that traumatized patients had higher levels of IL-1RA and TNF-α than patients without trauma experience. The lack of relationship between cytokine level and depression was evident both in those without and with trauma.

• Balieva, Flora Nicol; Finlay, Andrew Y.; Kupfer, Jörg; Aragones, Lucia Tomas; Lien, Lars & Gieler, Uwe [Vis alle 20 forfattere av denne artikkelen] (2018). The role of therapy in impairing quality of life in dermatological patients: A multinational study. Acta Dermato-Venereologica. ISSN 0001-5555. 98(6), s. 563–569. doi: 10.2340/00015555-2918. Fulltekst i vitenarkiv Vis sammendrag

  Skin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%). The largest reduction in HRQoL attributable to therapy, as a percentage of total DLQI, adjusted for confounders, was seen in blistering conditions (10.7%), allergic/drug reactions (10.2%), psoriasis (9.9%), vasculitis/immunological ulcers (8.8%), atopic dermatitis (8.7%), and venous leg ulcers (8.5%). In skin cancer, although it had less impact on HRQoL, the reduction due to therapy was 6.8%. Treatment for skin disease contributes considerably to reducing HRQoL: the burden of dermatological treatment should be considered when planning therapy and designing new dermatological therapies.

• Abraham, Ruth; Lien, Lars & Hanssen, Ingrid (2018). Coping, resilience and posttraumatic growth among Eritrean female refugees living in Norwegian asylum reception centres: A qualitative study. International Journal of Social Psychiatry. ISSN 0020-7640. 64(4), s. 359–366. doi: 10.1177/0020764018765237. Vis sammendrag

  Background: The links between migration and health are well documented. Being a refugee exacerbates migrants’ vulnerability through trauma and loss. The aim of this study is to identify sources of resilience, coping and posttraumatic growth in female Eritrean refugees living in Norwegian asylum reception centres. Method: The study had a qualitative, descriptive and explorative design with two focus group interviews and 10 individual in-depth interviews. Participants included 18 female Eritrean refugees aged 18–60, who had obtained refugee status and were still living in an asylum reception centre. A content-focused hermeneutic analytic approach was used. Results: Interviewees described the challenges of pre-flight and flight trauma, conditions at the refugee centre, communication difficulties and the ‘endless’ waiting for transfer to a municipality. To cope, they found it helpful to focus on the future and to think positively. Fellowship with and support from fellow Eritrean refugees were essential as they became a proxy family and provided a strong ethnic identity. Their religious belief also helped them cope and gave them hope for the future. Discussion: The interviewees in this study perceived their psychological problems as a normal reaction to what they had been through. Religious belief was an important resilience factor, as was social support, especially from peers. Conclusion: The interviewees’ coping was based on the realization of their psychological reactions being normal while doing their utmost to focus on their aims and hopes for the future. Keywords Refugees, resilience, coping, posttraumatic growth, religiosity, positive psychiatry

• Martinez, Priscilla; Lien, Lars; Zemore, Sarah E.; Bramness, Jørgen Gustav & Neupane, Sudan Prasad (2018). Circulating cytokine levels are associated with symptoms of depression and anxiety among people with alcohol and drug use disorders. Journal of Neuroimmunology. ISSN 0165-5728. 318, s. 80–86. doi: 10.1016/j.jneuroim.2018.02.011.
• Silwal, Sanju; Dybdahl, Ragnhild; Chudal, Roshan; Sourander, Andre & Lien, Lars (2018). Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquakes. Journal of Affective Disorders. ISSN 0165-0327. 234, s. 239–246. doi: 10.1016/j.jad.2018.03.002. Vis sammendrag

  Background In 2015, Nepal was hit by two major earthquakes, which caused 8900 deaths and displaced more than 450,000 people. We assessed the prevalence of post-traumatic stress symptoms (PTSS) and depressive symptoms and explored potential risk factors among adolescents. Methods This cross-sectional study comprised 893 students aged 11–17 in school grades 7–10. They lived in two districts affected by the earthquakes: Sindhupalchok and Kathmandu. Psychiatric symptoms were assessed using Child PTSD symptom scale and Depression Self-Rating Scale. Multiple logistic regression analysis examined the associations between demographic, earthquake-related factors and psychiatric symptoms. Results The prevalence of PTSS in the Sindhupalchok and Kathmandu districts were 39.5% and 10.7%, and depression symptoms were 40.4% and 23.2% respectively. The moderating effect of gender on the relationship between age and PTSS was significant. In the multivariate logistic analyses, the factors associated with PTSS and depression were: being female, prior exposure to trauma and being directly affected by the earthquakes. Limitations Due to the lack of pre-earthquake prevalence rates, our estimates may have been due to chronic long-lasting problems of poverty and lack of access to physical and mental health services. The use of self-reported questionnaires might have overestimated the prevalence rates compared to psychiatric interviews. Conclusions One year after the earthquakes, adolescents living in Sindhupalchok had a higher prevalence of PTSS and depressive symptoms than those living in Kathmandu. Socio-economic and earthquake-related factors were associated with psychiatric outcomes. The findings indicate the need for early psychosocial interventions, prevention and future research after emergency relief

• Lesner, Karolina; Reich, Adam; Szepietowski, Jacek C.; Dalgard, Florence; Gieler, Uwe & Tomasaragones, Lucia [Vis alle 22 forfattere av denne artikkelen] (2017). Determinants of psychosocial health in psoriatic patients: A multinational study. Acta Dermato-Venereologica. ISSN 0001-5555. 97(10), s. 1182–1188. doi: 10.2340/00015555-2760. Fulltekst i vitenarkiv Vis sammendrag

  There are limited data on the differences in the impact of psoriasis between various countries with respect to quality of life (QoL). The aim of this study was to explore the psychosocial health of patients with psoriasis in different European countries. A total of 682 patients were recruited in 13 European countries. All patients completed a questionnaire regarding sociodemographic information, negative life events, suicidal ideation and satisfaction with their dermatologist. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS), and QoL with the Dermatology Life Quality Index (DLQI) and EuroQoL (EQ-5D). The lowest anxiety and depression scoring was noted in patients from Denmark, the lowest level of impairment in QoL in subjects from Spain, and the highest level of impairment in QoL in patients from Italy. The most relevant parameters influencing patients’ well-being were severity of pruritus and satisfaction with their dermatologist. The level of anxiety and depression symptoms correlated significantly with suicidal ideation.

• Szabo, Csanad; Altmayer, Anita; Lien, Lars; Poot, Francoise; Gieler, Uwe & Tómas-Aragonés, Lucía [Vis alle 21 forfattere av denne artikkelen] (2017). Attachment styles of dermatological patients in europe: A multicentre study in 13 countries. Acta Dermato-Venereologica. ISSN 0001-5555. 97(7), s. 813–818. doi: 10.2340/00015555-2619. Fulltekst i vitenarkiv
• Brekke, Eva; Lien, Lars & Biong, Stian (2017). Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders. International Journal of Mental Health and Addiction. ISSN 1557-1874. 16(1), s. 53–65. doi: 10.1007/s11469-017-9780-9. Fulltekst i vitenarkiv Vis sammendrag

  Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.

• Neupane, Sudan Prasad; Bramness, Jørgen Gustav & Lien, Lars (2017). Comorbid post-traumatic stress disorder in alcohol use disorder: relationships to demography, drinking and neuroimmune profile. BMC Psychiatry. ISSN 1471-244X. 17(312), s. 1–10. doi: 10.1186/s12888-017-1479-8. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: This study examined how alcohol use disorder (AUD) patients with post-traumatic stress disorder (PTSD) differed from those without PTSD in terms of demography, drinking patterns and C-reactive protein, inflammatory cytokines, tryptophan metabolism parameters, and brain-derived neurotrophic factor (BDNF). METHODS: A consecutive sample (N = 187) of treatment-receiving AUD individuals were recruited from Nepalese facilities. They underwent fully structured psychiatric interviews. Serum levels of inflammatory cytokines [interleukin (IL)-6, IL-1 Receptor antagonist (IL-1Ra), IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ)] were determined by a multiplex assay, kynurenine and tryptophan levels by high-performance liquid chromatography, and BDNF by enzyme-linked immunosorbent assay (ELISA). RESULTS: The prevalence of exposure to severe trauma and PTSD was 74% and 17%, respectively. PTSD comorbidity was not associated with age, gender, or socioeconomic status, but with co-occurring major depression, history of attempted suicide, earlier peak of drinking problems, higher drinking quantity and withdrawal symptoms, experiencing alcoholic blackouts, and drinking problems among parents. None of the assessed neuroimmune parameters was related to comorbid PTSD. CONCLUSIONS: The findings support routine trauma screening in AUD treatment samples and screening for risky drinking in trauma populations to help guide interventions. The expected aberrations in neuroimmune functioning may not be found when examined in a sample with multiple psychiatric morbidities

• Hanevik, Hilde; Hestad, Knut; Lien, Lars; Joa, Inge; Larsen, Tor Ketil & Danbolt, Lars Johan (2017). Religiousness in First-Episode Psychosis. Archive for the Psychology of Religion/ Archiv für Religionspsychologie. ISSN 0084-6724. 39(2), s. 139–164. doi: 10.1163/15736121-12341336. Vis sammendrag

  The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, their religiousness often contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy.

• Abebe, Dawit Shawel; Lien, Lars & Elstad, Jon Ivar (2017). Immigrants’ utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. s. 1–9. doi: 10.1007/s00127-017-1381-1. Fulltekst i vitenarkiv Vis sammendrag

  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

• Sampogna, Francesca; Abeni, Damiano; Gieler, Uwe; Tomas-Aragones, Lucia; Lien, Lars & Titeca, Geraldine [Vis alle 21 forfattere av denne artikkelen] (2017). Impairment of Sexual Life in 3,485 Dermatological Outpatients From a Multicentre Study in 13 European Countries. Acta Dermato-Venereologica. ISSN 0001-5555. 97(4), s. 478–482. doi: 10.2340/00015555-2561. Fulltekst i vitenarkiv Vis sammendrag

  Skin conditions may have a strong impact on patients’ sexual life, and thus influence personal relationships. Sexual issues are difficult to discuss directly in clinical practice, and a mediated instrument may be useful to capture such information. In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation.

• Brekke, Eva; Lien, Lars; Davidson, Larry & Biong, Stian (2017). First-person experiences of recovery in co-occurring mental health and substance use conditions. Advances in Dual Diagnosis: Policy, practice and research in mental health and substance use. ISSN 1757-0972. 10(1), s. 13–24. doi: 10.1108/ADD-07-2016-0015. Fulltekst i vitenarkiv Vis sammendrag

  Purpose The purpose of this paper is to explore and describe experiences of recovery among people with co-occurring mental health and substance use conditions (co-occurring conditions) in a rural community in Norway. Design/methodology/approach In-depth individual interviews with eight persons with co-occurring conditions were conducted, audiotaped, transcribed and analysed using a phenomenological approach. This study is part of a research project investigating recovery orientation of services in a Norwegian district. Findings The analysis yielded four dimensions of recovery: feeling useful and accepted; coming to love oneself; mastering life; and emerging as a person. Insecure and inadequate housing and limited solutions to financial problems were described as major obstacles to recovery. Research limitations/implications Further research into the facilitation of recovery as defined by persons with concurrent disorders is needed, particularly regarding the facilitation of community participation. Practical implications This study supports an increased focus on societal and community factors in promoting recovery for persons with co-occurring conditions, as well as service designs that allow for an integration of social services and health care, and for collaboration among services. Social implications The results suggest that the community can aid recovery by accepting persons with co-occurring conditions as fellow citizens and welcoming their contributions. Originality/value The paper provides an enhanced understanding of how persons with co-occurring conditions may experience recovery.

• Balieva, Flora Nicolaeva; Kupfer, Jörg; Lien, Lars; Gieler, U; Finlay, AY & Tomas-Aragones, Lucia [Vis alle 16 forfattere av denne artikkelen] (2016). The burden of common skin diseases assessed with the EQ5D™: a European multicentre study in 13 countries. British Journal of Dermatology. ISSN 0007-0963. 176(5), s. 1170–1178. doi: 10.1111/bjd.15280. Vis sammendrag

  Background Generic instruments measuring health related quality of life (HRQoL), like EQ5D, enable comparison of skin diseases with healthy populations and non-dermatological medical conditions, as well as calculation of utility data. Objectives The aims were to measure HRQoL in patients with common skin diseases and healthy controls across Europe using the EQ5D. Methods This multi-center observational cross-sectional study was conducted in 13 European countries. Each dermatology clinic recruited at least 250 consecutive adult outpatients to complete questionnaires, including the EQ5D. Results There were 5369 participants, 4010 patients and 1359 controls. Mean self-rated health state reported by patients was 69.9 (SD 19.7), controls 82.2 (SD 15.5). When adjusted for confounding factors, including comorbidity, mean patient EQ-VAS scores were 10.5 points lower than for controls (standardized β = −0.23). Odds ratio with 95% confidence interval for impairment in all 5 dimensions of EQ5D adjusted for confounders was doubled for patients compared with controls. Patients with hidradenitis suppurativa (HS), blistering conditions, leg ulcers, psoriasis and eczemas had the highest risk for reduction in HRQoL in most dimensions (two-tenfold). Data on differences of impairment by dimensions offer new insights. Conclusions This study confirms the large impact skin conditions have on patients’ wellbeing, differentiating between aspects of HRQoL. Patients with HS, blistering diseases, leg ulcers, infections and most chronic skin diseases reported reduced HRQoL comparable to patients with chronic obstructive lung disease, diabetes mellitus, cardio-vascular disease and cancers. These findings are important in the prioritization of resource allocation between medical fields and within dermatological sub-specialities.

• Hagen, Christina; Lien, Lars; Hauff, Edvard & Heir, Trond (2016). Mindfulness, Sustained Attention and Post-traumatic Stress in Tsunami Survivors. PSYCHOLOGY AND COGNITIVE SCIENCES. ISSN 2380-727X. 2 (2 ), s. 54–63. doi: 10.17140/PCSOJ-2-115.
• Lien, Lars (2016). Smoking, Mental Health and Addiction: A Review of the Literature. Journal of addiction and preventive medicine. ISSN 2474-5049. 1(1)(105).
• Lien, Lars; Hauff, Edvard; Martinez, Priscilla; Eide, Arne Henning; Swarts, Leslie & Ayazi, Touraj (2016). Alcohol use in South Sudan in relation to social factors, mental distress and traumatic events. BMC Public Health. ISSN 1471-2458. 16(937). doi: 10.1186/s12889-016-3605-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Alcohol use is a major public health problem with vast implications for poor, war-torn countries. The objective of this study was to describe prevalence of alcohol use and risky drinking across socio-demographic factors in South Sudan, and to determine the association between risky drinking, traumatic events and mental distress. Methods This is a randomized, population based, cross-sectional study from the north-western part of South Sudan with nearly 500 participants. We used the Alcohol Use Disorders Identification Test (AUDIT) as main outcome variable, the General Health Questionnaire (GHQ-28) for mental distress and five questions to assess traumatic events. Results The mean AUDIT score was 2.7 (SD 0.3) with 14,2 % in the high risk problem drinking category. Being male, lack of a regular income and psychological distress were significantly associated with higher AUDIT score. Traumatic events, however, was not associated with higher score on AUDIT. Conclusion Despite decades of civil war and great poverty the alcohol use in this population was at the same level as other countries in Southern Africa. Traumatic events were not related to risk of problem drinking.

• Hagen, Christina; Lien, Lars; Hauff, Edvard & Heir, Trond (2016). Is mindfulness protective against PTSD? A neurocognitive study of 25 Tsunami disaster survivors. Journal of Negative Results in Biomedicine (JNRBM). ISSN 1477-5751. 15(1). doi: 10.1186/s12952-016-0056-x. Vis sammendrag

  Background: It has been suggested that mindfulness is a protective factor that buffers individuals from experiencing severe posttraumatic stress following exposure to a trauma. We aimed to examine the association between dispositional (trait) mindfulness and posttraumatic stress in individuals who had been exposed to the trauma of a natural disaster. Method: A disaster group (n = 25) consisting of Norwegian tourists who survived the 2004 South East Asian tsunami at a location with high mortality rates was recruited. Dispositional mindfulness and posttraumatic stress were measured with the Five-Facet Mindfulness Questionnaire and the Impact of Event Scale-Revised Version, respectively. Results: There was no significant association between mindfulness and posttraumatic stress. Moreover, there were no significant associations between posttraumatic stress and the mindfulness sub-facets of observing, acting with awareness, non-judging, and non-reacting. However, there was a significant positive correlation between the descriptive factor of mindfulness and IES-R total. There were no significant linear correlations between the five sub-facets of mindfulness and the three categories of posttraumatic symptoms, intrusion, avoidance and hyper-arousal. Conclusions: Our findings do not indicate a relationship between dispositional mindfulness and posttraumatic stress levels after exposure to a trauma, except for the descriptive sub-facet of mindfulness and here the correlation is positive and not negative as would be expected if mindfulness is a protective factor for posttraumatic stress. Future studies should investigate the relationship between mindfulness and posttraumatic stress while accounting for factors such as trauma history, type of trauma, and individual differences in traumatic stress reactions.

