Interrater reliability of the violence risk assessment checklist for youth: a case vignette study.

BACKGROUND: Facilities providing health- and social services for youth are commonly faced with the need for assessment and management of violent behavior. These providers often experience shortage of resources, compromising the feasibility of conducting comprehensive violence risk assessments. The Violence Risk Assessment Checklist for Youth aged 12-18 (V-RISK-Y) is a 12-item violence risk screening instrument developed to rapidly identify youth at high risk for violent behavior in situations requiring expedient evaluation of violence risk. The V-RISK-Y instrument was piloted in acute psychiatric units for youth, yielding positive results of predictive validity. The aim of the present study was to assess the interrater reliability of V-RISK-Y in child and adolescent psychiatric units and acute child protective services institutions. METHODS: A case vignette study design was utilized to assess interrater reliability of V-RISK-Y. Staff at youth facilities (N = 163) in Norway and Sweden scored V-RISK-Y for three vignettes, and interrater reliability was assessed with the intraclass correlation coefficient (ICC). RESULTS: Results indicate good interrater reliability for the sum score and Low-Moderate-High risk level appraisal across staff from the different facilities and professions. For single items, interrater reliability ranged from poor to excellent. CONCLUSIONS: This study is an important step in establishing the psychometric properties of V-RISK-Y. Findings support the structured professional judgment tradition the instrument is based on, with high agreement on the overall risk assessment. This study had a case vignette design, and the next step is to assess the reliability and validity of V-RISK-Y in naturalistic settings.

Are symptoms assessed differently for schizophrenia and other psychoses in legal insanity evaluations of violent crimes?

BACKGROUND: Forensic evaluations of legal insanity include the experts' assessment of symptoms present at the mental state examination (MSE) and the mental state at the time of offense (MSO). Delusions and hallucinations are most important. We explored how often symptoms were recorded in written forensic reports. DESIGN: This exploratory, cross-sectional study included 500 reports of legal insanity written in 2009-2018 from cases of violent crimes in Norway. The first author read all reports and coded symptoms recorded from the experts' assessments of the offenders. Two co-authors repeated this procedure for 50 randomly selected reports. Interrater reliability was calculated with Gwet's AC1. Generalized Linear Mixed Models with Wald tests for fixed effects and Risk Ratios as effect sizes were used for the statistical analyses. RESULTS: Legal insanity was the main conclusion in 23.6% of the reports; 71.2% of these were diagnosed with schizophrenia while 22.9% had other psychotic disorders. Experts recorded few symptoms from MSO, but more from MSE, although MSO is important for insanity. We found a significant association between delusions and hallucinations recorded present in the MSO and legal insanity for defendants with other psychotic disorders, but no association for defendants with schizophrenia. The differences in symptom recordings between diagnoses were significant. CONCLUSION: Few symptoms were recorded from the MSO. We found no association between presence of delusions or hallucinations and legal insanity for defendants with schizophrenia. This may indicate that a schizophrenia diagnosis is more important to the forensic conclusion than the symptoms recorded in the MSO.

Factor structure and internal consistency of the parent patient activation measure (P-PAM) in parents of children with ADHD in norwegian paediatric mental health.

BACKGROUND: This study aimed to explore the internal consistency and factor validity of the 13-item self-report questionnaire Parent-Patient Activation Measure (P-PAM) in a sample of parents of children with Attention-deficit/hyperactivity disorder. METHODS: In a cross-sectional study, 239 parents were recruited from four outpatient clinics of the Child and Adolescent Mental Health Services and completed the P-PAM along with demographic variables. The factor structure of the P-PAM was examined through exploratory factor analysis, and internal consistency was estimated with the use of both Cronbach's alpha and McDonald's omega. A confirmatory factor analysis was used to estimate and test individual parameters. RESULTS: The fit indices suggest an acceptable two-factor model of P-PAM and show high internal consistency and reliability for both factors, indicating that the scale measures two concepts. CONCLUSIONS: Our findings provide evidence for an acceptable factor structure and a high reliability of P-PAM as a measure of parent activation, suggesting that the theoretical factors reflect the construct of parent activation as intuitively compiled into an inner cognitive factor and an outer behavioral factor, which are related.

Does Women's Screening History Have Any Impact on Mammography Screening Attendance After Tailored Education?: A Systematic Review and Meta-analysis.

