Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence.

Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents and associated with an increased risk of psychiatric diagnoses. This study aimed to ascertain how the number of PTEs differed across adolescent psychiatric diagnoses. Data on PTE exposure were derived from the youth@hordaland survey, and Axis 1 data were from the linked Norwegian National Patient Registry (NPR). Among 10,257 total adolescents, 9,555 (age range: 16-19 years, 53.9% female) consented to register linkage, 8,845 of whom were included in the analyses. Having contact with Child and Adolescent Mental Health Services (CAMHS) predicted more PTEs (estimated marginal mean [EMM] = 1.04, SE = 0.05) and exposure to two or more PTEs compared to having no CAMHS contact (EMM = 0.60) after adjusting for age, ethnicity, sex, and parental education. Adolescents diagnosed with attention-deficit/hyperactivity disorder, depression, trauma-related disorders, conduct disorder, and anxiety experienced significantly more PTEs (EMMs = 0.90-1.63) than those with no CAMHS contact (EMM = 0.57, SE = 0.01). All diagnostic categories except psychosis, autism spectrum disorders, and eating disorders had a significantly higher rate of PTEs compared with adolescents with no CAMHS contact. The study highlights the potential role of exposure to multiple PTEs as a transdiagnostic risk factor, although the level of risk varies between diagnoses.

Associations Between Distinct Trauma Classes and Mental Health Care Utilization in Norwegian Adolescents: A National Registry Study.

Adolescents who experience potentially traumatic experiences (PTEs) have an increased risk of psychopathology. PTEs often co-occur and may form interrelated patterns of exposure. This study investigated underlying classes of PTE exposure among Norwegian adolescent participants in the youth@hordaland study, and whether such classes were associated with contact with child and adolescent mental health services (CAMHS) and psychiatric diagnoses. The data stem from the population-based youth@hordaland study conducted in 2012 which was linked to the Norwegian Patient Registry (NPR, n = 8845). Exposure to PTEs was assessed by adolescent self-report whereas psychiatric disorders (Axis 1) were derived from the NPR. Latent Class Analysis was used to identify distinct classes of PTE exposure-patterns in the data. Logistic regression analyses were performed to investigate associations between classes of PTEs and contact with CAMHS and psychiatric diagnoses. Three classes of PTE exposure were identified based on model fit indices and theoretical considerations. Compared with participants in the low trauma class (88% of participants), those in the Situational-(6%) and Interpersonal trauma class (6%) had higher odds-ratios (ORs) for contact with CAMHS (OR = 2.27 (95% CI [1.78, 2.87])) and (OR = 3.26 (95% CI [2.61, 4.04])) respectively, and for being diagnosed with a psychiatric disorder in CAMHS (ORs ranged from 2.19 - 10.4) after adjusting for sex and parental education. There were more participants diagnosed with ADHD within the Interpersonal trauma class compared to the Situational trauma class when adjusting for sex and parental education (OR = 2.22 (95% CI [1.17, 4.40])). Three relatively homogeneous PTE classes, consisting of distinct patterns of trauma exposure were associated with a higher odds of contact with CAMHS and of being diagnosed with a psychiatric disorder in CAMHS. The study highlights the co-occurrence of PTEs and their impact across the diagnostic spectrum.

Sleep and body mass index in adolescence: results from a large population-based study of Norwegian adolescents aged 16 to 19 years.

BACKGROUND: The aim of this study was to examine the association between body mass index (BMI) and sleep duration, insomnia and symptoms of obstructive sleep apnea (OSA) in adolescents. METHODS: Data were taken from a large population based study of 9,875 Norwegian adolescents aged 16-19. BMI was calculated from the self-reported body weight and categorized according to recommended age and gender specific cut offs for underweight, overweight and obesity. Detailed sleep parameters (sleep duration, insomnia, and OSA symptoms) were reported separately for weekdays and weekends. Data were analyzed using Pearson's chi-squared test and ANOVAs for simple categorical and continuous comparisons, and multinomial logistic regressions for analyses adjusting for known confounders. RESULTS: There was evidence for a curvilinear relationship between BMI and both sleep duration and insomnia for girls, whereas the relationship was linear for boys. Compared to the average weekday sleep duration among adolescents in the normal weight range (6 hrs 29 min), both underweight (5 hrs 48 min), overweight (6 hrs 13 min) and obese (5 hrs 57 min) adolescents had shorter sleep duration. OSA symptoms were linearly associated with BMI. Controlling for demographical factors as well as physical activity did not attenuate the associations. Additional adjustment for depression reduced the association between insomnia and obesity to a non-significant level. The evidence for a link between both underweight and overweight/obesity, and short sleep duration and OSA symptoms remained in the fully adjusted analyses. The associations were generally stronger for girls. CONCLUSIONS: This is one of the first population-based studies to investigate the relationship between sleep and BMI in adolescents while simultaneously controlling for important confounding factors. These findings require further research to investigate the temporal association between weights and sleep problems.

