Death-is-life-enhancing: Adaptation and validation of the Norwegian Death Mindsets Measure (NDMM).

While existing psychological frameworks and their accompanying measures focus on death as anxiety-inducing and debilitating, we highlight an overlooked perspective of death-that death can be a basis for living with more meaning and presence. The present research adapts and validates the Death Mindsets Measure (DMM), which assesses the mindset that "death-is-life-enhancing," for a Norwegian context. Firstly, we translated the DMM and consulted with Norwegian bereavement experts and bereaved Norwegians on items' clarity and relevance to cultural perspectives of death. Secondly, we validated the Norwegian DMM (NDMM) on a predominantly bereaved community sample of Norwegians (N = 241). Using structural equation modeling, we confirmed the hierarchical two-factor structure of our measure. The NDMM also demonstrated high internal consistency and discriminant validity with existing death anxiety and death attitudinal measures. Finally, our measure explained additional variance in psychological well-being beyond existing death anxiety and attitudinal measures.

The associations of grief-related rumination with prolonged grief and posttraumatic stress symptoms: A longitudinal study of bereaved after the 2011 terror attack in Norway.

After the sudden and violent death of a loved one, many bereaved experience symptoms of prolonged grief (PG) and posttraumatic stress (PTS). The present study investigated the cross-sectional and longitudinal associations of grief-related rumination with PG and PTS symptoms among bereaved parents and siblings after the Utøya terror attack in Norway on 22 July 2011 (N = 110, Mage = 43.2 years, 59.1% female). Participants' responses on the Rumination Scale, the Inventory of Complicated Grief and the Impact of Event Scale-Revised 28, 40 and 102 months after the loss were analysed. Cross-sectionally and longitudinally, grief-related rumination was positively and strongly linked with PG and PTS symptoms. When controlling for the baseline levels of PG and PTS symptoms and demographics of the sample, grief-related rumination predicted PG symptoms after 12 months but not after 74 months. Further, grief-related rumination predicted significantly the PTS symptoms of avoidance after 12 and 74 months and hyperarousal after 74 months beyond sample demographics and baseline symptoms. The results suggest that grief-related rumination is an important factor in PG and PTS symptoms after traumatic bereavement.

The prevalence of potentially traumatic events in the seventh survey of the population-based Tromsø study (Tromsø 7).

Aims: Potentially traumatic events (PTEs) can have detrimental consequences for an individual's physical and mental health. Exposure to PTEs is therefore increasingly assessed in population-based studies. Consistent with this trend, the most recent wave of the longitudinal population-based Tromsø study (Tromsø 7) in Northern Norway included a list of PTEs. The aim of the present study was to describe the prevalence of PTEs in the sample and examine demographic correlates of reported PTE exposure in this group. Methods: In Tromsø 7, a total of 21,083 participants aged ⩾40 years (52.5% female, mean age 57.3 years) were asked about exposure to nine PTEs that occurred in childhood, in adulthood and in the previous year. Differences between demographic groups in exposure to PTEs were examined using chi-square tests and logistic regression analyses. Results: Overall, 67% of the participants reported at least one PTE across the three time intervals. A life-threatening illness or serious accident of a loved one (36.8%) or of the respondent (24.0%) and bullying (21.5%) were the most frequently reported PTEs. Female sex, younger age, indigenous or immigrant ethnicity and higher education were associated with an increased likelihood of reporting at least one PTE. Group differences with respect to specific PTEs were observed. Conclusions: The experience of PTEs is common among the participants in the Tromsø 7 study. The current study lays the foundation for further research into the associations between PTEs and physical and mental health within the Tromsø study.

Depression, anxiety, PTSD, and OCD after stillbirth: a systematic review.

BACKGROUND: This systematic review aimed to provide an updated summary of studies investigating depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) in parents after stillbirth (from 20 weeks gestational age until birth). METHODS: A literature search was conducted in the databases Web of Science and PsychINFO. Main inclusion criteria were 1) peer-reviewed, quantitative, English-language articles published from 1980; (2) studies investigating depression, anxiety, PTSD, or OCD among parents following stillbirth; and (3) studies defining stillbirth as equal to or after 20 weeks of gestation. RESULTS: Thirteen quantitative, peer-reviewed articles were eligible for inclusion. Selected articles investigated depression, anxiety, and PTSD, while no studies on OCD met our inclusion criteria. The majority of studies investigated women, while only two studies included men. The results indicated heightened short- and long-term levels of depression, anxiety, and PTSD in parents after stillbirth compared to those of parents with live birth. Studies investigating predictors found that social support, marital status, negative appraisals, and variables related to care and management after stillbirth affected levels of symptoms. CONCLUSIONS: Parents who experience stillbirth have a considerably higher risk of reporting symptoms of depression, anxiety, and PTSD compared with parents with live births. More longitudinal studies are needed to increase our knowledge of how symptoms develop over time, and more research on fathers, transgender, non-binary and gender fluid individuals is needed. Research on the association between stillbirth and OCD is also warranted. Knowledge of the severity of anxiety, depression, and PTSD after stillbirth, and predictors associated with symptom severity could provide healthcare professionals with valuable information on how to provide beneficial postpartum care.