BACKGROUND: Many ethnic minority women have low attendance at breast cancer screening. OBJECTIVES: This brief report explores whether women's screening histories impact mammography screening attendance after tailored education. RESEARCH DESIGN: Systematic searches were conducted in 5 databases. Randomized controlled trials of educational interventions tailored to ethnic minority women that measured attendance at mammography screening were eligible for inclusion. Data extraction and risk of bias assessment were performed independently. Data were combined in a meta-analysis by using random effects models. Heterogeneity was estimated by using I2 statistics. RESULTS: Six studies with 3521 women were eligible for inclusion. The D+L pooled risk ratio (RR) for mammography attendance for never screened participants was 1.54 (95% confidence interval, 1.24-1.91; P<0.001), with low heterogeneity (I2=27.1%, P=0.231). The D+L pooled risk ratio for attendance for ever screened participants was 1.26 (95% confidence interval, 1.11-1.43; P<0.001), with low heterogeneity (I2=35.5%, P=0.213). CONCLUSIONS: Tailored education increased attendance at mammography by 54% among never screened women and 26% among ever screened women. Although these findings must be interpreted with caution, the findings suggest that women's screening history is an important and ignored variable that affects how effective tailored education is on mammography screening attendance.

Changes to body mass index, work self-efficacy, health-related quality of life, and work participation in people with obesity after vocational rehabilitation: a prospective observational study.

BACKGROUND: People on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the participants' health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D). METHODS: This prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables. RESULTS: The participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (- 2.33, 95% CI: - 3.10 to - 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = - 0.34, 95% CI: - 0.65 to - 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = - 0.02, 95% CI: - 0.04 to 0.001) and work absence (B = - 0.01, 95% CI: - 0.02 to - 0.002). The regression model explained 71.8% of the HRQoL variance. CONCLUSION: The results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended. TRIAL REGISTRATION: Norwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374 , registered 18. September 2017. https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=.

Psychometric properties of the Five-item World Health Organization Well-being Index used in mental health services: Protocol for a systematic review.

AIMS: To synthesize evidence of the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and critically appraise the methodologies of the included studies. DESIGN: Protocol for a systematic psychometric review. METHODS: The review protocol has been registered in the International Prospective Register for Systematic Reviews. The bibliographic databases MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science will be searched for relevant studies. The psychometric properties of each study will be evaluated according to the Consensus-based Standards for the Selection of Health Measurements Instruments. DISCUSSION: The results of our psychometric review will synthesize the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and identify possible gaps in the literature regarding methodological quality and its reliability, validity, and responsiveness to change. IMPACT: The evaluation of patient well-being is important, and the Five-item World Health Organization Well-being Index is an increasingly used patient-reported outcome measure. It is simple to collect, free to use, and consists of five questions using positive health statements. Although the number of studies assessing the validity, reliability, and responsiveness of the questionnaire is increasing worldwide, there is a need to summarize the existing evidence of the psychometric properties of this questionnaire. The proposed study's findings will contribute to future research recommendations and help midwives and nurses in different settings pick an effective, appropriate questionnaire to evaluate patient well-being.

The quality and quantity of staff-patient interactions as recorded by staff. A registry study of nursing documentation in two inpatient mental health wards.

BACKGROUND: Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. METHODS: The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. RESULTS: Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. CONCLUSION: These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts.

Nursing documentation in inpatient psychiatry: The relevance of nurse-patient interactions in progress notes-A focus group study with mental health staff.

AIMS AND OBJECTIVES: To gain insight into mental health staff's perception of writing progress notes in an acute and subacute psychiatric ward context. BACKGROUND: The nursing process structures nursing documentation. Progress notes are intended to be an evaluation of a patient's nursing diagnoses, interventions and outcomes. Within this template, a patient's status and the care provided are to be recorded. The therapeutic nurse-patient relationship is recognised as a key component of psychiatric care today. At the same time, the biomedical model remains strong. Research literature exploring nursing staff's experiences with writing progress notes in psychiatric contexts, and especially the space given to staff-patient relations, is sparse. DESIGN: Qualitative design. METHODS: Focus group interviews with mental health staff working in one acute and one subacute psychiatric ward were conducted. Systematic text condensation, a method for transverse thematic analysis, was used. RESULTS: Two main categories emerged from the analysis: the position of the professional as an expert and distant observer in the progress notes, and the weak position of professional-patient interactions in progress notes. CONCLUSIONS: The participants did not perceive that the current recording model, which is based on the nursing process, supported a focus on patients' resources or reporting professional-patient interactions. This model appeared to put ward staff in an expert position in relation to patients, which made it challenging to involve patients in the recording process. Essential aspects of nursing care related to recovery and person-centred care were not prioritised for documentation. RELEVANCE TO CLINICAL PRACTICE: This study contributes to the critical examination of the documentation praxis, as well as to the critical examination of the documentation tool as to what is considered important to document.