• Nilsen, Andre Sevenius; Hilland, Eva; Kogstad, Norunn; Heir, Trond; Hauff, Edvard & Lien, Lars [Vis alle 7 forfattere av denne artikkelen] (2016). Right temporal cortical hypertrophy in resilience to trauma: an MRI study. European Journal of Psychotraumatology. ISSN 2000-8066. 7. doi: 10.3402/ejpt.v7.31314. Fulltekst i vitenarkiv Vis sammendrag

  Background: In studies employing physiological measures such as magnetic resonance imaging (MRI), it is often hard to distinguish what constitutes risk-resilience factors to posttraumatic stress disorder (PTSD) following trauma exposure and what the effects of trauma exposure and PTSD are. Objective: We aimed to investigate whether there were observable morphological differences in cortical and sub-cortical regions of the brain, 7–8 years after a single potentially traumatic event. Methods: Twenty-four participants, who all directly experienced the 2004 Indian Ocean Tsunami, and 25 controls, underwent structural MRI using a 3T scanner. We generated cortical thickness maps and parcellated sub-cortical volumes for analysis. Results: We observed greater cortical thickness for the trauma-exposed participants relative to controls, in a right lateralized temporal lobe region including anterior fusiform gyrus, and superior, middle, and inferior temporal gyrus. Conclusions: We observed greater thickness in the right temporal lobe which might indicate that the region could be implicated in resilience to the long-term effects of a traumatic event. We hypothesize this is due to altered emotional semantic memory processing. However, several methodological and confounding issues warrant caution in interpretation of the results.

• Ayazi, Touraj; Swartz, Leslie; Eide, Arne Henning; Lien, Lars & Hauff, Edvard (2016). Psychotic-like experiences in a conflict-affected population: a cross-sectional study in South Sudan. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 51(7), s. 971–979. doi: 10.1007/s00127-016-1243-2. Vis sammendrag

  Purpose This study investigates the prevalence of psychotic- like experiences (PLEs) and examines exposure to potentially traumatic events and other relevant risk factors for PLEs in the general population of a conflict-affected, low-income country. Methods We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire was applied to investigate exposure to potentially traumatic events. The Mini-International Neuropsychiatric Interview was used to detect PLEs. Results The estimated prevalence of lifetime PLEs was 23.3 % and the rate of PLEs which were evaluated as bizarre was 9.5 %. Exposure to higher number of potentially traumatic events, younger age, rural residency, being unemployed, not having a regular income and having traditional religion were significantly associated with having PLEs. PLEs were significantly associated with reporting of psychological distress when controlling for other covariates. Conclusions The finding of association between traumatic exposure and PLEs calls for greater attention to the diversity of negative mental health outcomes in conflictaffected populations.

• Jaradat, Yousef; Nijem, Khaldoun; Lien, Lars; Stigum, Hein; Bjertness, Espen & Bast-Pettersen, Rita (2016). Psychosomatic symptoms and stressful working conditions among Palestinian nurses: a cross-sectional study. Contemporary Nurse: health care across the lifespan. ISSN 1037-6178. 52(4), s. 381–397. doi: 10.1080/10376178.2016.1188018. Vis sammendrag

  Background: High levels of perceived stressful working conditions have been found to have an adverse effect on physical and mental health. Objectives: To examine the associations between self-reported stressful working conditions and Psychosomatic Symptoms (PSS), and to investigate possible gender differences. Methods: The present cross-sectional study comprises 430 nurses employed in Hebron district, Palestine. Self-reported stressful working conditions were recorded, and a Psychosomatic Symptoms Check list was used to assess prevalence of PSS. Findings: Median score on the psychosomatic symptom checklist for the group was 11, (range 1–21). Women reported more symptoms than men, with medians 11.6 and 10.0, respectively (p = .0001). PSS were associated with more self-reported stressful working conditions for both men (p < .0001) and women (p < .0001). The association was strongest among men. Conclusions: PSS were associated with high self-reported stressful working conditions, and this association was strongest among the men

• Sagatun, Åse; Wentzel-Larsen, Tore; Heyerdahl, Sonja & Lien, Lars (2016). Mental health in adolescence and subsequent receipt of medical benefits in young adulthood: The mediating role of upper secondary school completion. Scandinavian Journal of Public Health. ISSN 1403-4948. 44(4), s. 431–438. doi: 10.1177/1403494815622309. Vis sammendrag

  Background: Mental health problems in adolescence are associated with impaired function in young adulthood. Our aim was to assess how a hypothetical reduction in mental health problems in adolescence was related to medical benefits in young adulthood and to examine the mediating role of completion of upper secondary school. Methods: We used a population-based sample of more than 10,000 10th-grade adolescents with self-reported data on internalizing and externalizing mental health problems. The sample was linked to the Norwegian national registers of education and medical benefits. The mediation analysis was based on a causal inference framework. Results: During a three-year period in young adulthood, 6.4% of men and 5.9% of women received medical benefits. A two-point hypothetical reduction in externalizing problems was related to a lower probability of receiving medical benefits of 1.5 (95% confidence interval (CI) 1.0–2.1) percentage points in young men and 1.8 (95% CI 1.3–2.3) percentage points in young women. The proportion mediated by the completion of upper secondary school was 52% (95% CI 36–76) among boys and 42% (95% CI 29–60) among girls. The corresponding reduction in the probability of receiving medical benefits was 1.8 percentage points for internalizing problems in both sexes (95% CI boys 1.2–2.4 and girls 1.4–2.2). The proportion mediated was lower for internalizing problems and was only significant among girls (19%). Conclusions: Intervention and prevention strategies targeting internalizing and externalizing problems in adolescents may have the potential to reduce the receipt of medical benefits in young adulthood. The completion of upper secondary school seems to be a mechanism for this association, especially for externalizing problems

• Khalifa, Dina Mohammed Sami; Glavin, Kari; Bjertness, Espen & Lien, Lars (2016). Determinants of postnatal depression in Sudanese women at 3 months postpartum: A cross-sectional study. BMJ Open. ISSN 2044-6055. 6(3). doi: 10.1136/bmjopen-2015-009443. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Maternal mental health is a neglected issue in Sudanese healthcare. The aim of this study was to explore the factors associated with postnatal depression (PND) at 3 months postpartum in a sample of Sudanese women in Khartoum state. Setting: Recruitment was from two major public antenatal care (ANC) clinics in two maternity teaching hospitals in Khartoum state. The study participants were recruited during their pregnancy and were followed up and screened for PND at 3 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Participants: A sample of 300 pregnant Sudanese women in their second or third trimester was included in the study. The inclusion criteria were Sudanese nationality, pregnancy in the second or third trimester and satisfactory contact information. Outcome measures: PND was assessed using the EPDS at a cut-off score of ≥12. Maternal and sociodemographic factors of interest were illustrated in a directed acyclic graph (DAG) to identify which variables to adjust for in multivariate analyses and to show their type of effect on PND. A forward logistic regression model was built to assess the factors that are independently associated with PND. Results: History of violence increased the odds of PND sevenfold, OR=7.4 (95% CI 1.9 to 27.6). Older age of mothers decreased the odds of PND by almost 20%, OR=0.82 (95% CI 0.73 to 0.92). Exclusive breast feeding and regular prenatal vitamins during pregnancy are associated with an 80% decrease in odds of PND, OR=0.2 (95% CI 0.06 to 0.70) and 0.17 (95% CI 0.06 to 0.5), respectively. Conclusions: Factors associated with PND in this study are comparable to factors from other developing countries, although findings should be judged with caution owing to the high number of women who refused recruitment into the study.

• Balieva, Flora Nicolaeva; Lien, Lars; Kupfer, Jörg; Halvorsen, Jon Anders & Dalgard, Florence (2016). Are Common Skin Diseases among Norwegian Dermatological Outpatients Associated with Psychological Problems Compared with Controls? An Observational Study. Acta Dermato-Venereologica. ISSN 0001-5555. 96(2), s. 227–231. doi: 10.2340/00015555-2200. Vis sammendrag

  Dermatological disease has been shown to be associated with psychological comorbidity. The aim of this observational study is to describe the distribution of skin disease and the prevalence of depression, anxiety and stress among Norwegian dermatological outpatients. Thirteen percent of outpatients had clinical anxiety compared with 3.7% of healthy controls, and 5.8% had clinical depression compared with 0.9% of controls. Adjusted odds ratio for clinical anxiety was 4.53 in patients compared with controls, and for clinical depression 6.25, which is much higher than previously described in a larger European study. Patients with tumours had less depression. Chronic inflammatory skin conditions had an especially high impact on patient’s psychological wellbeing and should not be undervalued relative to, for instance, skin cancer in health strategies. These results argue strongly for including skin disease prevention and treatment in future health strategies. Key words: depression; anxiety; psychiatric comorbidity; distribution of dermatological disease; skin cancer; chronic skin diseases.

• Homlong, Lisbeth; Rosvold, Elin Olaug; Bruusgaard, Dag; Lien, Lars; Sagatun, Åse & Haavet, Ole Rikard (2015). A prospective population-based study of health complaints in adolescence and use of social welfare benefits in young adulthood. Scandinavian Journal of Public Health. ISSN 1403-4948. 43(6), s. 629–637. doi: 10.1177/1403494815589862. Vis sammendrag

  Background: There is a lack of knowledge on how health problems in adolescence are connected to work marginalization in adulthood. The aim of this study was to study work marginalization in young adulthood, measured by use of long-term social welfare benefits, and its associations with self-reported health complaints, total symptom burden and self-rated general health at ages 15–16. Methods: We linked data from a youth health survey conducted during 1999–2004 to data from Norwegian registries that followed each participant through February 2010. Cox regression analysis was used to compute hazard ratios (HRs) for the use of long-term social welfare benefits in young adulthood, based on health measures in 15–16 year-olds. Results: During the follow-up, 17% of the study population received some sort of long-term social welfare benefit. In the baseline survey, 95% of the adolescents reported one or more health complaints. The mean number of health complaints was 4.8. Girls reported a significantly higher mean number of complaints (5.7) than did boys (3.8) (p < 0.001). Several individual health complaints were associated with an increased use of long-term social welfare benefits. We found an increasing relative hazard of social welfare usage, depending on the number of complaints reported at baseline. Ill self-perceived general health was found to be strongly associated with the use of benefits during the follow-up: In girls, we found HRs of 1.41 (CI 1.21–1.65), 2.76 (2.29–3.31) and 2.77 (1.51–5.07) for those with good, not so good and bad health, respectively; compared to very good health. The corresponding numbers in boys were 1.41 (1.25–1.59), 1.93 (1.60–2.32) and 1.31 (0.72–2.38), respectively. Conclusions: Several health measures in adolescents were found to be associated with future work marginalization in young adulthood. The associations remained significant, even after correcting for such strong predictors as the parents’ education and family economy. Total symptom burden and self-perceived general health can add additional knowledge onto how adolescent health is related to work marginalization, in a longitudinal perspective

• Ayazi, Touraj; Swartz, Leslie; Eide, Arne Henning; Lien, Lars & Hauff, Edvard (2015). Perceived current needs, psychological distress and functional impairment in a war-affected setting: a cross-sectional study in South Sudan. BMJ Open. ISSN 2044-6055. 5(8). doi: 10.1136/bmjopen-2014-007534. Vis sammendrag

  Objectives To examine the current perceived needs of the general population in a war-affected setting, and to study the influence of perceived needs on the participants’ mental health status and functional impairment across genders. Methods A cross-sectional community survey (n=464) was conducted in war-affected South Sudan. Three regression models were analysed. Perceived needs were assessed with the Humanitarian Emergency Settings Perceived Needs Scale. Psychological distress was measured with the General Health Questionnaire and level of functioning by the Short Form Health Survey (SF-12). Results The most frequently expressed needs were related to drinking water, alcohol and drug use in the community and access to sanitation facilities. No gender differences were found regarding the level of perceived needs or the number of traumatic events. Higher level of perceived needs significantly predicted psychological distress and lower level of functioning even when numbers of experienced trauma events were taken into account. Conclusions The associations of higher level of needs and trauma experiences, on the one hand, and negative health outcomes on the other, necessitate a greater integration of interventions directed towards the population's perceived needs and mental health, particularly for those who have been exposed to trauma.

• Khalifa, Dina Mohammed Sami; Glavin, Kari; Bjertness, Espen & Lien, Lars (2015). Postnatal depression among Sudanese women: Prevalence and validation of the Edinburgh Postnatal depression scale at 3 months postpartum. International Journal of Women's Health. ISSN 1179-1411. 7, s. 677–684. doi: 10.2147/IJWH.S81401. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Postnatal depression (PND) rates in low-resource countries have reached levels between 4.9% and 59%. Maternal mental health has not been researched in Sudan, and there are no existing statistics on prevalence or significant risk factors for PND. Consequently, no screening test has been validated to screen for PND at the primary health care level. This study investigates the 3 months prevalence of PND and validates the Edinburgh Postnatal Depression Scale (EPDS) against the Mini-International Neuropsychiatric Interview (MINI). Methodology: Pregnant Sudanese women in the second and third trimesters were recruited to the study during routine antenatal care visits in two major maternity hospitals in Khartoum state. They were screened for PND at 3 months postpartum using the EPDS. Test positive women were matched with test negative women according to nearest date of birth. A clinical psychologist verified their depression status using the MINI. Results: The follow-up rate was 79%. At a cutoff point of $12, the 3 months prevalence of PND was 9.2%. The sensitivity and specificity of the EPDS were 89% and 82%, respectively. The EPDS and MINI showed a strong positive relationship (odds ratio =36). The positive predictive value and negative predictive value, using this study’s prevalence, were 33% and 98.7%, respectively. The receiver operator characteristic analysis showed an area under the curve of 0.89. The cut-off point $12 was the most acceptable point as it had the lowest number needed to diagnose (1.4) and a false-positive rate of 18%. Conclusion: The EPDS is a valid tool for screening for PND on a Sudanese population. It was accepted, easily administered, and understood by postnatal women. Health care personnel, especially village midwives, should be trained on screening and referral of depressed women for clinical evaluation and management. Due to limited resources available in Sudan, shorter screening tests need to be validated in the future

• Sagatun, Åse; Heyerdahl, Sonja; Wentzel-Larsen, Tore & Lien, Lars (2015). Medical benefits in young adulthood: A population-based longitudinal study of health behaviour and mental health in adolescence and later receipt of medical benefits. BMJ Open. ISSN 2044-6055. 5(5). doi: 10.1136/bmjopen-2014-007139. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To examine the extent to which smoking, alcohol, physical activity and mental health problems in 15–16-year-olds are associated with receipt of medical benefits in young adulthood, after adjustment for confounders. Design: Prospective population-based cohort survey linked to national registers. Participants: In the ‘Youth studies’ from the Norwegian Institute of Public Health, 15 966 10th graders in 6 Norwegian counties answered a health behaviour and mental health questionnaire; 88% were linked to National Insurance Administration Registers (FD-Trygd). Outcome measure: Time to receipt of medical benefits, based on FD-Trygd. Follow-up was from age 18 years until participants were aged 22–26 years. Method: We performed Cox regression analyses to examine the extent to which variations in health behaviour and mental health problems during 10th grade were associated with receipt of medical benefits during follow-up. Results: Daily smoking at age 15–16 years was associated with a significant increase in hazard of receiving health benefits at follow-up compared with not smoking for boys, HR (95% CI) 1.56 (1.23 to 1.98), and for girls 1.47 (1.12 to 1.93). Physical activity was associated with a decrease in hazard compared with inactivity from 23% to 53% in boys and from 21% to 59% in girls, while use of alcohol showed a mixed pattern. The hazard for benefits use rose with increasing levels of emotional symptoms, peer problems, conduct problems and hyperactivity–inattention problems (Strengths and Difficulties Questionnaire) at 15–16 years among both genders. Conclusions: Health behaviour and mental health problems in adolescence are independent risk factors for receipt of medical benefits in young adulthood.