Dental anxiety and potentially traumatic events: a cross-sectional study based on the Tromsø Study-Tromsø 7.

OBJECTIVE: The objectives of the study were to describe the prevalence of dental anxiety and the possible associations between dental anxiety and potentially traumatic events in an adult population. METHOD: The study is based on cross-sectional questionnaire data from the 7th wave of the Tromsø Study, a study of the adult general population in the municipality of Tromsø carried out in 2015-2016. The Modified Dental Anxiety Scale was used to measure dental anxiety across potentially traumatic events, oral health, dental attendance (avoidance) and current mental health symptoms (Hopkins Symptom Checklist). Individuals with high and low dental anxiety scores were compared to investigate differences in the distribution of potentially traumatic events, current mental health symptoms, avoidance, sex and oral health, and hierarchical multivariable regression was used to study the influence of traumatic events on dental anxiety. RESULTS: High dental anxiety was reported by 2.9% of the sample and was most prevalent among females and in the youngest age groups. Individuals with high dental anxiety reported more current mental health symptoms, and they were more likely to report poorer oral health and more irregular dental visits compared to individuals with no or lower dental anxiety scores. Concerning traumatic events, the reporting of painful or frightening dental treatment showed the biggest difference between those with high dental anxiety and low dental anxiety scores (a moderate effect). The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital and childhood neglect significantly predicted dental anxiety in the step they were entered in, but only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms. CONCLUSIONS: The prevalence of high dental anxiety was lower than expected (2.9%), but dentally anxious individuals expressed a high burden of mental health symptoms, poor oral health and the avoidance of dental care. The regression analysis indicated that experiences with sexual abuse could affect dental anxiety levels in the absence of generalised symptoms of anxiety and depression.

Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction.

BACKGROUND: The patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients' experiences of being involved in their treatment. OBJECTIVE: To investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction. DESIGN: Cross-sectional. SETTING AND PARTICIPANTS: The sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection. MAIN VARIABLES STUDIED: Perceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out-Patient Experiences Questionnaire. RESULTS: About half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction. DISCUSSION AND CONCLUSION: The findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention. PATIENT OR PUBLIC CONTRIBUTION: The hospital's user panel was involved in the development of items assessing user involvement.

International Assessment of DSM-5 and ICD-11 Personality Disorder Traits: Toward a Common Nosology in DSM-5.1.

INTRODUCTION: The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 classification of personality disorders (PD) are largely commensurate and, when combined, they delineate 6 trait domains: negative affectivity, detachment, antagonism/dissociality, disinhibition, anankastia, and psychoticism. OBJECTIVE: The present study evaluated the international validity of a brief 36-item patient-report measure that portrays all 6 domains simultaneously including 18 primary subfacets. METHODS: We developed and employed a modified version of the Personality Inventory for DSM-5 - Brief Form Plus (PID5BF+). A total of 16,327 individuals were included, 2,347 of whom were patients. The expected 6-factor structure of facets was initially investigated in samples from Denmark (n = 584), Germany (n = 1,271), and the USA (n = 605) and subsequently replicated in both patient- and community samples from Italy, France, Switzerland, Belgium, Norway, Portugal, Spain, Poland, Czech Republic, the USA, and Brazil. Associations with interview-rated DSM-5 PD categories were also investigated. RESULTS: Findings generally supported the empirical soundness and international robustness of the 6 domains including meaningful associations with familiar interview-rated PD types. CONCLUSIONS: The modified PID5BF+ may be employed internationally by clinicians and researchers for brief and reliable assessment of the 6 combined DSM-5 and ICD-11 domains, including 18 primary subfacets. This 6-domain framework may inform a future nosology for DSM-5.1 that is more reasonably aligned with the authoritative ICD-11 codes than the current DSM-5 AMPD model. The 36-item modified PID5BF+ scoring key is provided in online supplementary Appendix A see www.karger.com/doi/10.1159/000507589 (for all online suppl. material).