Triglycerides as a biological marker of repeated re-hospitalization resulting from deliberate self-harm in acute psychiatry patients: a prospective observational study.

BACKGROUND: Biological factors have been associated with deliberate self-harm (DSH) but have not been integrated with clinical factors in routine risk assessments.This study aimed to examine the incremental validity of lipid levels and platelet serotonin when combined with psychosocial factors in risk assessments for repeated admissions due to DSH. METHODS: In this prospective observational study of 196 acutely admitted patients, results of blood tests performed upon admission and the MINI Suicidal Scale and psychosocial DSH risk factor assessments performed at discharge were compared with the incidence of DSH recorded during the first 3 and 12 months after discharge. RESULTS: High triglyceride levels were found to be a significant marker for patients admitted 3 or more times due to DSH (repeated DSH, DSH-R) when tested against other significant risk factors. When all (9) significant univariate factors associated with 12-month post-discharge DSH-R were analyzed in a multivariate logistic regression, the MINI Suicidal Scale (p = 0.043), a lack of insight (p = 0.040), and triglyceride level (p = 0.020) remained significant. The estimated 12-month area under the curve of the receiver operator characteristic (ROC-AUC) for DSH-R was 0.74 for triglycerides, 0.81 for the MINI, 0.89 for the MINI + psychosocial factors, and 0.91 for the MINI + psychosocial factors + triglycerides. The applied multifaceted approach also significantly discriminated between 12-month post-discharge DSH-R patients and other DSH patients, and a lack of insight (p = 0.047) and triglycerides (p = 0.046) remained significant for DSH-R patients in a multivariate analysis in which other DSH patients served as the reference group (rather than non-DSH patients). CONCLUSION: The triglyceride values provided incremental validity to the MINI Suicidal Scale and psychosocial risk factors in the assessment of the risk of repeated DSH. Therefore, a bio-psychosocial approach appears promising, but further research is necessary to refine and validate this method.

User involvement in structured violence risk management within forensic mental health facilities -- a systematic literature review.

AIMS AND OBJECTIVES: To examine empirical literature on user involvement in collaboration between patients and nurses. The scope of the review was limited to structured violence risk management interventions in forensic mental health settings. BACKGROUND: Violence in forensic mental health settings represents a significant problem for patients and staff. Structured violence risk management interventions in forensic mental health have been reported to ignore patient participation, despite the growing attention on user involvement in clinical practice. DESIGN: A systematic review. METHOD: Searches were conducted in six databases: the Cochrane Systematic Reviews, MEDLINE, CINAHL, ProQuest, ScienceDirect and PsycINFO. Papers were assessed according to a predetermined set of inclusion and exclusion criteria. RESULTS: After searches of the reference lists of retrieved articles were conducted, only three papers met the inclusion criteria. CONCLUSIONS: This review has shown that empirical research on the topic of risk management interventions in which patients are involved is scarce. RELEVANCE TO CLINICAL PRACTICE: There is barely any research evidence of the clinical effect of user involvement approaches on violence risk management in forensic mental health practice. Therefore, we suggest that clinicians may learn from positive experiences concerning user involvement in general psychiatry and carefully adapt and test them out in the forensic treatment context.

Comparison of V-RISK-Y and V-RISK-10 for risk of violence: A one-year study from a psychiatric emergency department for adolescents.

There has been a lack of short and simple screening instruments to assess the risk of violence in youth. Many acute youth departments have used the V-RISK-10, a risk screener for adults. V-RISK-Y is a risk screener based on the V-RISK-10 and adapted to youths. Our aim was to compare the predictive validity between V-RISK-Y and VRISK-10 in an emergency psychiatric adolescent ward. Target population were all 92 patients admitted within one year, and study population consisted of 49 (53 %) patients who had completed data. V-RISK-10 and V-RISK-Y were scored at admission and compared with recorded episodes of violence during the hospitalization. V-RISK-Y showed higher AUC values for recorded violence and some of the individual items also showed better results. Most differences were not significant, but results may still be of clinical interest.