• Teodorescu, Dinu-Stefan; Heir, Trond; Siqveland, Johan; Hauff, Edvard; Wentzel-Larsen, Tore & Lien, Lars (2015). Chronic pain in multi-traumatized outpatients with a refugee background resettled in Norway: a cross-sectional study. BMC Psychology. ISSN 2050-7283. 3(1). doi: 10.1186/S40359-015-0064-5. Vis sammendrag

  Traumatized refugees often report significant levels of chronic pain in addition to posttraumatic stress disorder symptoms, and more information is needed to understand pain in refugees exposed to traumatic events. This study aimed to assess the frequency of chronic pain among refugee psychiatric outpatients, and to compare outpatients with and without chronic pain on trauma exposure, psychiatric morbidity, and psychiatric symptom severity. We conducted a cross-sectional study of sixty-one psychiatric outpatients with a refugee background using structured clinical diagnostic interviews to assess for traumatic events [Life Events Checklist (LEC)], PTSD (Posttraumatic Stress Disorder) and complex PTSD [Structured Clinical Interview for DSM-IV PTSD Module (SCID-PTSD) and Structured Interview for Disorders of Extreme Stress (SIDES)], chronic pain (SIDES Scale VI) and psychiatric symptoms [M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.)]. Self-report measures were used to assess symptoms of posttraumatic stress [Impact of Event Scale-revised (IES-R)], depression and anxiety [Hopkins Symptom Checklist (HSCL-25)] and several markers of acculturation in Norway. Of the 61 outpatients included, all but one reported at least one chronic pain location, with a mean of 4.6 locations per patient. Chronic pain at clinical levels was present in 66% of the whole sample of outpatients, and in 88% of the outpatients with current PTSD diagnosis. The most prevalent chronic pain locations were head (80%), chest (74%), arms/legs (66%) and back (62%). Women had significantly more chronic pain locations than men. Comorbid PTSD and chronic pain were found in 57% of the outpatients. Significant differences were found between outpatients with and without chronic pain on posttraumatic stress, psychological distress, and DESNOS severity. Chronic pains are common in multi-traumatized refugees in outpatient clinics in Norway, and are positively related to symptomatology and severity of psychiatric morbidity. The presence of chronic pain, as well as comorbid chronic pain and PTSD, in psychiatric outpatients with a refugee background call for an integrated assessment and treatment for both conditions

• Dalgard, Florence; Gieler, Uwe; Tomas-Aragones, Lucia; Lien, Lars; Poot, Francoise & Jemec, Gregor B E [Vis alle 20 forfattere av denne artikkelen] (2015). The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries. Journal of Investigative Dermatology. ISSN 0022-202X. 135, s. 984–991. doi: 10.1038/jid.2014.530. Vis sammendrag

  The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants––3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67–3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68–2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33–2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

• Sørensen, Torgeir; Lien, Lars; Landheim, Anne & Danbolt, Lars Johan (2015). Meaning-Making, Religiousness and Spirituality in Religiously Founded Substance Misuse Services—A Qualitative Study of Staff and Patients’ Experiences. Religions. ISSN 2077-1444. 6(1), s. 92–106. doi: 10.3390/rel6010092. Vis sammendrag

  The Norwegian health authorities buy one third of their addiction treatment from private institutions run by organizations and trusts. Several of these are founded on religious values. The aim of the study was to investigate such value-based treatment and the patients’ experiences of spirituality and religiousness as factors of meaning-making in rehabilitation. The study was performed in an explorative qualitative design. Data were collected through focus-group interviews among therapists and in-patients at a religiously founded substance misuse service institution. The analysis was carried out by content analysis through systematic text-condensation. Through different activities and a basic attitude founded on religious values, the selected institution and the therapists facilitated a treatment framework which included a spiritual dimension and religious activity. The patients appreciated their free choice regarding treatment approaches, which helped them to make meaning of life in various collective and individual settings. Rituals and sacred spaces gave peace of mind and confidence in a situation that up to now had been chaotic and difficult. Sermons and wording in rituals contributed to themes of reflection and helped patients to revise attitudes and how other people were met. Private confessions functioned for several patients as turning point experiences influencing patients’ relations to themselves and their surroundings. Spirituality and religious activity contributed to meaning-making among patients with substance use disorder and had significance for their rehabilitation

• Neupane, Sudan Prasad; Lien, Lars; Ueland, Thor; Mollnes, Tom Eirik; Aukrust, Pål & Bramness, Jørgen Gustav (2015). Serum brain-derived neurotrophic factor levels in relation to comorbid depression and cytokine levels in Nepalese men with alcohol-use disorders. Alcohol. ISSN 0741-8329. 49(5), s. 471–478. doi: 10.1016/j.alcohol.2015.01.012. Vis sammendrag

  Neurodegenerative and inflammatory processes are involved separately in major depression (MD) and alcohol-use disorders (AUD). Little is known about the nature of this relationship in the context of comorbid AUD and depression disorders. In this study, we determined brain-derived neurotrophic factor (BDNF) serum levels in patients with AUD and tested whether BDNF levels were related to history of major depression, recent depressive symptoms, AUD severity, and TNF-α and IL-6 levels. Nepalese male AUD inpatients (N = 152) abstinent from alcohol for an average of 34 days were administered structured interviews to assess depression symptoms and pattern and extent of alcohol use, and to generate research diagnoses for AUD and MD. AUD severity was assessed by scores on the Alcohol Use Disorder Identification Test. Serum BDNF and cytokines were measured using ELISA and multiplex technology, respectively. Although serum BDNF levels were unrelated to MD history, patients with recent depressive symptoms (n = 42) had lower (mean ± SD) BDNF serum levels compared to those without (n = 110) (21.6 ± 8.1 ng/mL vs. 26.0 ± 9.6 ng/mL; p = 0.010), and patients with higher AUD severity and binge-drinking patterns had higher mean serum BDNF levels compared to lower AUD severity and non-binging (25.9 ± 9.7 ng/mL vs. 22.1 ± 8.7 ng/mL; p = 0.022 and 25.7 ± 9.3 vs. 21.8 ± 9.7 ng/mL; p = 0.029, respectively). Positive correlations were present between BDNF and TNF-α (r = 0.39, p < 0.001) and IL-6 (r = 0.2, p = 0.027). In particular, TNF-α levels were predictive of BDNF levels after controlling for confounders (B = 0.3 [95% CI = 0.2–0.5], p < 0.001). These findings show that in alcohol-using populations, peripheral BDNF levels are related to severity of AUD as well as presence of depressive symptoms. The significant associations between inflammatory and neurotrophic factors may have implications for neuroadaptive changes during recovery from AUD.

• Salah, Tarig; Ayazi, Touraj; Lien, Lars; Eide, Arne Henning & Hauff, Edvard (2015). Social phobia among long-term internally displaced persons: An epidemiological study of adults in two internally displaced person settlements in Sudan. International Journal of Social Psychiatry. ISSN 0020-7640. 61(6), s. 550–559. doi: 10.1177/0020764014564800. Vis sammendrag

  Background: Despite the high worldwide prevalence and association with other mental disorders and disability, only few studies are available on social phobia in low-income countries. Aims: This study aims to assess the prevalence, socio-demographic correlates and comorbidity of social phobia and its association with disability among long-term internally displaced persons (IDPs) in one urban and one rural area in Central Sudan. Methods: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas. Results: The overall lifetime prevalence of social phobia was 14.2%, with higher rates among IDPs in the rural area and among those who were less educated. Social phobia was associated with other mental disorders in both study areas. Disability and prolonged displacement increased the risk of having social phobia in the rural area. Conclusion: Further work needs to be done to improve our understanding and to establish proper interventions in dealing with social phobia, other common mental disorders and disability among long-term IDPs in these impoverished areas.

• Neupane, Sudan Prasad; Lien, Lars; Martinez, Priscilla; Hestad, Knut & Bramness, Jørgen Gustav (2015). The relationship of alcohol use disorders and depressive symptoms to tryptophan metabolism: Cross-sectional data from a nepalese alcohol treatment sample. Alcoholism: Clinical and Experimental Research. ISSN 0145-6008. 39(3), s. 514–521. doi: 10.1111/acer.12651. Vis sammendrag

  Background Activation of the kynurenine pathway of tryptophan metabolism results in increased production of potentially depressogenic tryptophan catabolites and a reduction in tryptophan availability for serotonin synthesis. As alcohol consumption affects tryptophan metabolism and disposition, we determined serum levels of tryptophan, kynurenine, and an index of tryptophan degradation (kynurenine/tryptophan ratio) in patients with alcohol-use disorder (AUD) and compared their levels considering abstinence duration, AUD severity, and comorbid depression. Methods The study sample included 169 AUD inpatients from 8 alcohol treatment facilities in Kathmandu, Nepal. The Composite International Diagnostic Interview was administered to generate the AUD diagnosis. The Alcohol Use Disorder Identification Test (AUDIT) captured AUD severity and patterns of alcohol use. The Hopkins Symptom Checklist-25 was used to reveal current depressive symptoms. Serum kynurenine and tryptophan levels were determined by high-performance liquid chromatography, and tryptophan degradation was measured by KT ratio (kynurenine/tryptophan × 103). Results Patients with above average AUDIT scores had higher mean serum levels of kynurenine (2.1 μM ± 0.7 vs. 1.8 μM ± 0.6, p = 0.006) and KT ratios (48.6 ± 17.6 vs. 40.4 ± 14.3, p = 0.002) than those with below average scores. Patients with current depressive symptoms had higher mean tryptophan concentrations (49.9 μM ± 13 vs. 45.7 μM ± 14.1, p = 0.047) and lower KT ratios (41.4 ± 14 vs. 47.5 ± 17.6, p = 0.028) compared to patients whose reported depressive symptoms were below the standard cutoff. Higher tryptophan levels and lower KT ratios in the depressed group were specific to patients with longer abstinence and higher AUD severity. Conclusions Depression-related deregulation in tryptophan metabolism was found to depend on length of abstinence and on AUD severity. Together, results suggest that in AUD populations, peripheral tryptophan metabolism is subject to interactions between AUD severity and depressive symptoms

• Bratlien, Unni; Øie, Merete Glenne ; Haug, Elisabeth; Møller, Paul; Andreassen, Ole Andreas & Lien, Lars [Vis alle 7 forfattere av denne artikkelen] (2015). Self-reported symptoms and health service use in adolescence in persons who later develop psychotic disorders: A prospective case-control study. Early Intervention in Psychiatry. ISSN 1751-7885. 9(3), s. 221–227. doi: 10.1111/eip.12102. Vis sammendrag

  Aim To investigate self-reported psychiatric and somatic symptoms and health service use at age 16 in persons who later developed a psychotic disorder compared with a control group from the same geographical areas. Method Responses concerning psychiatric or somatic health and health service use from Norwegian youth studies in a cohort of 15- and 16-year-olds in three Norwegian counties (N = 11 101, 90% response rate) were gathered. The questionnaire responses from persons later identified with a lifetime diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) psychotic disorders (n = 30) (confirmed psychosis, CP) were compared with responses from the rest of the group (population control, PC) (n = 11 067). Follow-up analyses were made for cases with a confirmed onset of a psychotic disorder after the time of the survey (n = 21). Results The main significant differences between the CP and PC groups were more self-reported anxiety, depression and ‘feeling in need of treatment for eating disorders’ at age 16 in the CP group. The rate of self-reported eating disorder symptoms alone reached the level of statistical significance in the follow-up analyses. The CP group did not use available health services to a markedly greater extent than the control group. Conclusion We found that, in comparison with others, youths who were later identified with a psychotic disorder reported more symptoms at age 16.

• Abebe, Dawit Shawel; Lien, Lars & Hjelde, Karin Harsløf (2014). What We Know and Don't Know About Mental Health Problems Among Immigrants in Norway. Journal of Immigrant and Minority Health. ISSN 1557-1912. 16(1), s. 60–67. doi: 10.1007/s10903-012-9745-9. Fulltekst i vitenarkiv
• Zeratsion, Henok Tesfay; Bjertness, Cecilie Bergsmark; Bjertness, Espen; Dalsklev, Madeleine Mahin; Haavet, Ole Rikard & Halvorsen, Jon Anders [Vis alle 8 forfattere av denne artikkelen] (2014). The Influence of Parental Divorce on Educational Ambitions of 18/19 Year-Old Adolescents from Oslo, Norway. Journal of Child and Family Studies. ISSN 1062-1024. doi: 10.1007/s10826-014-0090-6. Vis sammendrag

  Former studies have shown that children and adolescents of divorced parents have significantly poorer educational attainment than their peers from continuously married parents. Educational ambition is important because it has relationship with educational attainment. Our aim was to investigate the associations between parental divorce and educational ambitions among adolescents in the Scandinavian region. Data were used from Young-HUBRO surveys that were conducted in Oslo in the years 2000/2001 and 2004. A change in educational ambition was investigated in a prospective study (n = 1,861) by comparing 18/19 year-olds who experienced late parental divorce with adolescents of continuously married parents. 18/19 year-old adolescents who experienced parental divorce during childhood or adolescence were compared in a cross-sectional study (n = 2,391) with their peers from continuously married parents. Multinomial logistic regression models were fitted to include, among others, mental health problem as a potential confounder. The prospective study showed that a change from ambition for university/college education to having undecided educational ambition was significantly higher among adolescents with experience of late parental divorce than among adolescents of continuously married parents (OR 1.8; 95 % CI 1.1–3.0). In the cross-sectional study, adolescents who experienced parental divorce during childhood or adolescence were more likely to have undecided educational ambition, compared to their peers from continuously married parents (OR 1.3; 95 % CI 1.1–1.8). In conclusion, experience of parental divorce seems to be associated with undecided educational ambition among 18/19 year-old adolescents. Mechanisms that reduce the adverse influence of parental divorce on educational ambitions need to be in place

• Strømme, Kirsten Kierulf; Strømme, Petter; Bjertness, Espen & Lien, Lars (2014). Intrauterine growth restriction: A population-based study of the association with academic performance and psychiatric health. Acta Paediatrica. ISSN 0803-5253. 103(8), s. 886–891. doi: 10.1111/apa.12657. Vis sammendrag

  To investigate whether intrauterine growth restriction (IUGR), resulting in small for gestational age (SGA) infants, is associated with increased susceptibility to psychiatric problems and academic impairment in late teens. A cohort of all 10th-grade students in Oslo, Norway, followed up between 2001 and 2004 (n = 2131), was linked with foetal growth data. IUGR was considered equal to SGA at the lowest 2.5th, 5th, and 10th percentiles and appropriate for gestational age (AGA) as the highest 90th percentile. Mental health was evaluated using the Hopkins Symptoms Check List and the Strength and Difficulties Questionnaire, and academic achievements and ambitions were self-reported by the students.Psychiatric problems were equally prevalent in all groups. However, the SGA girls performed inferiorly compared to their AGA peers in the school subjects English [3.6 vs 3.9 (p = 0.03)], mathematics [4.0 vs 4.3 (p = 0.01)] and social science [4.2 vs 4.4 (p = 0.05)], but not for Norwegian. This association was not observed in boys. There was an association between academic impairment and prematurity, occurring more frequently among immigrants (p < 0.001). SGA had a small negative impact on academic achievements in adolescent girls, but not boys. There was no association between SGA and psychiatric problems in either gender

• Halvorsen, Jon Anders; Lien, Lars; Dalgard, Florence; Bjertness, Espen & Stern, Robert (2014). Suicidal ideation, mental health problems, and social function in adolescents with eczema: A population-based study. Journal of Investigative Dermatology. ISSN 0022-202X. 134(7), s. 1847–1854. doi: 10.1038/jid.2014.70. Vis sammendrag

  There are few studies on psychosocial problems in adolescents with eczema. We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning with eczema. A total of 4,744 adolescents (18–19 years) were invited for the study, of whom 3,775 (80%) participated. The overall prevalence of current eczema was 9.7%. Among those with current eczema, 15.5% reported suicidal ideation compared with 9.1% among those without eczema, significantly associated in a multivariate model (odds ratio 1.87, 95% confidence interval 1.31–2.68). In a subgroup analyses, the prevalence of suicidal ideation in those with both eczema and itch was 23.8%, and was significantly associated, compared with those without eczema (3.57, 2.46–5.67). Eczema was associated with mental health problems assessed by the Strength and Difficulties Questionnaire (1.72, 1.21–2.45) and the Hopkins Symptom Checklist 10 (1.63, 1.23–2.16). Five questions assessed social function: feeling attached to family and friends; thriving at school; experiencing bullying; and romantic relationships. Boys with current eczema were less likely to have had romantic relationships (1.93, 1.21–3.08). Eczema in late adolescence is associated with suicidal ideation and mental health problems but rarely with social problems. Our findings point to the importance of addressing mental health issues in adolescents with eczema

• Martinez, Priscilla; Lien, Lars; Landheim, Anne; Kowal, Paul & Clausen, Thomas (2014). Quality of life and social engagement of alcohol abstainers and users among older adults in South Africa. BMC Public Health. ISSN 1471-2458. 14(316). doi: 10.1186/1471-2458-14-316. Vis sammendrag

  Background: The literature from developed countries suggests a relationship between alcohol use and quality of life and social engagement, where harmful drinkers have lower quality of life and less social engagement. Despite the high rates of harmful alcohol use in South Africa, little is known about the association between drinking pattern and quality of life and social engagement in this context. We aimed to determine if quality of life and social engagement varied across different drinking patterns among older South African adults, contributed to drinking pattern when controlling for socio-demographic factors, and varied differentially between genders. Methods: This is a secondary analysis of data from the Survey on Global Ageing and Adult Health (SAGE). Alcohol use was measured as self-reports of use over the previous seven days, and we constructed gender-specific alcohol variables. The WHO Quality of Life-scale was used to measure quality of life, and social engagement was measured by frequency of participation in social activities. We used ANOVA to observe differences in quality of life and social engagement scores across drinking patterns, and regression models were used to identify factors independently associated with drinking pattern. Results: There were 2572 (84.4%) lifetime abstainers, and 475 (15.6%) persons who had a drink in the last 7 days. In bivariate analysis, quality of life was lowest among at risk drinking men compared to abstainers (OR = 0.21, p = 0.02), although this association was not significant in adjusted analysis. Social engagement did not vary statistically significantly across the drinking patterns in the total sample or within gender. Conclusions: Quality of life and social engagement were not independently associated with drinking pattern among older adults in South Africa in this sample. In order to better understand their alcohol use, further exploratory research is warranted to identify other potentially relevant subjective factors of alcohol use among older adults in South Africa.