Time trends in the effects of mindfulness-based cognitive therapy for depression: A meta-analysis.

Recent studies suggest that the effects of cognitive therapies for depression show systematic changes over time. A meta-analysis was conducted to explore the temporal development of the effect of mindfulness-based cognitive therapy (MBCT) for current depression in studies that used the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HDRS) as outcome measures. A systematic search of research databases yielded 20 studies that were included in the analyses. The results showed that MBCT is effective in reducing depressive symptoms. The effect sizes of studies using the BDI or the HDRS as an outcome measure were not moderated by the time of publication. Funnel plots and the trim and fill method suggested that publication bias was low. However, the number of available studies was small, and the time period investigated relatively short. The results should therefore be considered preliminary.

Coping, thought suppression, and perceived stress in currently depressed, previously depressed, and never depressed individuals.

BACKGROUND: Previous research shows that depression is associated with an increase in stressful life events and perceived stress as well as dysfunctional ways of coping with stress. However, knowledge about coping in previously depressed individuals is scant. METHODS: This study compared perceived stress, coping, and thought suppression in a sample of 30 currently depressed, 63 previously depressed, and 42 never depressed individuals. RESULTS: Analysis of variance revealed that previously depressed individuals showed less wishful thinking and thought suppression than the currently depressed individuals, but scored significantly higher on these strategies than the never depressed individuals. However, the group differences became nonsignificant when controlling for perceived stress and intrusions. CONCLUSIONS: This study shows that both current depression and previous depression is related to avoidant coping (wishful thinking and thought suppression). However, these associations might be explained by the higher level of perceived stress among individuals with current or previous depression.

Hierarchical Structure and Cross-Cultural Measurement Invariance of the Norwegian Version of the Personality Inventory for DSM-5.

The Personality Inventory for DSM-5 (PID-5) was created to aid a trait-based diagnostic system for personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013a ). In this study, we aimed to evaluate the Norwegian version of the PID-5 by examining its score reliability, hierarchical structure, congruency with international findings, and cross-cultural measurement invariance with a matched U.S. SAMPLE: For this purpose, 503 university students (76% females) were administered the PID-5. The Norwegian PID-5 showed good score reliability and structural validity from 1 to 5 factors. The 5-factor structure was generally congruent with international findings, and support for measurement invariance across the Norwegian and a matched U.S. sample was found. Conclusively, the results indicate that scores on the Norwegian PID-5 have sound psychometric properties, which are substantially comparable with the original U.S. version, supporting its use in a Norwegian population.

Effectiveness of cognitive behavioral group therapy for depression in routine practice.

BACKGROUND: Previous research has shown that cognitive- behavioral group therapy (group CBT) is an effective treatment for depression. However, the effectiveness of this approach in routine care needs more research. The current study retrospectively examines the outcomes of patients who received group CBT for depression at a psychiatric outpatient clinic between 2003 and 2013. METHODS: Based on patient records, 143 patients were identified as having received the treatment, and 88 patients were included in the outcome analyses. The Beck Depression Inventory (BDI-II) score was the main outcome measure. RESULTS: The dropout rate was 17.5%. The average BDI-II score decreased from 28.5 to 18.5 from pre-treatment to post-treatment and remained stable at 3-months follow-up. The effect sizes at post-treatment and follow-up were large (d = .97 and d = 1.10, respectively). At post-treatment, 44% of the patients showed a significant improvement in depression, including 30% who recovered; at follow-up, the proportions increased to 57% and 40%, respectively. No predictors of dropout or treatment response were found. CONCLUSIONS: Group CBT for depression can be delivered in routine care settings with good results. However, there are still many patients who drop out or do not benefit from treatment.

Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack.

Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.

Many bereaved individuals, especially females, reported insomnia and somatic symptoms, including fatigue, pain, and other related symptoms.Somatic symptoms, avoidance, and hyperarousal were identified as being associated with functional impairment among the bereaved.Post-traumatic stress symptoms played a more significant role than prolonged grief symptoms in explaining the reduced physical health experienced by the bereaved.

Associations between stressful life events in childhood/adolescence and adulthood: results from the 7th Tromsø survey.