The investigation of early warning signs of aggression in forensic patients by means of the 'Forensic Early Signs of Aggression Inventory'.

AIMS AND OBJECTIVES: The Forensic Early Warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying early warning signs and constructing individual early detection plans (EDP) for the prevention of aggressive incidents. The aims of this research were as follows: First, to study the prevalence of early warning signs of aggression, measured with the FESAI, in a sample of forensic patients, and second, to explore whether there are any types of warning signs typical of diagnostic subgroups or offender subgroups. BACKGROUND: Reconstructing patients' changes in behaviour prior to aggressive incidents may contribute to identify early warning signs specific to the individual patient. The EDP comprises an early intervention strategy suggested by the patient and approved by the nurses. Implementation of EDP may enhance efficient risk assessment and management. DESIGN: An explorative design was used to review existing records and to monitor frequencies of early warning signs. METHODS: Early detection plans of 171 patients from two forensic hospital wards were examined. Frequency distributions were estimated by recording the early warning signs on the FESAI. Rank order correlation analyses were conducted to compare diagnostic subgroups and offender subgroups concerning types and frequencies of warning signs. RESULTS: The FESAI categories with the highest frequency rank were the following: (1) anger, (2) social withdrawal, (3) superficial contact and (4) non-aggressive antisocial behaviour. There were no significant differences between subgroups of patients concerning the ranks of the four categories of early warning signs. CONCLUSION: The results suggest that the FESAI covers very well the wide variety of occurred warning signs reported in the EDPs. No group profiles of warning signs were found to be specific to diagnosis or offence type. RELEVANCE TO CLINICAL PRACTICE: Applying the FESAI to develop individual EDPs appears to be a promising approach to enhance risk assessment and management.

Lethal intimate partner violence: an interactional perspective on women's perceptions of lethal incidents.

Intimate partner homicide (IPH) is the only lethal violence in which women are the principal victims. This research reports on an investigation of possible differences between dynamics of lethal and nonlethal intimate partner violence (IPV). A representative sample of 157 help-seeking female victims of IPV in Norway was interviewed. Results from multivariate logistic regression analysis indicated that women who perceived they had been subjected to lethal IPV were different from those who had not perceived the IPV as lethal concerning interactional dimensions of IPV and in their help-seeking responses. There was no difference related to sociodemographic factors. Because some IPV help-seeking women may be at a heightened risk for lethal violence, it is imperative that their efforts to seek assistance are responded to with care and structured risk assessment.

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment.

Introduction: This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions. Materials and Methods: Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables. Results: The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUCG. Conclusion: The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

The safe pilot study: A prospective naturalistic study with repeated measures design to test protective factors against violence in and after discharge from forensic facilities.

Assessing violence risk amongst forensic patients is a vital legal and clinical task. The field of violence risk assessment has developed considerably over the past two decades but remains primarily risk focused. Despite this, growing attention to and work on protective factors or strengths has occurred. In this prospective naturalistic study with repeated observer-rated measures of 27 forensic patients, we tested the role of three potentially important but understudied dynamic protective factors: hope, insight, and resilience, along with a history of criminality, in terms of their impact on violence. Main effects models indicated that higher hopelessness and past criminal convictions were predictive of violence acts; higher resilience was associated with lower violence. In interaction models, hopelessness remained predictive. Importantly, there were significant interactions between resilience and past criminal convictions, with higher levels of resilience leading to lower violence, most amongst those with criminal convictions, and between resilience and hopelessness related emotional distress, in that higher resilience at high levels of patient acknowledged emotional distress due to hopelessness led to lower violence. Findings indicate the importance of focusing on strengths or protective factors in the assessment of risk and treatment planning for forensic patients. Despite the small sample, the repeated measures design was feasible and informative.

Validation of a violence risk screening for youth in psychiatric inpatient care-a pilot study of V-RISK-Y.