• Abebe, Dawit Shawel; Hafstad, Gertrud Sofie; Brunborg, Geir Scott; Kumar, Bernadette. N & Lien, Lars (2014). Binge drinking, cannabis and tobacco use among ethnic Norwegian and ethnic minority adolescents in Oslo, Norway. Journal of Immigrant and Minority Health. ISSN 1557-1912. doi: 10.1007/s10903-014-0077-9. Vis sammendrag

  The aim of the study was to assess prevalence and factors associated with binge drinking, cannabis use and tobacco use among ethnic Norwegians and ethnic minority adolescents in Oslo. We used data from a school-based cross-sectional survey of adolescents in junior- and senior high schools in Oslo, Norway. The participants were 10,934 adolescents aged 14 to 17 years, and just over half were females. The sample was comprised of 73.2% ethnic Norwegian adolescents, 9.8% 1st generation immigrants, and 17% 2nd generation adolescents from Europe, the US, the Middle East, Asia and Africa. Logistic regression models were applied for the data analyses. Age, gender, religion, parental education, parent-adolescent relationships, depressive symptoms and loneliness were as covariates in the regression models. Ethnic Norwegian adolescents reported the highest prevalence of binge drinking (16.1%), whereas the lowest prevalence was found among 2nd generation adolescents from Asia (2.9%). Likewise, the past-year prevalence for cannabis use ranged from 10.6% among 2nd generation Europeans and those from the US to 3.7% among 2nd generation Asians. For daily tobacco use, the prevalence ranged from 12.9% among 2nd generation Europeans and the US to 5.1% among 2nd generation Asians. Ethnicity, age, gender, religion, parental education, and parent-adolescent relationships and mental health status were significantly associated with binge drinking, cannabis and tobacco use. These factors partly explained the observed differences between ethnic Norwegians and ethnic minority adolescents in the current study. There are significant differences in substance use behaviors between ethnic Norwegian and immigrant youth. Factors like age, gender, religion, parental education and relationships and mental health status might influence the relationship between ethnicity and substance abuse. The findings have implications for planning selective- as well as universal prevention interventions.

• Zeratsion, Henok Tesfay; Bjertness, Cecilie Bergsmark; Lien, Lars; Haavet, Ole Rikard; Dalsklev, Madeleine Mahin & Halvorsen, Jon Anders [Vis alle 8 forfattere av denne artikkelen] (2014). Does parental divorce increase risk behaviors among 15/16 and 18/19 year-old adolescents? A study from Oslo, Norway. Clinical Practice and Epidemiology in Mental Health. ISSN 1745-0179. 10, s. 59–66. doi: 10.2174/1745017901410010059.
• Neupane, Sudan Prasad; Lien, Lars; Martinez, Priscilla; Aukrust, Pål; Ueland, Thor & Mollnes, Tom Eirik [Vis alle 8 forfattere av denne artikkelen] (2014). High frequency and intensity of drinking may attenuate increased inflammatory cytokine levels of major depression in alcohol-use disorders. CNS Neuroscience & Therapeutics. ISSN 1755-5930. 20(10), s. 898–904. doi: 10.1111/cns.12303. Fulltekst i vitenarkiv Vis sammendrag

  As major depression (MD) is often comorbid with alcohol-use disorders (AUD) and alcohol itself modulates the immune system, we examined serum levels of interleukin (IL)-6, IL-10, tumor necrosis factor (TNF), and interferon (IFN)-γ in AUD patients with and without MD. Putative interactions between alcohol variables and MD on cytokine levels were also assessed. A consecutive sample of inpatients with AUD (N = 176) from eight alcohol treatment centers in Kathmandu, Nepal, was assessed for alcohol use and depression by administering fully structured psychiatric interviews. Serum cytokine levels were determined using multiplex technology. Alcohol-use disorders patients with a positive history of MD had higher levels of the inflammatory cytokines IL-6 (P = 0.019), TNF (P = 0.020), and IFN-γ (P = 0.001), but not of IL-10 (P = 0.853). AUD patients with MD had higher concentrations of cytokines compared with those without, regardless of the severity of the alcohol problem, but the difference was greater among those drinking in lower frequency and intensity. These findings provide evidence for altered functioning of the immune system in AUD patients with comorbid MD. However, frequent and intense drinking may attenuate the difference in the cytokine profiles between AUD patients with and without MD

• Ayazi, Touraj; Lien, Lars; Eide, Arne Henning; Swartz, Leslie & Hauff, Edvard (2014). Association between exposure to traumatic events and anxiety disorders in a post-conflict setting: a cross-sectional community study in South Sudan. BMC Psychiatry. ISSN 1471-244X. 14:6. doi: 10.1186/1471-244X-14-6. Vis sammendrag

  Background The negative effect of exposure to traumatic events on mental health is well known. Most studies of the effects of trauma on mental health in war-affected populations have focused on post-traumatic stress disorder (PTSD) and depression. Although some studies confirm the existence of anxiety symptoms in war-affected populations, the extent to which exposure to traumatic events is independently associated with anxiety diagnoses (other than PTSD) has received less attention. The study aimed to determine whether having an anxiety diagnosis, other than PTSD, was associated with experiencing traumatic events in a post-conflict setting, across genders and after controlling for demographic and socio-economic variables. Methods In this cross-sectional community study (n = 1200), we applied the Harvard Trauma Questionnaire (HTQ) to investigate the extent of trauma exposure and PTSD. The Mini-International Neuropsychiatric Interview (MINI) was used to investigate the prevalence of anxiety disorders: generalized anxiety disorder (GAD), panic disorder (PD), social phobia, obsessive-compulsive disorder (OCD), and agoraphobia. Multinomial logistic regression analyses were conducted to examine the association between these disorders, previous trauma exposure, and socio-economic factors. Results The participants were 56.4% male and 43.6% female. The age ranged between 18 and 73 years old (Mean 34.63, SD = 12.03). The estimated rates of GAD-only and PD-only (without comorbidity with PTSD) were 5.5% and 3.1%, respectively. Exposure to traumatic events and socio-economic disadvantage were significantly associated with having one or more anxiety diagnoses. After controlling for age, sex, rural/urban setting, and socio-economic disadvantage, exposure to trauma was independently associated with anxiety diagnosis. There were gender differences in the pattern of risk factors for having PTSD, GAD or PD. Conclusion In individuals with a history of war-related trauma exposure, attention should be given to symptoms of GAD and PD, in addition to PTSD symptoms

• Sagatun, Åse; Heyerdahl, Sonja; Wentzel-Larsen, Tore & Lien, Lars (2014). Mental health problems in the 10th grade and non-completion of upper secondary school: the mediating role of grades in a population-based longitudinal study. BMC Public Health. ISSN 1471-2458. 14:16. doi: 10.1186/1471-2458-14-16. Vis sammendrag

  Background School drop-out is a problem all over the world with adverse life-course consequences. The aim of this paper is to study how internalising and externalising problems in the 10th grade are associated with non-completion of upper secondary school, and to examine the mediating role of grade points in the 10th grade across general academic and vocational tracks in upper secondary school. We also study the impact of health behaviour. Methods Population-based health surveys were linked with Norwegian registries on education and sociodemographic factors (n?=?10 931). Mental health was assessed by the self-report Strengths and Difficulties Questionnaire. Logistic regression was used to analyse the relations between mental health and health behaviour in 10th grade and non-completion of upper secondary school. The mediating effect of grade points was studied by causal mediation analysis. Results Adolescents not completing upper secondary school reported more externalising problems and girls more internalising problems in the 10th grade, after adjustments. Smoking and physical inactivity increased the odds of non-completion of upper secondary school. Causal mediation analyses showed that a reduction in externalising problems of 10 percentage points led to lower rates of non-completion of 4?5 percentage points, and about three-quarters of this total effect was mediated by grades. For internalising problems the total effect was significant only for girls (1 percentage point), and the mediated effect of grades was about 30%. The effect of mental health problems on school dropout was mainly the same in both vocational and general tracks. Conclusions Assuming a causal relationship from mental health problems to school performance, this study suggests that externalising problems impair educational attainment. A reduction of such problems may improve school performance, reduce school drop-out and reduce the adverse life-course consequences.

• Bratlien, Unni; Øie, Merete Glenne ; Haug, Elisabeth; Møller, Paul; Andreassen, Ole Andreas & Lien, Lars [Vis alle 7 forfattere av denne artikkelen] (2014). Environmental factors during adolescence associated with later. Development of psychotic disorders: a nested case-control study. Psychiatry Research. ISSN 0165-1781. 215(3), s. 579–585. doi: 10.1016/j.psychres.2013.12.048. Fulltekst i vitenarkiv Vis sammendrag

  Etiologies of psychotic disorders (schizophrenia and bipolar disorder) are conceptualized as interplay between genetic and environmental factors. The adolescent period is characterized by changes in social roles and expectations that may interact with biological changes or psychosocial stressors. Few studies focus on the adolescents’ own reports of perceived risk factors. To assess differences at age 16 between persons who later develop psychotic disorders (“Confirmed Psychosis”, CP) and their class-mates (“Population Controls”, PC) we collected information on: (1) Social support factors (size of social network and expectancies of social support from friends), (2) Cognitive functioning (concentrating in the classroom, actual grades and expectancies of own academic achievements) and (3) Problems and stressors in families (illness or loss of work for parents), and in relationship with others (exposure to bullying, violence or sexual violation). Self-reported data from students at 15–16 years of age were linked to the case-registers from the “Thematically Organized Psychosis (TOP) Study”. The CP group reported more economic problems in their families, smaller social network and lower academic expectation than the PC group. The results support the notion that long-term socioeconomic stressors in adolescence may serve as risk factors for the development of psychotic disorders

• Abebe, Dawit Shawel; Torgersen, Leila; Lien, Lars; Hafstad, Gertrud Sofie & von Soest, Tilmann (2014). Predictors of Disordered Eating in Adolescence and Young Adulthood: A Population-Based, Longitudinal Study of Females and Males in Norway. International Journal of Behavioral Development. ISSN 0165-0254. 38(2), s. 128–138. doi: 10.1177/0165025413514871. Fulltekst i vitenarkiv
• Bratlien, Unni; Øie, Merete Glenne ; Lien, Lars; Agartz, Ingrid; Romm, Kristin Lie & Vaskinn, Anja [Vis alle 9 forfattere av denne artikkelen] (2013). Social dysfunction in first-episode psychosis and relations to neurocognition, duration of untreated psychosis and clinical symptoms. Psychiatry Research. ISSN 0165-1781. 207(1-2), s. 33–39. doi: 10.1016/j.psychres.2012.10.010.
• Hustoft, Hilde; Hestad, Knut; Lien, Lars; Møller, Paul & Danbolt, Lars Johan (2013). "If I Didn't Have My Faith I Would Have Killed Myself!": Spiritual Coping in Patients Suffering From Schizophrenia. The international journal for the psychology of religion. ISSN 1050-8619. 23(2), s. 126–144. doi: 10.1080/10508619.2012.688003.
• Salah, Tarig; Abdelrahman, Abdallah; Lien, Lars; Eide, Arne Henning; Martinez, Priscilla & Hauff, Edvard (2013). The mental health of internally displaced persons: An epidemiological study of adults in two settlements in Central Sudan. International Journal of Social Psychiatry. ISSN 0020-7640. 59(8), s. 782–788. doi: 10.1177/0020764012456810. Vis sammendrag

  Aims: There is a scarcity of data on mental health problems among Sudanese internally displaced persons (IDPs). This study aims to assess the prevalence of mental disorders of IDPs in Sudan, and to determine and compare the association between mental disorders and socio-demographic variables between the rural and urban long-term IDP populations. Methods: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas. Results: The overall prevalence of having any mental health disorder in the IDP population was 52.9%. The most common disorders were major depressive disorder (24.3%), generalized anxiety disorder (23.6%), social phobia (14.2%) and post-traumatic stress disorder (12.3%). Years of displacement and education were associated with different mental disorders between the two areas, and there were no gender differences in prevalence of mental disorders in either area. Conclusion: This study shows high prevalence rates of mental disorders in both urban and rural IDP populations in Sudan, indicating a need to explore the circumstances for these high rates and to develop appropriate responses.

• Lien, Lars & Welander-Vatn, Audun (2013). Factors associated wity the persistence of bullying victimization from 10th grade to 13th grade: a longitudinal study. Clinical Practice and Epidemiology in Mental Health. ISSN 1745-0179. 9, s. 243–250. doi: 10.2174/1745017901309010243. Vis sammendrag

  Background: Bullying among adolescents represents a major public health challenge. The aim of this study was to map the stability of bullying victimization across the transitional phase from lower to upper secondary school, and to describe the sociodemographic, academic and health-related characteristics of those bullied during the transition. Method: 3674 Norwegian adolescents were followed longitudinally from the age of 15/16 until the age of 18/19, answering questionnaires about health, academic achievements, life events, lifestyle and sociodemography. The 337 participants reporting exposure to bullying victimization at age 15/16 were the target group, as we made comparisons between those reporting victimization only at the age of 15/16 (n=289) with the participants for whom the bullying had continued into later adolescence (n = 48). Results: 14% of those victimized at age 15/16, reported continuation of bullying victimization into upper secondary school. These adolescents were significantly more likely to report having divorced parents, low parental educational level, poor self-perceived economy, muscle and skeletal pain, symptoms of mental distress, lower school marks in Norwegian and higher body-mass index (BMI) when group differences at age 18/19 were assessed through basic inferential statistical tests. However, the multivariate logistic regression analyses only revealed statistically significantly increased adjusted odds ratios for the variables mental distress and school-marks in Norwegian. Conclusion: The persistence of exposure to bullying from 10th grade to 13th grade is associated with mental health complaints and poor school performance. Preventive measures to take care of students being continuously bullied should be in place in secondary schools

• Fredheim, Terje; Haavet, Ole Rikard; Danbolt, Lars Johan; Kjønsberg, Kari & Lien, Lars (2013). Intellectual disability and mental health problems: a qualitative study of general practitioners' views. BMJ Open. ISSN 2044-6055. 3. doi: 10.1136/bmjopen-2012-002283. Vis sammendrag

  To investigate general practitioners' (GPs) experiences in managing patients with intellectual disabilities (ID) and mental and behavioural problems (MBP). DESIGN: Qualitative study using in-depth interviews. SETTING: General practice in Hedmark county, Norway. PARTICIPANTS: 10 GPs were qualitatively interviewed about their professional experience regarding patients with ID and MBP. Data were analysed by all authors using systematic text condensation. RESULTS: The participants' knowledge was primarily experience-based and collaboration with specialists seemed to be individual rather than systemic. The GPs provided divergent attitudes to referral, treatment, collaboration, regular health checks and home visits. CONCLUSIONS: GPs are in a position to provide evidence-based and individual treatment for both psychological and somatic problems among patients with ID. However, they do not appear to be making use of evidence-based treatment decisions. The GPs feel that they are left alone in decision-making, and find it difficult to find trustworthy collaborative partners. The findings in this study provide useful information for further research in the field

• Ayazi, Touraj; Lien, Lars; Eide, Arne Henning; Shadar, Elizabeth Joseph Shadar & Hauff, Edvard (2013). Community attitudes and social distance towards the mentally ill in South Sudan: a survey from a post-conflict setting with no mental Health services. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. doi: 10.1007/s00127-013-0775-y. Vis sammendrag

  Purpose This study investigates attitudes and social distance towards the mentally ill in a post-conflict, low-income country. Methods A cross-sectional community survey (n = 1,200) was conducted in South Sudan. Associations between various sociodemographic variables and attitudes toward/social distance from the mentally ill were investigated. Results The regression analysis showed that lower levels of education were positively associated with social distance, and Christian or Muslim beliefs, compared with traditional beliefs, were negatively associated with social distance. Familiarity with mental illness or psychological distress was not significantly associated with social distance. Participants who endorsed community-oriented attitudes (rather than hospital/drug-oriented attitudes) about health care for the mentally ill were more likely show a decreased social distance. Participants who believed that the mentally ill were dangerous had higher scores on the social distance scale. Conclusions A high level of stigma towards the mentally ill exists in South Sudan, especially in the rural areas. Alongside efforts to build up mental health services in South Sudan, the existing stigma needs to be addressed. Information regarding the role of the community both in preventing mental illnesses and in service delivery should be prioritised.