BACKGROUND: Exposure to highly stressful life events (SLEs), such as accidents, violence, or serious illness, is common. With the accumulation of SLEs, the risk of detrimental somatic and mental health outcomes increases. To understand patterns of SLE exposure, research into the associations between SLEs is needed. METHOD: The sample comprised 21,069 participants of the population-based Tromsø7 (2015/2016) study (52.7% female, mean age = 57.3 years, SD = 11.4 years). Participants were asked whether they had experienced eleven SLEs in childhood/adolescence and adulthood. Correlations, network analysis, and logistic regression analysis were used to examine the associations between SLEs. RESULTS: Medium-sized to large correlations between SLEs in childhood/adolescence and SLEs in adulthood were found. Two clusters of SLEs emerged in the network analysis in childhood/adolescence and in adulthood, respectively, interpreted as interpersonal (e.g. violence and sexual abuse) and impersonal SLEs (e.g. a life-threatening illness or serious accident). SLEs in childhood/adolescence predicted the number of SLEs in adulthood as well as exposure to the specific SLE categories in adulthood. Childhood neglect was an important predictor of SLE exposure in adulthood. CONCLUSIONS: Public health policies should focus on the prevention of SLEs and the early intervention after SLE exposure, especially childhood neglect.

Highly stressful life events (SLEs) are systematically interconnected.SLEs in childhood and adolescence are associated with exposure to SLEs in adulthood.Childhood physical and emotional neglect is strongly related to other SLEs in childhood/adolescence and adulthood.

The higher-order structure of early maladaptive schemas: A meta-analytical approach.

Background: Early maladaptive schemas (EMSs) are themes regarding oneself and one's relationship with others. In schema therapy, 18 EMSs are described that were initially proposed to be clustered in five domains. The current EMS model comprises four domains. However, empirical investigations into the grouping of EMSs have yielded divergent results. The purpose of the present study was to use a meta-analytical approach to examine the higher-order organization of EMSs. Methods: To be included in the statistical analyses, studies had to report the associations between all 18 EMSs using a form of the Young Schema Questionnaire. In a systematic literature review in PsycInfo, Embase, MEDLINE, Web of Science, and Google scholar, 27 studies were identified that reported the associations between EMSs in 33 independent samples (N = 13,958, M age = 16-72.3 years, 64.0% female). The correlations between EMSs were pooled across samples and analyzed using confirmatory factor analysis (CFA) and principal component analysis (PCA). Results: The CFA results showed weak support for any of the previously suggested EMS domains. After PCA, four EMS domains were retained that closely resembled the theoretically proposed organization of EMSs. The four components showed fair to good congruence in the clinical and non-clinical subsamples. However, a model with three EMS domains showed a simpler structure. Discussion: The results suggest a need for further theoretical and empirical clarification of the higher-order structure of EMSs. Systematic review registration: https://osf.io/57wyz.

Prolonged grief, post-traumatic stress, and functional impairment in parents and siblings 8 years after the 2011 Utøya terror attack.

Background: Research on bereavement after terrorism is limited and primarily aiming on short-term consequences.Objective: To better understand the long-term health consequences of terrorism, we studied bereaved parents and siblings eight years after the Utøya terrorist attack in Norway. We examined the participants' symptom levels of prolonged grief (PG) and post-traumatic stress (PTS), as well as their psychosocial functioning and employment status.Method: Bereaved parents (n = 88) and siblings (n = 34) aged 19 and above (mean age = 49.7 years, SD = 13.8 years, 59.8% female) completed the Inventory of Complicated Grief (ICG), the Impact of Event Scale-Revised (IES-R), and the Work and Social Adjustment Scale (WSAS) to assess PG, PTS, and functional impairment, respectively. In addition, information about employment status was obtained. The proportion of participants scoring above recommended thresholds on the ICG, IES-R, and WSAS was calculated. Differences between parents and siblings and gender differences on these measures were examined.Results: In total, 62.3% of the participants had scores on the ICG indicating a risk for prolonged grief, while 45.9% scored over cutoff on the IES. There was a high overlap between symptoms of PG and PTS. Females had significantly higher scores on both the ICG and the IES compared to males. There were no differences between parents and siblings regarding PG and PTS symptoms. One out of three showed severe functional impairment on the WSAS. Approximately 30% of all the bereaved were outside the labour force, and one third of the parents had become unable to work after the terrorist attack.Conclusion: Many bereaved parents and siblings, following the Utøya terror attack, report long-lasting health consequences with symptoms of PG and PTS and functional impairment. The results suggest a need for follow up of bereaved after a terror attack and identify family members in need of health services.