The reason for this study was the void of validated risk assessment screening tools for violence in adolescence psychiatry. Our aims were to test the predictive validity and feasibility of a pilot version of the Violence Risk Screening for Youth (V-RISK-Y). The V-RISK-Y was based on a violence risk screen for adults, the V-RISK-10, and adapted to adolescents, resulting in 12 risk items that are scored for (a) presence and (b) relevance for future violence. In this naturalistic, prospective observational study, the V-RISK-Y was scored at admission and compared with recorded episodes of violent acts and threats during hospital stay. The target population was all 92 patients admitted to the emergency department of adolescent psychiatry at Oslo University Hospital for 1 year, of which 67 patients were scored with the V-RISK-Y at admission and constituted the study sample. The predictive validity of the V-RISK-Y for violent behavior showed an AUC of 0.762 (p = 0.006). Staff approved the screener and found it to be equally or better usable than the V-RISK-10, which was previously used in the department. Still, a high proportion of raters failed to follow the scoring instructions of relevance scores, reducing feasibility. The results must be interpreted within the limits of a pilot study and low power. We conclude that results suggest changes of certain parts of the V-RISK-Y and provide a basis for testing a revised edition of the screener in a more comprehensive study, preferably with a multicenter design.

Transcultural adaptation and assessment of psychometric properties of the Spanish version of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes.

PURPOSE: To adapt the Scale for the Evaluation of Staff Patient Interactions in Progress Notes to Spanish and to test the psychometric properties. DESIGN AND METHODS: The study was conducted in two phases: (1) Adaptation of the instrument to Spanish following the Standards for Educational and Psychological Testing. (2) Psychometric study in a sample of mental health nurses. FINDINGS: The Cronbach's alpha values were 0.97 for the total scale and 0.83 to 0.81 for each dimension. The inter-rater reliability values were between 0.94 and 0.97. PRACTICE IMPLICATIONS: The scale is a reliable tool for assessing nurses' clinical notes in relation to the quality of nurse-patient interactions.

Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: Protocol for a controversies in psychiatry research project.

OBJECTIVES: Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry-based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. METHODS: By using the natural variation in health providers' preference for compulsory care as a source of quasi-randomisation we will estimate causal effects of compulsory care on short- and long-term trajectories. CONCLUSIONS: This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group.

A mixed method approach to clarify the construct validity of interprofessional collaboration: an empirical research illustration.

The rapid development of empirical studies in the field of interprofessional collaboration (IPC) calls for a wide array of scientific approaches ranging from recruitment and motivation to measurement and design questions. Regardless of whether researchers choose qualitative or quantitative approaches, they must substantiate their findings. We argue that more attention should be given to reliability and validity issues to improve our understanding of IPC as a phenomenon and practice. A mixed methods approach is presented as a relevant design format for the study of IPC. This paper aims to argue that a combination of methodologies may be a feasible way to enhance our understanding of IPC, with a special focus on reliability and validity issues; illustrate the application of different methodologies in an IPC research project; and emphasize the distinction between validity and validation to mitigate possible obstacles in integrating qualitative and quantitative research in the study of IPC.

Is There an Association Between Salivary Cortisol and Dropping Out of Inpatient Substance Addiction Treatments? A Prospective Repeated Measures Study.

Several studies have found an association between salivary cortisol levels and dropping out of inpatient substance addiction treatment programs. The results are mixed due to variations in the study design and the lack of standardized routines for cortisol assessment. The aim of this study was to investigate whether there was (1) an association between salivary cortisol levels and dropping out from inpatient substance addiction treatments; (2) higher predictive validity for dropout in one of the cortisol indexes: Area Under the Curve with respect to ground (AUCG) or Daily Cortisol Slope (DCS); (3) an interaction effect with time for each cortisol index; and (4) different dropout rates for sex and patients in short-term versus long-term treatment programs. This was a prospective, repeated-measures observational study. Patients (n = 173) were recruited from 2 inpatient facilities in the central region of Norway between 2018 and 2021. Salivary cortisol was measured 4 times during the treatment period, with 8 samples collected over 2 consecutive days at each time point. Cortisol levels were calculated using the cortisol indices AUCG and DCS. Dropout was used as the outcome measure at each time point. Associations were calculated using a logistic linear regression. The results suggest a main effect of AUCG, whereby higher levels reduce dropout risk (OR = 0.92, P = .047). An interaction with time in treatment also revealed a higher dropout risk (OR = 1.09, P = .044) during week 4 of the treatment, depending on the AUCG. These results support using AUCG as the recommended index when assessing cortisol, and that the relationship between cortisol levels and length of treatment should be further investigated.