• Strøm, Ida Frugård; Thoresen, Siri; Wentzel-Larsen, Tore; Hjemdal, Ole Kristian; Lien, Lars & Dyb, Grete (2013). Exposure to life adversity in high school and later work participation: A longitudinal population-based study. Journal of Adolescence. ISSN 0140-1971. 36(6), s. 1143–1151. doi: 10.1016/j.adolescence.2013.09.003. Vis sammendrag

  This paper investigates whether exposure to violence, sexual abuse, or bullying is associated with later work participation and whether high school completion has a potential mediating role. Self-reported junior high school questionnaire data were linked for eight consecutive years to prospective registry data for the demographics, educational progress, employment activity, and social benefits of 11,874 individuals. Ordinal regression analysis showed that violence and/or bullying at 15 years of age predicted negative work participation outcomes eight years later, independent of high school completion and other relevant factors. Although increasing educational level may have some preventive effect, these results indicate that prevention efforts should be initiated at an early age and should target adverse life experiences.

• Tennegedara, Saheer; Lien, Lars; Hauff, Edvard & Kumar, Bernadette. N (2013). Ethnic differences in seasonal affective disorder and associated factors among five immigrant groups in Norway. Journal of Affective Disorders. ISSN 0165-0327. 151(1), s. 237–242. doi: 10.1016/j.jad.2013.05.086.
• Zeratsion, Henok Tesfay; Dalsklev, Madeleine Mahin; Bjertness, Espen; Lien, Lars; Haavet, Ole Rikard & Halvorsen, Jon Anders [Vis alle 8 forfattere av denne artikkelen] (2013). Parental divorce in late adolescence does not seem to increase mental health problems: a population study from Norway. BMC Public Health. ISSN 1471-2458. 13. doi: 10.1186/1471-2458-13-413.
• Neupane, Sudan Prasad; Lien, Lars; Hilberg, Thor & Bramness, Jørgen Gustav (2013). Vitamin D deficiency in alcohol-use disorders and its relationship to comorbid major depression: A cross-sectional study of inpatients in Nepal. Drug and Alcohol Dependence. ISSN 0376-8716. 133(2), s. 480–485. doi: 10.1016/j.drugalcdep.2013.07.006. Vis sammendrag

  Background Mounting evidence suggests that deficiency of vitamin D may be associated with major health problems, including alcohol-use disorders (AUD) and major depression (MD). This study aimed to identify the vitamin D status of Nepalese inpatients with an AUD. We explored socio-demographic and alcohol-use related correlates and the relationship between vitamin D deficiency and comorbid MD. Methods A cross-sectional study was conducted on AUD inpatients (N = 174) at eight alcohol/drug treatment centres around Kathmandu. Structured questionnaires were administered to assess the socio-demographic and alcohol-use parameters and to establish DSM-IV diagnoses of AUD and MD. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25(OH)D) concentration of <50 nmol/L. Results The prevalence of vitamin D deficiency was 64%. Higher age, having a stable job or business, shorter time since last alcohol intake and winter serum samples were related to having lower 25(OH)D levels. Several features of AUD severity were associated with low vitamin D levels: guilt about drinking, using alcohol as eye-opener, and history of relapse after alcohol treatment (p ≤ 0.03). Patients with a comorbid major depression, in particular secondarily depressed cases, were less likely to have vitamin D deficiency (X2 = 6.8; p = 0.01). Conclusions This study confirms high rates of vitamin D deficiency in alcohol treatment sample and shows a positive association between vitamin D deficiency and severity of alcohol-use disorders. Competing risk and other confounders may help explain the vitamin D status among patients with alcohol-use disorders and comorbid major depression.

• Hustoft, Hilde; Hestad, Knut; Lien, Lars; Teglbjaerg, Hanne Stubbe & Danbolt, Lars Johan (2013). Expressive art therapy for psychosis: A multiple case study. The Arts in Psychotherapy. ISSN 0197-4556. 40(3), s. 312–321. doi: 10.1016/j.aip.2013.05.011. Vis sammendrag

  A number of researchers have pointed to the value of art therapy for patients suffering from psychosis. Even so, it still remains unclear how and why art therapy works. This article describes the course of an art therapy group for five women suffering from psychotic disorder and their statements of the usefulness of the therapy. The group focused on exploring the patient's psychotic experience expressed through her artwork. Hopefully, this study will contribute to deepen the understanding of the working mechanisms of art therapy.

• Ayazi, Touraj; Lien, Lars; Eide, Arne; Jenkins, Rachel; Albino, Rita A. & Hauff, Edvard (2013). Disability associated with exposure to traumatic events: results from a cross-sectional community survey in South Sudan. BMC Public Health. ISSN 1471-2458. 13. doi: 10.1186/1471-2458-13-469. Vis sammendrag

  There is a general lack of knowledge regarding disability and especially factors that are associated with disability in low-income countries. We aimed to study the overall and gender-specific prevalence of disability, and the association between exposure to traumatic events and disability in a post-conflict setting. We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire (HTQ) was applied to investigate exposure to trauma events. Disability was measured using the Washington Group Short Measurement Set on Disability, which is an activity-based scale derived from the WHO’s International Classification of Disability, Functioning and Health. The estimated prevalence of disability (with severe difficulty) was 3.6% and 13.4% for disability with moderate difficulties. No gender differences were found in disability prevalence. Almost all participants reported exposure to at least one war-related traumatic event. The result of a hierarchical regression analysis showed that, for both men and women, exposure to traumatic events, older age and living in a polygamous marriage increased the likelihood of having a disability. The finding of association between traumatic experience and disability underlines the precariousness of the human rights situation for individuals with disability in low-income countries. It also has possible implications for the construction of disability services and for the provision of health services to individuals exposed to traumatic events.

• Jaradat, Yousef Mohammad Mustafa; Bast-Pettersen , Rita Elisabeth; Nijem, Khaldoun; Bjertness, Espen; Lien, Lars & Kristensen, Petter [Vis alle 7 forfattere av denne artikkelen] (2012). The impact of shift work on mental health measured by GHQ-30: a comparative study. Middle East Journal of Psychiatry and Alzheimers. ISSN 1838-9619. 3(1), s. 8–16. Vis sammendrag

  Background: Shift work has been associated with adverse physiological and psychological effects.Objective: To estimate associations between mental health and demanding work schedules (rotating shift) among nurses.Methods: A cross-sectional study was conducted among nurses. 422 nurses were included in analyses, of whom 261 (62%) were women and 161 (38%) were men. The General Health Questionnaire 30-items (GHQ-30) was used to measure mental distress, Health Risk Behaviors scale used to measure Life-style behavior, and Generic Job Satisfaction scale to measure level of job satisfaction.Results: In linear regression, adjusted mental distress symptoms were significantly more prevalent among rotating shift workers (+ 4.1 units, p = 0.002)than fixed day-workers.Men reported less distress (-2.2 units, p = 0.04) than women. Effects on mental health from rotating shift were moderated by job satisfaction.Conclusions: In this study, men had less overall mental distress than did women, but seemed to be more prone to mental distress reactions in association with rotating shifts. High job satisfaction moderated the mental distress associated with shift work.

• Dalgard, Florence; Stern, Robert; Lien, Lars & Hauser, Stuart (2012). Itch, Stress and Self-efficacy Among 18-year-old Boys and Girls: A Norwegian Population-based Cross-sectional Study. Acta Dermato-Venereologica. ISSN 0001-5555. 92(5), s. 547–552. doi: 10.2340/00015555-1309.
• Halvorsen, Jon Anders; Dalgard, Florence; Thoresen, Magne; Bjertness, Espen & Lien, Lars (2012). Itch and Pain in Adolescents are Associated with Suicidal Ideation: A Population-based Cross-sectional Study. Acta Dermato-Venereologica. ISSN 0001-5555. 92(5), s. 543–546. doi: 10.2340/00015555-1251.
• Danbolt, Lars Johan & Lien, Lars (2012). Kirken - et bra sted å jobbe : en kvalitativ studie av hva som oppleves positivt med å arbeide i Den norske kirke. Tidsskrift for Praktisk Teologi (TPT). ISSN 1893-4773. 29(2), s. 4–17. Vis sammendrag

  TPT-vitenskapelig

• Ayazi, Touraj; Lien, Lars; Eide, Arne; Ruom, Majok Malek & Hauff, Edvard (2012). What are the risk factors for the comorbidity of posttraumatic stress disorder and depression in a war-affected population? a cross-sectional community study in South Sudan. BMC Psychiatry. ISSN 1471-244X. 12(1). doi: 10.1186/1471-244X-12-175.
• Sørensen, Torgeir; Danbolt, Lars Johan; Holmen, Jostein; Koenig, Harold G. & Lien, Lars (2012). Does death of a family member moderate the relationship between religious attendance and depressive symptoms? The HUNT study, Norway. Depression Research and Treatment. ISSN 2090-1321. 2012. doi: 10.1155/2012/396347. Fulltekst i vitenarkiv
• Sørensen, Torgeir; Dahl, Alv A; Fosså, Sophie Dorothea; Holmen, Jostein; Lien, Lars & Danbolt, Lars Johan (2012). Is 'Seeking God's Help' Associated with Life Satisfaction and Disease-specific Quality of Life in Cancer Patients? The HUNT Study. Archive for the Psychology of Religion/ Archiv für Religionspsychologie. ISSN 0084-6724. 34(2), s. 191–213. doi: 10.1163/15736121-12341237.
• Teodorescu, Dinu-Stefan; Siqveland, Johan; Heir, Trond; Wentzel-Larsen, Tore; Hauff, Edvard & Lien, Lars (2012). Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway. Health and Quality of Life Outcomes. ISSN 1477-7525. 10(84). doi: 10.1186/1477-7525-10-84.
• Teodorescu, Dinu-Stefan; Heir, Trond; Hauff, Edvard; Wentzel-Larsen, Tore & Lien, Lars (2012). Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway. Scandinavian Journal of Psychology. ISSN 0036-5564. 53(4), s. 316–332. doi: 10.1111/j.1467-9450.2012.00954.x. Vis sammendrag

  Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.

• Haug, Elisabeth; Melle, Ingrid; Andreassen, Ole Andreas; Raballo, Andrea; Bratlien, Unni & Øie, Merete Glenne [Vis alle 8 forfattere av denne artikkelen] (2012). The association between anomalous self-expenence and suicidality in first-episode schizophrenia seems mediated by depression. Comprehensive Psychiatry. ISSN 0010-440X. 53(5), s. 456–460. doi: 10.1016/j.comppsych.2011.07.005.
• Haug, Elisabeth; Lien, Lars; Raballo, Andrea; Bratlien, Unni; Øie, Merete Glenne & Andreassen, Ole Andreas [Vis alle 8 forfattere av denne artikkelen] (2012). Selective Aggregation of Self-Disorders in First-Treatment DSM-IV Schizophrenia Spectrum Disorders. Journal of Nervous and Mental Disease. ISSN 0022-3018. 200(7), s. 632–636. doi: 10.1097/NMD.0b013e31825bfd6f.
• Lien, Lars; Halvorsen, Jon Anders; Haavet, Ole Rikard & Dalgard, Florence (2012). The relation of early experienced negative life events and current itch. A longitudinal study among adolescents in Oslo, Norway. Journal of Psychosomatic Research. ISSN 0022-3999. 72(3), s. 226–229. doi: 10.1016/j.jpsychores.2011.12.001.
• Haug, Elisabeth; Øie, Merete Glenne ; Melle, Ingrid; Andreassen, Ole Andreas; Raballo, Andrea & Bratlien, Unni [Vis alle 8 forfattere av denne artikkelen] (2012). The association between self-disorders and neurocognitive dysfunction in schizophrenia. Schizophrenia Research. ISSN 0920-9964. 135(1-3), s. 79–83. doi: 10.1016/j.schres.2011.11.015.
• Abebe, Dawit Shawel; Lien, Lars; Torgersen, Leila & Soest, Tilmann M von (2012). Binge eating, purging and non-purging compensatory behaviours decrease from adolescence to adulthood: A population-based, longitudinal study. BMC Public Health. ISSN 1471-2458. 12. doi: 10.1186/1471-2458-12-32.
• Bukuluki, Paul; Ddumba-Nyanzi, Ismail; Kisuule, John David; Ovuga, Emilio; Lien, Lars & Mafigiri, David (2012). Nodding syndrome in post conflict northern Uganda: A human security perspective. Global Health Governance. ISSN 1939-2389. 6(1).
• Martinez, Priscilla; Landheim, Anne; Clausen, Thomas & Lien, Lars (2011). A comparison of alcohol use and correlates of drinking patterns among men and women aged 50 and above in Ghana and South Africa. African Journal of Drug and Alcohol Studies. ISSN 1531-4065. 10(2), s. 75–87.
• Fredheim, Terje; Lien, Lars; Danbolt, Lars Johan; Kjønsberg, Kari & Haavet, Ole Rikard (2011). Experiences with general practitioners described by families of children with intellectual disabilities and challenging behaviour: a qualitative study. BMJ Open. ISSN 2044-6055. doi: 10.1136/bmjopen-2011-000304.
• Lien, Lars; Green, Kristian; Thoresen, Magne & Bjertness, Espen (2011). Pain complaints as risk factor for mental distress: a three-year follow-up study. European Child and Adolescent Psychiatry. ISSN 1018-8827. 20(10), s. 509–516. doi: 10.1007/s00787-011-0211-3.
• Abebe, Dawit Shawel; Lien, Lars & Von Soest, Tilmann (2011). The development of bulimic symptoms from adolescence to young adulthood in females and males. A population-based longitudinal cohort study. International Journal of Eating Disorders. ISSN 0276-3478. doi: 10.1002/eat.20950.
• Halvorsen, Jon Anders; Stern, Robert; Dalgard, Florence; Thoresen, Magne; Bjertness, Espen & Lien, Lars (2011). Suicidal Ideation, Mental Health Problems, and Social Impairment Are Increased in Adolescents with Acne: A Population-Based Study. Journal of Investigative Dermatology. ISSN 0022-202X. 131(2), s. 363–370. doi: 10.1038/jid.2010.264.
• Haavet, Ole Rikard; Sagatun, Åse & Lien, Lars (2011). Adolescents' adverse experiences and mental health in a prospective perspective. Scandinavian Journal of Public Health. ISSN 1403-4948. 39(1), s. 58–63. doi: 10.1177/1403494810375491. Vis sammendrag

  Aims: The aim of this study is to examine the possible changes in depressive symptoms related to various adverse experiences, based on a three-year follow-up among adolescents. Methods: All 10th graders invited to enter the youth section of the Oslo Health Study 2001 (n = 3,811) constituted a baseline of a longitudinal study. A high level of mental distress (Hscl-10 score ≥1.85) according to the different life experiences was compared, at baseline (15 years) and follow-up (18 years). Results: All adverse experiences were associated with a high Hscl-10 score except parents not living together and death of a close person at 15 and 18 years for boys, and death of a close person at 18 years of age for girls. A development from high Hscl-10 score at baseline to low score at follow up was defined as recovery from mental distress. The proportion of the youth that had a high Hscl-10 score related to reporting adverse life experiences at age 15, followed by a low Hscl-10 score three years later proved to be between 44% and 89% among boys and between 16% and 31% among girls. Conclusions: From a three year longitudinal perspective the recovery from mental distress is substantial and higher among boys than among girls. However, mental distress seems to persist in a considerable proportion of the adolescents. Consequently, it is insufficient to brush aside traumas and hurt and rely on a time healing process only.