Exposure to potentially traumatic events and PTSD symptomatology in Norwegian 11-13-year-olds: results from the Bergen Child Study.

BACKGROUND: Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents, but relatively little is known about the epidemiology of trauma and trauma-related psychopathology in children and youth. The present cross- sectional epidemiological study aimed to explore factors that is associated with posttraumatic stress symptoms (PTSS) in children. METHOD: Data stem from the Bergen Child Study, a series of cross-sectional multi-phase surveys of children born between 1993 and 1995 in Bergen, Norway. The sample used is from the second wave of the Bergen Child Study (BCS) conducted in 2006, a two-phase study. The study entailed a detailed psychiatric evaluation using the Development and well-being assessment (DAWBA). The DAWBA was administered to parents or caregivers and covered diagnostic areas, child and family background, and child strengths. A total of 2043 parents participated. RESULTS: Out of the total sample, parents reported that 4.8% children had experienced PTEs at some point in their lives. The findings revealed current PTSS in 30.9% of children exposed to PTE, which was 1.5% of the total sample. None of the parents reported PTSS in their children over the threshold for diagnosing posttraumatic stress disorder (PTSD). The most common PTSS cluster was arousal reactivity (90.0%), followed by negative cognitions and mood (80%). The least frequent symptom cluster was intrusions (63.3%) and avoidance (60%). Children with PTSS were reported to live in families with significantly more family stressors (p = 0.001, d = 0.8) and had utilized significantly more sources for help relative to those without PTSS (p = 0.001, d = 0.75). CONCLUSION: The present population study on children revealed a lower prevalence rate of PTEs and PTSD than previous studies. It provided findings in the field of trauma on parent- reported PTSS and PTSD symptom clusters not restricted to the clinical level of PTSD. Lastly, it highlighted how family-life stressors and support differed between those who had PTSS and those with no PTSS.

Perfectionism in Adolescence: Associations With Gender, Age, and Socioeconomic Status in a Norwegian Sample.

Background: Perfectionism in adolescence has received increased attention, but few studies have examined this in non-clinical samples. This study investigated perfectionism among adolescents from the general population in relation to demographic factors. Methods: The present study is cross-sectional and draws on the epidemiological youth@hordaland study. The sample consisted of 10.217 adolescents aged 16-19 years (52.9% girls). Self-reported perfectionism was assessed by the EDI-P scale from the Eating Disorder Inventory with two dimensions of perfectionism, namely self-oriented (SOP) and socially prescribed (SPP) perfectionism, and a total score. Perfectionism was analyzed in relation to age, gender, and socioeconomic status (SES) by perceived economic well-being and parental education level. Chi-squared tests, t-tests, and regression analyses were performed. Results: There were few gender differences on the mean scores on perfectionism, with similar levels on the total score of EDI-P and SOP, while girls scored slightly higher on SPP (p < 0.001). The latter gender difference represented a small effect size (Cohen's d = 0.053). Chi-square analyses with perfectionism split at the 90th percentile across gender showed that there were significantly more girls than boys among the high scorers both for EDI-P, EDI-SOP, and EDI-SPP. There were no significant differences between levels of perfectionism between the three age groups. The logistic regression analyses adjusted by age and gender showed that adolescents with a better perceived economic well-being had increased odds of high perfectionism. This was evident for overall EDI-P (OR = 1.760, 95% CI = 1.493-2.076), SOP (OR = 1.543, 95% CI = 1.292-1.843), and SPP (OR = 1.836, 95% CI = 1.559-2.163). Parental education was not significantly associated with perfectionism scores among the adolescents. Conclusions: The levels of perfectionism were relatively similar between the genders in the present study, besides slightly higher SPP among girls than boys. There were also significantly more girls than boys among the high scorers on overall perfectionism, SOP, and SPP, respectively. High perfectionism was related to SES for perceived economic well-being, but not for parental education level. Implications for further research and clinical interventions were suggested.

Associations between symptoms of eating disturbance and frequency of physical activity in a non-clinical, population-based sample of adolescents.