Eight years after the Utøya terrorist attack bereaved parents and siblings still report high levels of prolonged grief and post-traumatic stress symptoms.There were no differences between parents and siblings regarding prolonged grief and post-traumatic stress symptoms.Many bereaved are still suffering functional impairments. Post-traumatic stress symptoms are found to be an important predictor for functional impairments.

Relationships between early maladaptive schemas and psychosocial developmental task resolution.

In schema therapy, early maladaptive schemas (EMS) are hypothesized to be the result of adverse relational experiences in childhood that hinder the resolution of important psychological developmental tasks. The purpose of the present study was to examine the relationships between EMS and the resolution of the developmental tasks that are described in Erikson's scheme of personality development. One hundred and forty-five adult psychiatric outpatients completed measures of EMS and resolution of psychosocial development tasks at two occasions. Results from correlational and regression analyses showed that EMS are generally associated with unsuccessful psychosocial task resolution. Furthermore, schema change predicted changes in the resolution of developmental tasks. These findings give support to Young's theory of schema development.

The Norwegian Computerized Adaptive Test of Personality Disorder-Static Form (CAT-PD-SF): Reliability, Factor Structure, and Relationships With Personality Functioning.

The Computerized Adaptive Test of Personality Disorder-Static Form (CAT-PD-SF) is a self-report inventory developed to assess pathological personality traits. The current study explored the reliability and higher order factor structure of the Norwegian version of the CAT-PD-SF and the relationships between the CAT-PD traits and domains of personality functioning in an undergraduate student sample (N = 375). In addition to the CAT-PD-SF, the short form of the Severity Indices of Personality Problems and the Brief Symptom Inventory were administered. The results showed that the Norwegian CAT-PD-SF has good score reliability. Factor analysis of the CAT-PD-SF scales indicated five superordinate factors that correspond to the trait domains of the alternative DSM-5 model for personality disorders. The CAT-PD traits were highly predictive of impaired personality functioning after controlling for psychological distress. It is concluded that the CAT-PD-SF is a promising tool for the assessment of personality disorder traits.

The prevalence of severe grief reactions after bereavement and their associations with mental health, physical health, and health service utilization: a population-based study.

Background: Previous research has shown that bereaved individuals are at risk of developing physical and mental health problems. However, knowledge is scarce about the associations between severe grief reactions after bereavement and physical and mental health problems and the use of health services. Objectives: The present study sought to investigate the prevalence of severe grief reactions and to study the associations of severe grief reactions with mental and physical health and health care utilization. Method: The sample comprised 20,453 adults aged 40 and above (mean age = 57.2 years, SD = 11.3 years, 52.4% female) who participated in the seventh wave of the Tromsø study. Severe grief was assessed with one question asking whether the respondent has experienced the death of a loved one and currently has difficulty accepting the loss, yearns for the deceased, and experiences intense emotional pain related to the loss. Furthermore, participants answered questions about their current physical health, mental health (Hopkins Symptom Checklist - 10), and the use of health services in the past year. Results: Overall, 5.2% of the participants reported severe grief after a loss in childhood, 25.9% after bereavement in adulthood and 4.1% after bereavement in the previous year. Female gender, higher age, living without a partner, non-Norwegian ethnicity, and lower socio-economic status were associated with severe grief. Severe grief reactions were negatively related to self-reported health, predicted positively current levels of depression and anxiety, and were positively associated with the use of health services. Effect sizes were small. Gender differences in the use of health services were observed. Conclusion: Severe grief reactions are common in individuals aged 40 and older and associated with self-reported physical and mental health problems as well as increased use of health services. Health service providers should be attentive to possible severe grief in connection with health complaints.