• Fredheim, Terje; Danbolt, Lars Johan; Haavet, Ole Rikard; Kjønsberg, Kari & Lien, Lars (2011). Collaboration between General Practitioners and mental health care professionals: a qualitative study. International Journal of Mental Health Systems. ISSN 1752-4458. 5. doi: 10.1186/1752-4458-5-13.
• Danbolt, Lars Johan; Møller, Paul; Lien, Lars & Hestad, Knut (2011). The Personal Significance of Religiousness and Spirituality in Patients With Schizophrenia. The international journal for the psychology of religion. ISSN 1050-8619. 21(2), s. 145–158. doi: 10.1080/10508619.2011.557009.
• Halvorsen, Jon Anders; Stern, Robert; Dalgard, Florence; Thoresen, Magne; Bjertness, Espen & Lien, Lars (2010). Suicidal Ideation, Mental Health Problems, and Social Impairment Are Increased in Adolescents with Acne: A Population-Based Study. Journal of Investigative Dermatology. ISSN 0022-202X. 131, s. 363–370. doi: 10.1038/jid.2010.264.
• Lie, Birgit & Lien, Lars (2010). Ungdom og psykososial helse. I Kumar, Bernadette. N & Viken, Berit (Red.), Folkehelse i et migrasjonsperspektiv. Fagbokforlaget. ISSN 978-82-450-0319-2. s. 235–248.
• Danbolt, Lars Johan; Kjønsberg, Kari & Lien, Lars (2010). Hjelp når du trenger det: En kvalitativ studie av samhandling og gjensidighetskunnskap i den psykiske helsetjenesten. Tidsskrift for psykisk helsearbeid. ISSN 1503-6707. 7(3), s. 238–245.
• Haavet, Ole Rikard; Sagatun, Åse & Lien, Lars (2010). Adolescents’ adverse experiences and mental health in a prospective perspective. Scandinavian Journal of Public Health. ISSN 1403-4948. 39(1), s. 58–63. doi: 10.1177/1403494810375491. Vis sammendrag

  Aims: The aim of this study is to examine the possible changes in depressive symptoms related to various adverse experiences, based on a three-year follow-up among adolescents. Methods: All 10th graders invited to enter the youth section of the Oslo Health Study 2001 (n = 3,811) constituted a baseline of a longitudinal study. A high level of mental distress (Hscl-10 score ≥1.85) according to the different life experiences was compared, at baseline (15 years) and follow-up (18 years). Results: All adverse experiences were associated with a high Hscl-10 score except parents not living together and death of a close person at 15 and 18 years for boys, and death of a close person at 18 years of age for girls. A development from high Hscl-10 score at baseline to low score at follow up was defined as recovery from mental distress. The proportion of the youth that had a high Hscl-10 score related to reporting adverse life experiences at age 15, followed by a low Hscl-10 score three years later proved to be between 44% and 89% among boys and between 16% and 31% among girls. Conclusions: From a three year longitudinal perspective the recovery from mental distress is substantial and higher among boys than among girls. However, mental distress seems to persist in a considerable proportion of the adolescents. Consequently, it is insufficient to brush aside traumas and hurt and rely on a time healing process only.

• Lien, Lars; Thapa, Suraj Bahadur ; Rove, Jon Andreas; Kumar, Bernadette. N & Hauff, Edvard (2010). Premigration Traumatic Events and Psychological Distress Among Five Immigrant Groups. International Journal of Mental Health. ISSN 0020-7411. 39(3), s. 3–19. doi: 10.2753/IMH0020-7411390301.
• Berg, Akiah Ottesen; Melle, Ingrid; Torjesen, Peter A; Lien, Lars; Hauff, Edvard & Andreassen, Ole Andreas (2010). A Cross-Sectional Study of Vitamin D Deficiency Among Immigrants and Norwegians With Psychosis Compared to the General Population. Journal of Clinical Psychiatry. ISSN 0160-6689. 71(12), s. 1598–1604. doi: 10.4088/JCP.09m05299yel.
• Lien, Lars; Haavet, Ole Rikard & Dalgard, Florence (2010). Do mental health and behavioural problems of early menarche persist into late adolescence? A three year follow-up study among adolescent girls in Oslo, Norway. Social Science and Medicine. ISSN 0277-9536. 71(3), s. 529–533. doi: 10.1016/j.socscimed.2010.05.003.
• Bjertness, Espen; Sagatun, Åse; Green, Kristian; Lien, Lars; Søgaard, Anne-Johanne & Selmer, Randi Marie (2010). Response rates and selection problems, with emphasis on mental health variables and DNA sampling, in large population-based, cross-sectional and longitudinal studies of adolescents in Norway. BMC Public Health. ISSN 1471-2458. 10. doi: 10.1186/1471-2458-10-602. Vis sammendrag

  Background: Selection bias is a threat to the internal validity of epidemiological studies. In light of a growing number of studies which aim to provide DNA, as well as a considerable number of invitees who declined to participate, we discuss response rates, predictors of lost to follow-up and failure to provide DNA, and the presence of possible selection bias, based on five samples of adolescents. Methods: We included nearly 7,000 adolescents from two longitudinal studies of 18/19 year olds with two corresponding cross-sectional baseline studies at age 15/16 (10th graders), and one cross-sectional study of 13th graders (18/19 years old). DNA was sampled from the cheek mucosa of 18/19 year olds. Predictors of lost to follow-up and failure to provide DNA were studied by Poisson regression. Selection bias in the follow-up at age 18/19 was estimated through investigation of prevalence ratios (PRs) between selected exposures (physical activity, smoking) and outcome variables (general health, mental distress, externalizing problems) measured at baseline. Results: Out of 5,750 who participated at age 15/16, we lost 42% at follow-up at age 18/19. The percentage of participants who gave their consent to DNA provision was as high as the percentage that consented to a linkage of data with other health registers and surveys, approximately 90%. Significant predictors of lost to follow-up and failure to provide DNA samples in the present genetic epidemiological study were: male gender; non-western ethnicity; postal survey compared with school-based; low educational plans; low education and income of father; low perceived family economy; unmarried parents; poor self-reported health; externalized symptoms and smoking, with some differences in subgroups of ethnicity and gender. The association measures (PRs) were quite similar among participants and all invitees, with some minor discrepancies in subgroups of non-western boys and girls. Conclusions: Lost to follow-up had marginal impact on the estimated prevalence ratios. It is not likely that the invitation to provide DNA influenced the response rates of 18/19 year olds. Non-western ethnicity, male gender and characteristics related to a low social class and general and mental health problems measured at baseline are associated with lost to follow-up and failure to provide DNA.

• Lien, Lars; Green, Kristian; Thoresen, Magne & Bjertness, Espen (2010). Atopic conditions and mental health problems: a 3-year follow-up study. European Child and Adolescent Psychiatry. ISSN 1018-8827. 19(9), s. 705–713. doi: 10.1007/s00787-010-0106-8.
• Halvorsen, Jon Anders; Dalgard, Florence; Thoresen, Magne; Bjertness, Espen & Lien, Lars (2009). Itch and Mental Distress: A Cross-Sectional Study among Late Adolescents. Acta Dermato-Venereologica. ISSN 0001-5555. 89(1), s. 39–44. doi: 10.2340/00015555-0554.
• Lien, Lars; Green, Kristian; Welander-Vatn, Audun & Bjertness, Espen (2009). Mental and somatic health complaints associated with school bullying between 10th and 12th grade students; results from cross sectional studies in Oslo, Norway. Clinical Practice and Epidemiology in Mental Health. ISSN 1745-0179. 23(5). doi: 10.1186/1745-0179-5-6..
• Halvorsen, Jon Anders; Dalgard, Florence; Thoresen, Magne; Bjertness, Espen & Lien, Lars (2009). Is the association between acne and mental distress influenced by diet? Results from a cross-sectional population study among 3775 late adolescents in Oslo, Norway. BMC Public Health. ISSN 1471-2458. 9. doi: 10.1186/1471-2458-9-340.
• Lien, Lars; Sagatun, Åse; Heyerdahl, Sonja; Søgaard, Anne-Johanne & Bjertness, Espen (2009). Is the relationship between smoking and mental health influenced by other unhealthy lifestyle factors? Results from a 3-year follow-up study among adolescents in Oslo, Norway. Journal of Adolescent Health. ISSN 1054-139X. 45(6), s. 609–617. doi: 10.1016/j.jadohealth.2009.04.011. Vis sammendrag

  Purpose: Several studies have confirmed that smoking is a risk factor for depression in adolescence. These studies have not controlled for other lifestyle factors. The aim of this longitudinal study was to assess the relationship between smoking and depressive symptoms, controlling for other lifestyle factors. Methods: This school-based longitudinal self-report survey was conducted among 15- and 18-year-old students in Oslo, Norway. From a baseline cohort of 3811 students, 2489 (65%) participants were followed up after 3 years and completed questionnaires at baseline and follow-up. Mental distress was assessed with Hopkins Symptom Checklist, version 10. Results: There was a statistically significant association between daily smoking at age 15 and mental distress at age 18 for girls, but not for boys (odds ratio [OR] = 2.0 [1.5–2.8] and 1.3 [0.7–2.4], respectively). In girls, the association remained statistically significant even after adjustment for sociodemographic variables and several lifestyle factors. In an analysis of 15-years-old “never smokers,” a statistically significant association was found between smoking and mental distress for both genders at age 18. Mentally distressed adolescents at age 15 did not show a higher proportion of smoking at age 18 compared with those not distressed. Conclusions: In addition to supporting earlier findings that smoking seems to be causally related to depressive symptoms among adolescent girls, the contribution of this study is that this association only to some extent is confounded by other unhealthy lifestyle habits.

• Sagatun, Åse; Lien, Lars; Søgaard, Anne-Johanne; Bjertness, Espen & Heyerdahl, Sonja (2008). Ethnic Norwegian and ethnic minority adolescents in Oslo, Norway: A longitudinal study comparing changes in mental health. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 43(2), s. 87–95. doi: 10.1007/s00127-007-0275-z. Vis sammendrag

  Background: Little is known about ethnic disparities in mental health during late teens. The aim of this study was to compare changes in self reported mental health between adolescents with ethnic Norwegian and ethnic minority background aged 15-16 years followed for three years. Methods: The youth part of the Oslo Health Study constituted the baseline of this self-reported longitudinal study, carried out in schools in 2001 (n = 3811). The follow-up in 2004 was conducted partly in school and partly through mail. A total of 2489 (1112 boys and 1377 girls) participated in the follow-up. Twenty percent of the participants had an ethnic minority background. Mental health was measured by the Strengths and Difficulties Questionnaire (SDQ) and The Hopkins Symptom Checklist (HSCL-10). Results: Ethnic minority boys and girls reported poorer mental health than ethnic Norwegians of the same sex, both at baseline and follow-up. Exceptions were hyperactivity-inattention problems and prosocial behaviours where no differences were found. Consistent changes from baseline to follow-up were; an increase in mental distress and prosocial behaviour. No ethnic disparities were found for changes in mental health from ages 15 to 18 between the two groups. There was no different effect of perceived family economy, parents’ marital status and socioeconomic region of residence in Oslo on change in mental health between ethnic Norwegian and ethnic minority boys and girls from age 15 to 18 years. Conclusions: Ethnic disparities in mental health remained the same from age 15-16 and throughout teenage years. Demographic factors adjusted for had no different impact on changes in mental health between host and immigrant adolescents.

• Lien, Lars (2008). The association between mental health problems and inflammatory conditions across gender and immigrant status: A population-based cross-sectional study among 10th-grade students. Scandinavian Journal of Public Health. ISSN 1403-4948. 36, s. 353–360. doi: 10.1177/1403494808089062.
• Lien, Lars & Hauff, Edvard (2008). Psykiatri i fattige land: Ingen helse uten mental helse! Tidsskrift for Den norske legeforening. ISSN 0029-2001. 128(24), s. 2882–2884.
• Lien, Lars (2007). NORWAY. I D'Avanzo, Carolyn Erickson (Red.), Cultural Health Assessment. Elsevier. ISSN 9780323048347. s. 540–544.
• Lien, Lars; Haavet, Ole Rikard; Thoresen, Magne; Heyerdahl, Sonja & Bjertness, Espen (2007). Mental health problems, negative life events, perceived pressure and the frequency of acute infections among adolescents - Results from a cross-sectional, multicultural, population-based study. Acta Paediatrica. ISSN 0803-5253. 96, s. 301–306. doi: 10.1111/j.1651-2227.2007.00084.x. Vis sammendrag

  Aim: To study the association between mental health problems, negative life events, perceived pressure at school and the frequency of acute infectious illnesses in an adolescent population, and to explore whether the association differs by sex and immigration status. Methods: A cross-sectional study involving all tenth grade pupils in Oslo in 2000 and 2001. Of 8316 eligible pupils, 7346 participated in the study, giving a participation rate of 88%. Twenty-four percent of participants were first- or second-generation immigrants. Results: Mental health problems and negative life events were associated with the number of acute infections in a population-based setting, even after adjustment for possible confounding factors. For girls with an immigrant background, internalised mental health problems and own serious illness or injury had the strongest association with acute infections. For adolescents with a non-immigrant background, experiencing sexual violence had the strongest association, and for native-born boys the strongest association with acute infections was externalised mental health problems. Smoking was the cofactor with the strongest association to acute infections. Conclusion: There is a relationship between acute infection, mental health problems and negative life events among adolescents in a multicultural population-based setting.

• Lien, Lars (2007). Is breakfast consumption related to mental distress and academic performance in adolescents? Public Health Nutrition (PHN). ISSN 1368-9800. 10. doi: 10.1017/S1368980007258550.
• Vatn, Audun Svendsen; Bjertness, Espen & Lien, Lars (2007). Mobbing og helseplager hos barn og ungdom. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 127(15), s. 1941–1944.
• Dalgard, Florence; Lien, Lars & Dalen, Ingvild (2007). Itch in the community: associations with psychosocial factors among adults. Journal of the European Academy of Dermatology and Venereology. ISSN 0926-9959. 21, s. 1215–1219. doi: 10.1111/j.1468-3083.2007.02234.x.
• Diep, Phoung Phoung; Lien, Lars & Hofman, Jan (2007). A criteria-based clinical audit on the case-management of children presenting with malaria at Mangochi District Hospital, Malawi. World Hospitals and Health Services. ISSN 1029-0540. 43(2), s. 21–29.
• Lien, Nanna; Kumar, Bernadette. N & Lien, Lars (2007). Overvekt blant ungdom i Oslo. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 127(17), s. 2254–2258.
• Lien, Lars; Dalgard, Florence; Heyerdahl, Sonja; Thoresen, Magne & Bjertness, Espen (2006). The relationship between age of menarche and mental distress in Norwegian adolescent girls and girls from different immigrant groups in Norway: Results from an urban city cross-sectional survey. Social Science and Medicine. ISSN 0277-9536. 63(2), s. 285–295. doi: 10.1016/j.socscimed.2006.01.003.
• Lien, Lars; Lien, Nanna; Heyerdahl, Sonja; Thoresen, Magne & Bjertness, Espen (2006). Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway. American Journal of Public Health. ISSN 0090-0036. 96(5), s. 1815–1820. doi: 10.2105/AJPH.2004.059477. Vis sammendrag

  Objectives. We examined whether high levels of consumption of sugar-containing soft drinks were associated with mental distress, hyperactivity, and conduct problems among adolescents. Methods. A cross-sectional population-based survey was conducted with 10th-grade students in Oslo, Norway (n = 5498). We used the Hopkins Symptom Checklist and the Strengths and Difficulties Questionnaire to assess mental health outcomes. Results. There was a J-shaped dose–response relationship between soft drink consumption and mental distress, conduct problems, and total mental health difficulties score; that is, adolescents who did not consume soft drinks had higher scores (indicating worse symptoms) than those who consumed soft drinks at moderate levels but lower scores than those with high consumption levels. The relationship was linear for hyperactivity. In a logistic regression model, the association between soft drink consumption and mental health problems remained significant after adjustment for behavioral, social, and food-related variables. The highest adjusted odds ratios were observed for conduct problems among boys and girls who consumed 4 or more glasses of sugar-containing soft drinks per day. Conclusions. High consumption levels of sugar-containing soft drinks were associated with mental health problems among adolescents even after adjustment for possible confounders.