BACKGROUND: Physical activity is an important factor related to eating disorders, but the relationship between symptoms of eating disorders and physical activity is multifaceted. The aims of this study were to investigate how symptoms of eating disturbance (ED) were associated with physical activity, and to explore potential sex differences and the potential moderating effects from body mass index (BMI) scores. METHODS: Data stem from a large population-based survey of 10,172 Norwegian adolescents aged 16 to 19 years, the youth@hordaland-survey. The main dependent variable was self-reported number of days with physical activity per week, while the main independent variable was self-reported symptoms of ED using the five-item Eating Disturbance Screening (EDS-5) questionnaire. Control variables included sex, age, socioeconomic status, and BMI. RESULTS: Girls reported substantially more symptoms of ED compared with boys (M = 3.02 versus 1.32, d = 0.80, p < 0.001), as well as fewer days with physical activity per week (M = 2.88 versus 3.46, d = - 0.28, p < 0.001). For both sexes, symptoms of ED were negatively associated with physical activity (adjusted mean differences (adj. mean diff) ranging from - 0.03 to - 0.08, all p < 0.05). Interaction analyses showed, however, that associations between symptoms of ED and physical activity were significantly moderated by BMI scores for both girls (p < 0.01) and boys (p < 0.05). Specifically, ED symptoms were associated with lower physical activity levels among adolescents with higher BMI scores. CONCLUSIONS: The present study indicates that symptoms of ED were overall negatively associated with physical activity for both sexes during adolescence. However, associations between ED symptoms and physical activity levels differed considerably across the weight spectrum.

In the parents' view: weight perception accuracy, disturbed eating patterns and mental health problems among young adolescents.

BACKGROUND: An accurate weight perception has been associated with motivation to change eating habits in the case of under- or overweight. However, recent studies have reported frequent misperceptions among parents and their offspring, both in the form of under- and overestimation of weight status. The aim of the present study was to investigate weight perception accuracy among parents of young adolescents in relation to reports on disturbed eating patterns and mental health problems. METHODS: Weight perception accuracy was assessed among parents of young adolescents (N = 5,781, aged 11 - 13 years) who participated in the ongoing Bergen Child Study (BCS). Parental weight perception was classified in overestimation, underestimation and accurate. Other measures included demographic variables, the parents' evaluations of disturbed eating patterns and mental health problems among their offspring as well as the adolescents' own weight perception accuracy. RESULTS: The parents accurately perceived more than 80% of normal weight adolescents, but nearly 60% of the underweight adolescents were overestimated, and a substantial proportion of overweight girls (34. 8%) and boys (12.8%) were underestimated. In general, parents who were aware of deviations from average weight in their child also reported higher levels of disturbed eating patterns, emotional problems, and behavioral problems. After controlling for demographic factors, the risk of parental over- and underestimation was significantly predicted by weight status, the adolescents' weight perception accuracy as well as disturbed eating patterns reported by the parents (p < .05). CONCLUSIONS: Adolescents with under- or overweight proved most likely to be misperceived by their parents in this study. The pattern of perceptually correcting deviations from normal weight was interpreted as a positivity bias among the parents. These results suggest that weight perception accuracy should be targeted in family-focused interventions in order to strengthen adequate weight control among young adolescents.

Factors associated with low self-esteem in children with overweight.

OBJECTIVE: Low self-esteem is one of the main psychosocial factors related to childhood overweight. Yet not all overweight children are affected. Little is known about what characterises the group of overweight children with the lowest self-esteem. Our aim was to identify factors related to low domain-specific self-esteem in children with overweight/obesity. METHODS: Children (aged 10-13; N = 5,185) and parents from a large population-based sample completed the Eating Disturbance Scale, the Self-Perception Profile for Children, and questions about bullying and socio-economic status (SES). Parents reported the child's weight and height. 545 children with overweight/obesity were identified in the overall sample and selected for the current analyses. Self-esteem scores from this group were compared to scores from children with normal weight. Factors examined in relation to self-esteem in children with overweight/obesity were: age, gender, SES, disturbed eating, bullying, parents' evaluation of weight status and degree of overweight. RESULTS: Children with overweight scored significantly lower than normal-weight children on all self-esteem domains. Athletic competence and physical appearance were most impaired. Disturbed eating and bullying were related to low physical appearance as well as scholastic, social and athletic self-esteem. Being female, a pre-teen, having a higher BMI and being evaluated as overweight by parents were associated with lower satisfaction with physical appearance. CONCLUSIONS: Disturbed eating and bullying are significantly related to low self-esteem in the overweight group.

Body size estimation in early adolescence: factors associated with perceptual accuracy in a nonclinical sample.

This study investigated body size estimation in Norwegian adolescents (aged 12-15; N=406) using a distorting photograph technique. The percentage of over- or underestimation was calculated for pictures of the subject, other persons and a neutral object. The Eating Disorders Inventory for Children (EDI-C) was also completed. Among adolescents at risk of eating problems, girls tended to overestimate their own body size while boys showed a pattern of underestimation, compared to a relatively accurate body perception for low-risk subjects. The groups did not differ in the perception of the neutral object. Important predictors of perceived body size included the size estimation of other children, preoccupation with weight and shape, self-esteem, and emotional instability. The results support the predictive value of body size estimation. Gender differences in judgement bias can be interpreted within present aesthetic ideals and their relation to self perception, body image, and eating problems in adolescence.