Antecedentes: Investigaciones previas han mostrado que los individuos que han perdido a seres queridos se encuentran en mayor riesgo de desarrollar problemas de salud física y mental. Sin embargo, es escaso el conocimiento sobre las asociaciones entre las reacciones severas de duelo luego de la pérdida y los problemas de salud física y mental y el uso de los servicios de salud.Objetivo: El presente estudio buscó investigar la prevalencia de las reacciones severas de duelo y estudiar las asociaciones de las reacciones severas de duelo con la salud física y mental y la utilización de atención de salud.Método: La muestra se compuso de 20.453 adultos de 40 años y más (edad promedio = 57.2 años, DS = 11.3 años, 52.4% mujeres) que participaron en la séptima etapa del estudio Tromsø. El duelo severo se midió con una pregunta indagando si el encuestado ha experimentado la muerte de un ser querido y si actualmente tiene dificultades aceptando la pérdida, ansia del fallecido/a, y experimenta dolor emocional intenso relacionado a la pérdida. Además, los participantes respondieron preguntas sobre su actual salud física, salud mental (Lista de Chequeo de Síntomas de Hopkins­10), y el uso de los servicios de salud en el último año.Resultados: En general, 5.2% de los participantes reportaron duelo severo después de una pérdida en la infancia, 25.9% luego de la pérdida de un ser querido en la adultez y 4.1% luego de una pérdida en el último año. Se asociaron con el duelo severo el género femenino, una mayor edad, vivir sin una pareja, no ser de etnia noruega, y estatus socioeconómico más bajo. Las reacciones severas de duelo se relacionaron negativamente con el auto-reporte de salud, predijo positivamente los niveles actuales de depresión y ansiedad, y fueron asociados positivamente con el uso de los servicios de salud. Los tamaños de los efectos fueron pequeños. Se observaron diferencias de género en el uso de los servicios de salud.Conclusión: Las reacciones severas de duelo son comunes en los individuos de 40 y más años y se asociaron con el auto-reporte de problemas de salud física y mental como también con un incremento del uso de los servicios de salud. Los proveedores de los servicios de salud deberían estar atentos a la posible conexión entre el duelo severo y las quejas de salud.

Early maladaptive schemas as predictors of maternal bonding to the unborn child.

BACKGROUND: The quality of an expectant mother's bonding to the fetus has been shown to be associated with important developmental outcomes. Previous studies suggest that bonding quality is predicted by, for example, social support, psychological well-being, and depression. However, little is known regarding the role of maternal cognition in maternal-fetal bonding. Early maladaptive schemas (EMSs) are negative and stable assumptions about oneself and one's relationships with others that are developed during childhood and adolescence. In the present study, we examined the associations between EMSs and the quality of the bonding to the fetus in expectant mothers. METHODS: The present investigation is part of a larger study in which 220 pregnant women (approximately 12% of the pregnant women in the region) and 130 of their partners were recruited from October 2015 until December 2017. The sample for the current study comprised 165 pregnant women (mean age 30.8 years, SD 4.1 years). The participants completed the Young Schema Questionnaire Short Form 3 (YSQ-S3) between gestational weeks 24 and 37 and the Maternal Antenatal Attachment Scale (MAAS) and the Edinburgh Postnatal Depression Scale (EPDS) between gestational weeks 31 and 41. RESULTS: All EMS domains correlated significantly and negatively with scores for quality of maternal-fetal bonding on the MAAS. Only the Disconnection and Rejection domain correlated significantly and negatively with MAAS scores for intensity of preoccupation with the fetus. The Disconnection and Rejection domain was a significant independent predictor of the quality of maternal-fetal bonding. Symptoms of depression mediated the effect of the EMS domains on the quality of maternal-fetal bonding. The EMS domains Disconnection and Rejection, Impaired Autonomy and Performance, and Impaired Limits showed significant direct effects on bonding quality. CONCLUSIONS: EMSs are related to expectant mothers' self-reported bonding to their fetuses. This association was mediated by the mothers' symptoms of depression. The results may have implications for the early identification of pregnant women at risk of bonding difficulties and encourage more studies on cognitive schemas and mechanisms for maternal-fetal bonding.

Childhood trauma in schizophrenia spectrum disorders as compared to substance abuse disorders.

The prevalence of childhood trauma (CT) in schizophrenia spectrum disorders (SSDs) and substance abuse disorders (SUDs) is high. Direct comparisons of CT in these disorders are lacking, and it is not known whether there are differences in self-reported CT in SSDs as compared to SUDs. We aimed to compare the frequency, severity and types of CT in SDDs and SUDs. Patients with SSDs (n = 57) and SUDs (n = 57) were matched for age and gender. Overall levels of CT and CT subtypes were measured retrospectively by the Childhood Trauma Questionnaire Short-Form (CTQ-SF), and grouped into none/low and moderate/severe levels of CT. Group differences in CTQ-SF sum score and subscale scores, as well as differences in the severity of overall CT and CT subtypes were all non-significant. In both groups, 64.9% reported ≥ 1 subtypes of CT above cut-off. Of those who reported CT above the cut-off, 13.5% in the psychosis group reported ≥ 4 subtypes, as compared to 2.7% in the substance abuse group. We did not find statistically significant differences between SSDs and SUDs in terms of exposure to CT frequency or severity, all effect sizes were small (r < 0.15).