• Lien, Lars; Oppedal, Brit; Haavet, Ole Rikard; Hauff, Edvard; Thoresen, Magne & Bjertness, Espen (2006). Own and parental war experience as a risk factor for mental health problems among adolescents with an immigrant ackground: results from a cross sectional study in Oslo, Norway. Clinical Practice and Epidemiology in Mental Health. ISSN 1745-0179. 2. doi: 10.1186/1745-0179-2-30.
• Lien, Lars (2006). Does length of stay in Norway influence the mental health status of adolescent immigrants. Results from the young part of the Oslo health study. Norsk tidsskrift for migrasjonsforskning. ISSN 1502-4008. s. 14–30.
• Lien, Lars; Oppedal, Brit; Haavet, Ole Rikard; Hauff, Edvard; Thoresen, Magne & Bjertness, Espen (2006). Own and parental war experience as a risk factor for mental health problems among adolescents with an immigrant background: results from a cross sectional study in Oslo, Norway. Clinical Practice and Epidemiology in Mental Health. ISSN 1745-0179. 2. doi: 10.1186/1745-0179-2-30.
• Lien, Lars; Claussen, Bjørgulf; Hauff, Edvard; Thoresen, Magne & Bjertness, Espen (2005). Bodily pain and associated mental distress among immigrant adolescents. A population-based cross-sectional study. European Child and Adolescent Psychiatry. ISSN 1018-8827. 14(7), s. 371–375.
• Lien, Lars; Tambs, Kristian; Oppedal, Brit; Heyerdahl, Sonja & Bjertness, Espen (2005). Is relatively young age within a school year a risk factor for mental health problems and poor school performance? A population-based cross-sectional study of adolescents in Oslo, Norway. BMC Public Health. ISSN 1471-2458. 5(102).
• Lien, Lars (2005). Economic factors influencing the implementation of community care for severely ill schizophrenic patients. World Hospitals and Health Services. ISSN 1029-0540. 41(1), s. 21–24.
• Lien, Lars; Tambs, Kristian; Oppedal, Brit; Heyerdahl, Sonja & Bjertness, Espen (2005). Is relatively young age within a school year a risk factor for mental health problems and poor school performance? A population-based cross-sectional study of adolescents in Oslo. BMC Public Health. ISSN 1471-2458. 5(102). doi: 10.1186/1471-2458-5-102. Vis sammendrag

  Background: Several studies have shown that children who are relatively young within a school year are at greater risk for poorer school performance compared with their older peers. One study also reported that relative age within a school year is an independent risk factor for emotional and behavioral problems. The objective of this study was to test the hypothesis that relatively younger adolescents in the multiethnic population of Oslo have poorer school performance and more mental health problems than their relatively older classmates within the same school year. Methods: This population-based cross-sectional study included all 10th-grade pupils enrolled in 2000 and 2001 in the city of Oslo. The participation rate was 88%. Of the 6,752 pupils in the study sample, 25% had a non-Norwegian background. Mental health problems were quantified using the abbreviated versions of Symptom Check List-25 (SCL-10) and the Strength and Difficulties Questionnaire (SDQ). Information on school performances and mental health problems were self-reported. We controlled for confounding factors including parental educational level, social support, gender, and ethnicity. Results: The youngest one-third of pupils had significantly lower average school grades than the middle one-third and oldest one-third of their classmates (p < 0.001). Of the mental health problems identified in the questionnaires, the groups differed only on peer problems; the youngest one-third reported significantly more problems than the middle and oldest groups (p < 0.05). Age within a school year and gender showed significant interactions with total SDQ score, SDQ peer problems score, SDQ pro social score, and SCL-10 score. After stratifying for gender, the peer problem scores differed significantly between age groups only among boys. The SCL-10 score was significant, but only in girls and in the opposite direction to that expected, with the oldest pupils having significantly higher scores than the other two groups (p < 0.05). Conclusion: In adolescents from a multicultural city in Norway, relative age within a school year significantly influenced academic performance. In contrast to data from Great Britain, relative age within a school year was not an important risk factor for mental health problems in adolescents in Oslo.

• Lien, Lars & Sundby, Johanne (2004). Den globale urettferdigheten. I Fugelli, Per; Haug, Kjell; Høyer, Georg & Mæland, John-Gunnar (Red.), Sosialmedisin i teori og praksis. Gyldendal Akademisk. s. 383–399.
• Lien, Lars (2003). Financial and organisational reforms in the health sector; implications for the financing and management of mental health care services. Health Policy. ISSN 0168-8510. 63(1), s. 73–80. doi: 10.1016/S0168-8510(02)00054-4. Vis sammendrag

  Since 1980 many developed countries have planned and implemented health sector reforms of different scales and ambitions. Norway has been no exception, and the main political aspirations have been to increase efficiency and improve consumer choice and responsiveness. The major financial reform was the introduction of an activity based financing based on diagnostic related groups (DRG). Other central reforms include legislative rights for patients to choose hospital of their own choice, and the handing over of the responsibility of hospital based care form the county to the state. For some of these reforms mental health care is not included. The aim of the study is to appraise with examples from different countries whether it is feasible include metal health care into the reforms and whether the reforms in general are conducive for mental health care policy goals. The problems are elaborated and discussed at the level of techically and politically feasibility and the costs involved.

• Lien, Lars (2002). Trends in international health development. World Hospitals and Health Services. ISSN 1029-0540. 38(2), s. 31–35.
• Lien, Lars (2002). Are readmission rates influenced by how psychiatric services are organized? Nordic Journal of Psychiatry. ISSN 0803-9488. 56(1), s. 23–28. doi: 10.1080/08039480252803873. Vis sammendrag

  A transition is taking place in the organization of psychiatric services. The length of stay in hospitals is reduced and partly replaced by treatment and care in the community. The readmission rate is proposed as one indicator to analyse the effectiveness of this transition. A comprehensive literature review was conducted to ascertain whether readmission rates differ with different service systems. The search yielded 77 articles, of which 28 were selected on the basis of aims and objectives of the articles. The results show that approximately 50% of all patients admitted to psychiatric hospitals are previously admitted patients. Longer length of stay, appropriate discharge planning, and follow-up visits after discharge predicted fewer readmissions, whereas the quantity and quality of community care did not seem to have any impact on readmission rates. On the basis of the analysis of the literature review it is concluded that readmission rates are not a suitable indicator of quality of care in psychiatric hospitals. Readmission rates may, however, be an important tool in the planning of mental health services.

• Lien, Lars (1994). WHO strategies to reduce childhood mortality in developing countries. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 114(28), s. 3335–3337.
• Lien, Lars (1992). Physicians' initiative, cooperation and attitude when working with disability pension cases. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 112(2), s. 210–212.

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• Nguyen, Phuong Hong Ngoc; Lien, Lars; Tran, Van Cong; Nguyen, Thanh Tam & Söderström, Kerstin (2022). Emotional maltreatment in childhood and mental health prolems among adolescents: a systematic Review . Proceedings of 2nd 16 Hanoi Forum on Pedagogical and Educational Sciences. ISBN 9786043849363. 28 s.
• Lien, Lars & Lie, Tore Willy (2022). Sammensatte problemer, sammenvevde tiltak: Integrert behandling av rus og psykiske lidelser. Fagbokforlaget. ISBN 9788245035599. 344 s. Vis sammendrag

  Samtidig rus og psykisk lidelse innebærer ofte et komplekst og mangefasettert tilstandsbilde, med mange potensielle problemområder. Ulike og ofte organisatorisk separate helse- og sosialtjenester er relevante i den sammenheng, periodevis eller langsiktig, hvor disse lidelsene må behandles samtidig på veien mot et bedre liv. Denne boken trekker veksler på forfattere med lang erfaring i ROP-feltet, både klinisk og akademisk, hvor blant annet følgende spørsmål belyses: Hvordan gi best mulig integrert og helhetlig behandling? Hvilke samhandlingsmodeller anbefales, og hvordan få til lokalt samarbeid mellom ulike tjenestenivåer? Hvilken basiskunnskap og kompetanse innen rus og psykiske lidelser burde alle ha uansett hvor de jobber? Hvordan kan du bistå i en annen persons bedringsprosess? Boken beskriver en rekke relevante fagområder for å få til et godt tjenestetilbud for personer med ROP-lidelser: Integrert behandling i praksis ACT og FACT Bolig og bo-oppfølging Vold og suicidalitet Kartlegging og utredning Rus og avhengighet IPS og arbeid Kriminalomsorgen og politi Oppfølging av somatisk (u)helse Fastlegens rolle Oppfølging og involvering av pårørende Brukermedvirkning Recovery-orienterte tjenester for personer med ROP-lidelser Boken er relevant i en rekke helse- og sosialfaglige utdanninger, og nyttig for alle som følger opp personer med rus og psykiske lidelser, uavhengig av profesjon, enten de jobber kommunalt, i spesialisthelsetjenesten, er fastlege eller jobber i somatikken.

• Dybdahl, Ragnhild; Lien, Lars; Siem, Harald; Bakke, Hege Helene & Julardzija, Irma (2019). Asylsøkere og flyktninger. Psykisk helse og livsmestring. Universitetsforlaget. ISBN 9788215031514. 328 s.
• Danbolt, Lars Johan; Engedal, Leif Gunnar; Stifoss-Hanssen, Hans; Hestad, Knut & Lien, Lars (2014). Religionspsykologi. Gyldendal Akademisk. ISBN 978-82-05-41634-5. 387 s. Vis sammendrag

  Kan tro forebygge sykdom? Hvordan kan religion motivere til både gode og onde handlinger? Forfatterne av denne boken drøfter dette og flere spørsmål knyttet til religionens betydning for mennesker. Interessen for religion, tro og livssyn er økende. Vårt livssyn har betydning for hvem vi er, hva vi vurderer som viktig, og hvordan vi er i relasjon til andre. Samtidig synes mange det er vanskelig å forholde seg til menneskers tro i profesjonelle sammenhenger. I denne boken presenterer fagpersoner fra flere nordiske land forskning innenfor faget religionspsykologi. Du kan lese om hvordan religion kan motivere til terrorhandlinger, hvorfor vi samles til lystenning og rosetog, og om en kan finne en sammenheng mellom prosesser i hjernen og åndelige erfaringer. Boken gir også et innblikk i hvordan spiritualitet kan være både et problem og en løsning for mennesker med psykiske vansker.

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• Weihe, Hans-Jørgen Wallin; Lien, Lars & Bjørnsen, Ragnhild Holmen (2024). "Hva skjer med synet vårt på illegale stoffer når de brukes i behandling?". Dagens medisin. ISSN 1501-4290.
• Lien, Lars & Reitan, Solveig Klæbo (2024). Å holde seg til saken https://erfaringskompetanse.no/nyheter/a-holde-seg-til-saken/. Erfaringskompetanse.no.
• Lien, Lars (2024). Å holde seg til saken. Erfaringskompetanse.no.
• Bjertness, Espen; Bjertness, Marius Slåtto; Bjertness, Cecilie Bergsmark; Kromberg, Marika; Elessi, Khamis & Lien, Lars (2023). Save the remaining people of Gaza—save the children. The Lancet. ISSN 0140-6736. 402(10417), s. 2072–2073. doi: 10.1016/S0140-6736(23)02556-4.
• Weihe, Hans-Jørgen Wallin; Overå, Stian & Lien, Lars (2023). Dataspillavhengighet. I Overå, Stian; Martinsen, Marianne & Weihe, Hans-Jørgen Wallin (Red.), Penge- og dataspill. Lek læring, lidenskap og lidelse. Hertervig Akademisk. ISSN 9788282172493. s. 134–142.
• Bonsaksen, Tore; Steigen, Anne Mari; Stea, Tonje Holte; Kleppang, Annette Løvheim; Lien, Lars & Leonhardt, Marja (2023). Negative social media experiences and lower self-efficacy are associated with depressive symptoms.
• Heltne, Unni Marie; Sarkadi, Anna; Lien, Lars & Dybdahl, Ragnhild (2023). Correction: Training non-specialists in teaching recovery techniques (TRT) to help traumatised children in humanitarian settings: a qualitative analysis of experiences gained from 20 years of practice (International Journal for Equity in Health, (2023), 22, 1, (187), 10.1186/s12939-023-01999-z). International Journal for Equity in Health. ISSN 1475-9276. 22(1). doi: 10.1186/s12939-023-02021-2.
• Abudayya, Abdallah; Abu Ghali, Khaled; Hargreaves, Sally; Blanchet, Karl; Bjertness, Espen & Bhopal, Anand Singh [Vis alle 14 forfattere av denne artikkelen] (2023). An urgent call to save and protect lives of vulnerable populations in the Gaza Strip. The Lancet Regional Health - Europe. ISSN 2666-7762. 35. doi: 10.1016/j.lanepe.2023.100767.
• Lien, Lars & Reitan, Solveig Klæbo (2023). Vi må slutte å "psykeliggjøre" en hel generasjon - svar på spørreskjema gir ikke klinisk diagnose. Dagens medisin. ISSN 1501-4290.
• Reitan, Solveig Klæbo; Rasmussen, Kirsten & Lien, Lars (2023). ADHD: en oppklaring av misforståelser . Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Lien, Lars; Rasmussen, Kirsten & Reitan, Solveig Klæbo (2023). Udiagnostisert ADHD kan ha store konsekvenser. Morgenbladet. ISSN 0805-3847.
• Reitan, Solveig Klæbo & Lien, Lars (2023). Mental Helath Services in Norway, 2023 . BJPsych International. ISSN 2056-4740. doi: 10.1192/bji.2023.25.
• Lien, Lars; Reitan, Solveig Klæbo; Halvorsen, Niclas; Larsson, Anna Ulrika; lorentzen, kristina Norheim & mork, elisabeth [Vis alle 9 forfattere av denne artikkelen] (2023). "Pilleskam" i psykiatrien er et alvorlig samfunnsproblem. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Lien, Lars & Færden, Ann (2023). Psykisk helsehjelp i Ukraina. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 143(6). doi: 10.4045/tidsskr.23.0205.
• Reitan, Solveig Klæbo & Lien, Lars (2023). Det handler om å forebygge. Dagens medisin. ISSN 1501-4290.
• Reitan, Solveig Klæbo; Lien, Lars; Gabin, Jessica Mira; larsson, ulrika; mork, elisabeth & Weibell, Melissa Anne Elin Authen [Vis alle 7 forfattere av denne artikkelen] (2023). Psykiateres unnlatelsessynder overfor de mest alvorlig psykisk syke må rettes opp. . Dagens medisin. ISSN 1501-4290.
• Reitan, Solveig Klæbo; Lien, Lars; Gabin, Jessica Mira; larsson, ulrika; mork, elisabeth & Weibell, Melissa Anne Elin Authen [Vis alle 7 forfattere av denne artikkelen] (2023). Vi beklager våre unnlatelsessynder. Dagens medisin. ISSN 1501-4290.
• Roer, Grethe Emilie; Lien, Lars; Bolstad, Ingeborg; Aaseth, Jan & Abebe, Dawit Shawel (2022). PTSD, komorbid alkoholbrukslidelse og risiko for utvikling av kardiometabolske sykdommer: En nasjonal pasient-kohortstudie i Norge.
• Dangmann, Cecilie Ruud; Leonhardt, Marja; Kleppang, Annette Løvheim & Lien, Lars (2022). Assessment of mental health and psychosocial support in Ukrainian refugee minors resettled in Norway .
• Høye, Anne & Lien, Lars (2022). Somatisk sykdom og levevaner. I Lien, Lars & Lie, Tore Willy (Red.), Sammensatte problemer, sammenvevde tiltak: Integrert behandling av rus og psykiske lidelser. Fagbokforlaget. ISSN 9788245035599. s. 134–148. Vis sammendrag

  Samtidig rus og psykisk lidelse innebærer ofte et komplekst og mangefasettert tilstandsbilde, med mange potensielle problemområder. Ulike og ofte organisatorisk separate helse- og sosialtjenester er relevante i den sammenheng, periodevis eller langsiktig, hvor disse lidelsene må behandles samtidig på veien mot et bedre liv. Denne boken trekker veksler på forfattere med lang erfaring i ROP-feltet, både klinisk og akademisk, hvor blant annet følgende spørsmål belyses: Hvordan gi best mulig integrert og helhetlig behandling? Hvilke samhandlingsmodeller anbefales, og hvordan få til lokalt samarbeid mellom ulike tjenestenivåer? Hvilken basiskunnskap og kompetanse innen rus og psykiske lidelser burde alle ha uansett hvor de jobber? Hvordan kan du bistå i en annen persons bedringsprosess? Boken beskriver en rekke relevante fagområder for å få til et godt tjenestetilbud for personer med ROP-lidelser: Integrert behandling i praksis ACT og FACT Bolig og bo-oppfølging Vold og suicidalitet Kartlegging og utredning Rus og avhengighet IPS og arbeid Kriminalomsorgen og politi Oppfølging av somatisk (u)helse Fastlegens rolle Oppfølging og involvering av pårørende Brukermedvirkning Recovery-orienterte tjenester for personer med ROP-lidelser Boken er relevant i en rekke helse- og sosialfaglige utdanninger, og nyttig for alle som følger opp personer med rus og psykiske lidelser, uavhengig av profesjon, enten de jobber kommunalt, i spesialisthelsetjenesten, er fastlege eller jobber i somatikken.

• Lien, Lars & Lie, Tore Willy (2022). Tanker om samhandling. I Lien, Lars & Lie, Tore Willy (Red.), Sammensatte problemer, sammenvevde tiltak: Integrert behandling av rus og psykiske lidelser. Fagbokforlaget. ISSN 9788245035599. s. 13–23. Vis sammendrag

  Samtidig rus og psykisk lidelse innebærer ofte et komplekst og mangefasettert tilstandsbilde, med mange potensielle problemområder. Ulike og ofte organisatorisk separate helse- og sosialtjenester er relevante i den sammenheng, periodevis eller langsiktig, hvor disse lidelsene må behandles samtidig på veien mot et bedre liv. Denne boken trekker veksler på forfattere med lang erfaring i ROP-feltet, både klinisk og akademisk, hvor blant annet følgende spørsmål belyses: Hvordan gi best mulig integrert og helhetlig behandling? Hvilke samhandlingsmodeller anbefales, og hvordan få til lokalt samarbeid mellom ulike tjenestenivåer? Hvilken basiskunnskap og kompetanse innen rus og psykiske lidelser burde alle ha uansett hvor de jobber? Hvordan kan du bistå i en annen persons bedringsprosess? Boken beskriver en rekke relevante fagområder for å få til et godt tjenestetilbud for personer med ROP-lidelser: Integrert behandling i praksis ACT og FACT Bolig og bo-oppfølging Vold og suicidalitet Kartlegging og utredning Rus og avhengighet IPS og arbeid Kriminalomsorgen og politi Oppfølging av somatisk (u)helse Fastlegens rolle Oppfølging og involvering av pårørende Brukermedvirkning Recovery-orienterte tjenester for personer med ROP-lidelser Boken er relevant i en rekke helse- og sosialfaglige utdanninger, og nyttig for alle som følger opp personer med rus og psykiske lidelser, uavhengig av profesjon, enten de jobber kommunalt, i spesialisthelsetjenesten, er fastlege eller jobber i somatikken.

• Lien, Lars; Bergem, Anne Kristine & Reitan, Solveig Merete Klæbo (2022). Misbruk av matposisjoner til å skaffe seg seksuelle tjenester er fullstendig uakseptabelt. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Reitan, Solveig Merete Klæbo & Lien, Lars (2022). Personvern, media og en dømt terrorist. Dagens medisin. ISSN 1501-4290.
• Leonhardt, Marja; Granrud, Marie Dahlen; Bonsaksen, Tore & Lien, Lars (2022). Worries about climate change in Norwegian adolescents.
• Mthoko, Ndahambelela Frederika Nepando; Pazvakawambwa, Lilian; Leonhardt, Marja & Lien, Lars (2022). Physical comorbidity among patients attending mental health services at Windhoek Central Hospital, Namibia. Pan African Medical Journal. ISSN 1937-8688. 41. doi: 10.11604/pamj.2022.41.270.27134. Vis sammendrag

  Introduction physical health problems are common among people with mental illness. Understanding common co-occurring mental and physical conditions can aid health providers to effectively screen individuals and also integrate care for both conditions. The study aimed to determine the prevalence and types of comorbidity among patients attending the outpatient section of the Mental Health Care Centre, Windhoek Central Hospital. Methods a cross-sectional survey of 385 patients attending the Mental Health Care Centre of Windhoek Central Hospital was carried out using structured questionnaire. Results the study found that 33.8% of participants had comorbid physical and mental conditions. The most common co-occurring physical conditions were from the cardiovascular system (40.8%), infections (30.8%), and neurological conditions (13.0%). Female patients were more likely to have comorbidity compared to their male counterparts (OR=2.8; CI = 1.5-5.0; p=0.001), and the risk of comorbidity increased with age (OR=1.1; CI = 1.0-1.1; p<0.001). Conclusion the study emphasizes the inseparability of mental and physical health, and the bidirectional association between mental and physical conditions. The high prevalence of somatic disorder points to the need of integration of physical and mental health services. Mental health and somatic services must be adjusted to the fact that most of the people who come to seek help are likely to suffer from more than one illness.

• Dybdahl, Ragnhild; Lien, Lars; Engebretsen, Ingunn Marie Stadskleiv & Skar, Ane-Marthe Solheim (2022). Matsikkerhet og psykisk helse henger sammen. Bistandsaktuelt. ISSN 1501-0201.
• Lien, Lars & Bergem, Anne Kristine (2021). Psykiatrien trenger et løft – ikke tomme løfter. Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.21.0532.
• Lien, Lars & Stensrud, Bjørn (2020). Samtidig rusmisbruk og psykisk lidelse - "ROP-lidelser". I Gonzalez, Marianne Thorsen (Red.), Psykiske lidelser - Faglig forståelse og terapeutisk tilnærming. Sykepleiefaglige og flerfaglige perspektiver. Gyldendal Akademisk. ISSN 9788205516700. s. 177–186.
• Lien, Lars & Lund, Johan (2019). To 70th Jubilee og professor Gunnar Tellnes. Herald of the International Academy of Science. Russian Section. ISSN 1819-5733. s. 74–74.
• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2019). Hvordan håndterer kvinner som har opplevd seksuelle overgrep hverdagsstress - en retrospektiv kvalitativ studie.
• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2019). How women experience and cope with daily hassles after sexual abuse– a retrospective qualitative study.
• Toft, Helge; Lien, Lars; Neupane, Sudan Prasad; Abebe, Dawit Shawel; Tilden, Terje & Bramness, Jørgen Gustav (2019). Anti-inflammatory drugs obscure the relationship between mental distress and inflammatory cytokines.
• Dybdahl, Ragnhild & Lien, Lars (2018). Mental helse er nøkkel til utvikling. Avisa Vårt land.
• Abebe, Dawit Shawel & Lien, Lars (2018). Immigrant psychiatric patients and the utilisation of specialist services for circulatory system diseases – a nation-wide register study in Norway . European Journal of Public Health. ISSN 1101-1262. doi: 10.1093/eurpub/cky048.231. Vis sammendrag

  Background: Circulatory system diseases, particularly cardiovascular diseases, are the leading cause of impaired quality of life and excess premature death among psychiatric patients. Nevertheless, psychiatric patients are subject to unacceptably high levels of disparity in somatic healthcare. Little research has been conducted among immigrant psychiatric patients. This study aims to examine the use of specialist somatic services for circulatory system diseases among psychiatric patients with different countries of origin. Methods: Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (ages 0-90+) consisted of 317,260 ethnic Norwegians (native-born) and 14,938 immigrants from 11 countries that had contacts with specialist mental healthcare during 2008-2011. Countries of origin included Sweden, Poland, Bosnia-Herzegovina, Russia, Somalia, Turkey, Sir Lanka, Iraq, Iran, Pakistan and Vietnam. Statistical analyses were applied using logistic regression models. A p-value ≤ 0.05 was regarded as statistically significant. Results: There were no overall significant differences in rates of outpatient consultations for circulatory system diseases between immigrant (7%) and Norwegian (7.2%) psychiatric patients. A distinct exception was the high outpatient rate among people from Bosnia-Herzegovina, and the low outpatient rate among those from Somalia, Pakistan and Vietnam. Immigrant psychiatric patients had a lower overall admission rate (3.1%) compared to Norwegian psychiatric patients (4.7%). The majority of immigrant psychiatric patients had statistically significant lower admission rates than Norwegian psychiatric patients, except those from Sweden, Bosnia-Herzegovina and Sir Lanka. Conclusions: The findings suggest that the majority of immigrant psychiatric patients have lower hospitalisation rates for circulatory system diseases than Norwegian psychiatric patients. This suggests that limited access to hospitalisation could be the main possible explanation.

• Dybdahl, Ragnhild & Lien, Lars (2018). Mental health is an integral part of the sustainable development goals. Preventive Medicine and Community Health. doi: 10.15761/PMCH.1000104.
• Toft, Helge Prytz; Lien, Lars; Neupane, Sudan Prasad; Tilden, Terje; Wampold, Bruce E. & Bramness, Jørgen Gustav (2017). PTSD Patients in treatment show increasing cytokine levels despite symptom relief.
• Haug, Sigrid Helene Kjørven & Lien, Lars (2017). Implementation of the Cultural Formulation Interview in Norway-aim and scope with an emphasis on its recovery-oriented properties.
• Brekke, Eva; Lien, Lars; Davidson, Larry & Biong, Stian (2017). Recovery in Co-occurring Mental Health and Substance Use Disorders: First-person Perspectives.
• Silwal, Sanju; Dybdahl, Ragnhild; Chudal, Roshan; Sourander, Andre & Lien, Lars (2017). Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquake.
• Dybdahl, Ragnhild & Lien, Lars (2017). The role of trauma interventions in the sustainable global Development agenda.
• Ness, Ewa; Antonsen, Bjørg; Grøvli, Morten; Hymer, Knut-Erik; Lindkvist, Kari-Venke & Lien, Lars [Vis alle 11 forfattere av denne artikkelen] (2016). Færre tvangsinnleggelser – dilemmaer og utfordringer :. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 136(7), s. 598–599. doi: 10.4045/tidsskr.15.1031.
• Brekke, Eva; Lien, Lars; Biong, Stian & Davidson, Larry (2016). From double trouble to dual recovery: Patient perspectives on recovery in dual disorders.
• Øie, Merete Glenne & Lien, Lars (2016). Hvordan forstå kognisjon ved rusavhengighet? Nasjonal Kompetansetjeneste ROP-TV. http://roptv.no/videoer/psykisk/merete-glenne-oeie-hvordan-forstaa-kognitiv-funksjon-ved-rusavhengighet.
• Lien, Lars; Huus, Gitte & Morken, Gunnar (2015). L. Lien og medarbeidere svarer:. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 135(17), s. 1535–1535. doi: 10.4045/tidsskr.15.0924.
• Lien, Lars & Johannessen, Jan Olav (2015). Re: Flere og gale diagnoser med kriteriebasert diagnostikk. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 135(19), s. 1712–1772. doi: 10.4045/tidsskr.15.1022.
• Lien, Lars; Huus, Sigrid Birgitte & Morken, Gunnar (2015). L. Lien og medarbeidere svarer. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 135(21), s. 1923–1923. doi: 10.4045/tidsskr.15.1134.
• Lien, Lars; Huus, Gitte & Morken, Gunnar (2015). L. Lien og medarbeidere svarer :. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 135(17). doi: 10.4045/tidsskr.15.0924.
• Elstad, Jon Ivar; Kumar, Bernadette. N; Diaz, Esperanza & Lien, Lars (2015). Nei, innvandring fører ikke til en eksplosjon i helsekostnader | Elstad, Kumar, Diaz og Lien. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Pedersen, Monica Stolt; Landheim, Anne & Lien, Lars (2015). How are clinical audits used in mental health services to implement a national guideline in diual diagnosis: a qualitative study.
• Elstad, Jon Ivar; Kumar, Bernadette. N; Diaz, Esperanza & Lien, Lars (2015). Innvandring fører ikke til en eksplosjon i helsekostnader. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Lien, Lars; Huus, Sigrid Birgitte & Morken, Gunnar (2015). Psykisk syke lever kortere. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 135(3), s. 246–248. doi: 10.4045/tidsskr.14.0831.
• Pedersen, Monica Stolt; Landheim, Anne & Lien, Lars (2015). Clinical audit as a basis for improvement in mental health services, a qualitative study.
• Jaradat, Yousef; Nijem, Khaldoun; Kristensen, Petter; Bjertness, Espen; Lien, Lars & Stigum, Hein [Vis alle 7 forfattere av denne artikkelen] (2014). Psychosomatic symptoms and self-reported stressful working conditions among Palestinian female and male nurses: a cross-sectional study.
• Lien, Lars (2014). Røyking tredobler risikoen for frafall i skolen. [Internett]. Forskning.no.
• Pedersen, Monica Stolt; Landheim, Anne & Lien, Lars (2014). Bridging the gap between current practice and recommendations in national guidelines, a qualitative study of mental health services. Vis sammendrag

  Pedersen et al. BMC Health Services Research 2014, 14(Suppl 2):P94

• Martinez, Priscilla; Neupane, Sudan Prasad; Lien, Lars; Aukrust, Pål; Ueland, Thor & Mollnes, Tom Eirik [Vis alle 8 forfattere av denne artikkelen] (2014). Alcohol use severity may attenuate elevated cytokine levels associated with depression in Nepalese alcohol-use disorder patients.
• Neupane, Sudan Prasad; Lien, Lars; Martinez, Priscilla; Aukrust, Pål; Ueland, Thor & Mollnes, Tom Eirik [Vis alle 8 forfattere av denne artikkelen] (2014). Circulatory cytokine levels in Nepalese alcohol-use disorder patients with and without major depression.
• Danbolt, Lars Johan; Engedal, Leif Gunnar; Hestad, Knut; Lien, Lars & Stifoss-Hanssen, Hans (2014). Forord. I Danbolt, Lars Johan; Engedal, Leif Gunnar; Stifoss-Hanssen, Hans; Hestad, Knut & Lien, Lars (Red.), Religionspsykologi. Gyldendal Akademisk. ISSN 978-82-05-41634-5. s. 5–6. Vis sammendrag

  Kan tro forebygge sykdom? Hvordan kan religion motivere til både gode og onde handlinger? Forfatterne av denne boken drøfter dette og flere spørsmål knyttet til religionens betydning for mennesker. Interessen for religion, tro og livssyn er økende. Vårt livssyn har betydning for hvem vi er, hva vi vurderer som viktig, og hvordan vi er i relasjon til andre. Samtidig synes mange det er vanskelig å forholde seg til menneskers tro i profesjonelle sammenhenger. I denne boken presenterer fagpersoner fra flere nordiske land forskning innenfor faget religionspsykologi. Du kan lese om hvordan religion kan motivere til terrorhandlinger, hvorfor vi samles til lystenning og rosetog, og om en kan finne en sammenheng mellom prosesser i hjernen og åndelige erfaringer. Boken gir også et innblikk i hvordan spiritualitet kan være både et problem og en løsning for mennesker med psykiske vansker.

• Neupane, Sudan Prasad; Lien, Lars; Martinez, Priscilla; Aukrust, Pål; Ueland, Thor & Mollnes, Tom Eirik [Vis alle 8 forfattere av denne artikkelen] (2013). Alteration of circulatory cytokine levels in alcohol-use disorder patients with and without major depression.
• Strøm, Ida Frugård; Thoresen, Siri; Wentzel-Larsen, Tore; Hjemdal, Ole Kristian; Lien, Lars & Dyb, Grete (2013). A longitudinal population based study of work marginalization as a consequence of exposure to life adversities.
• Kvaal, Kari; Ulstein, Ingun; Lien, Lars & Skulberg, Knut Ragnvald (2013). Frivillig hjemmeomsorg i Norge.
• Abebe, Dawit Shawel; Torgersen, Leila; Lien, Lars & von Soest, Tilmann (2012). Binge eating and purging and non-purging compensatory behaviors from adolescence to young adulthood : A population-based longitudinal study among Norwegian youth.
• Halvorsen, Jon Anders; Vleugels, Ruth Ann; Bjertness, Espen & Lien, Lars (2012). A Population-Based Study of Acne and Body Mass Index in Adolescents. Archives of Dermatology. ISSN 0003-987X. 148(1), s. 131–132.
• Abebe, Dawit Shawel; Lien, Lars & Soest, Tilmann M von (2011). Developmental Trends of Bulimic Symptoms from Adolescence to Young Adulthood: A Population Based, Longitudinal Cohort Study.
• Sørensen, Torgeir; Dahl, Alv A; Fosså, Sophie Dorothea; Holmen, Jostein; Lien, Lars & Danbolt, Lars Johan (2011). Religion, spirituality and subjective experiences in cancer patients : a population-based study among patients with colorectal, breast and prostate cancer : the HUNT Study, Norway.
• Dalgard, Florence; Bjertness, Espen & Lien, Lars (2010). Suicidal Ideation, Mental Health Problems and Social Impairment are increased in Acne: A Population-Based Study in Adolescents. Journal of Investigative Dermatology. ISSN 0022-202X. 130, s. S70–S70.
• Jaradat, Yousef; Nijem, Khaldoun; Bjertness, Espen; Lien, Lars; Kristensen, Petter & Bast-Pettersen , Rita Elisabeth [Vis alle 7 forfattere av denne artikkelen] (2010). Effect of shift work on mental health of Palestinian nurses: a comparative study. The Lancet. ISSN 0140-6736.
• Lien, Lars; Djurovic, Srdjan; Thoresen, Magne; Bjertness, Espen & Andreassen, Ole Andreas (2008). Interaction between health behaviour, mental distress and the polymorphism of the serotonin transporter gene among adolescents in Oslo, Norway. European psychiatry. ISSN 0924-9338. 23, s. S174–S174.
• Halvorsen, JA; Lien, Lars; Thorsen, M; Bjertness, E & Dalgard, F (2007). Itch and mental distress among adolescents. Preliminary results from a. cross-sectional study. Acta Dermato-Venereologica. ISSN 0001-5555. 87, s. 471–471.
• Lien, Lars (2003). Tuberkulose og borgerkrig. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 123(23), s. 3426–3428.
• Lien, Lars (2003). Nye samarbeidsformer i internasjonalt helsearbeid. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 123( 4).
• Lien, Lars (2002). Is investing in health economically beneficial? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 20(122), s. 31–35.
• Bjørkhaug, Steinar Traae; Valeur, Jørgen; Bramness, Jørgen Gustav & Lien, Lars (2020). Alcohol-related alterations of the gut microbial flora. Universitetet i Oslo.
• Bramnes, Jørgen; Westby, Lena Catherine Lossius; Hjellvik, Vidar; Fauske, Halvor & Lien, Lars (2018). Legemidler og deres håndtering i barnverninstitusjoner. Nasjonal kompetansetjeneste for samtidig rusmisbruk og psykisk lidelse.
• Martinez, Priscilla; Lien, Lars; Clausen, Thomas & Landheim, Anne (2013). Alcohol use in special populations in Africa: Data from the World Health Survey and Study on Global AGEing and adult health. Universitetet i Oslo.
• Lien, Lars; Tellnes, Gunnar; Nygård, Jan Franz & Mowe, Gunnar (1995). Omfang og utvikling av yrkesskader ved sykmelding. Rapport 5/95. Rikstrygdeverket.

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