The effectiveness of the in-person and online Gottman Seven Principles Couple Enhancement Program: A propensity score matching design.

This study investigates the effectiveness of the 12-h Gottman Seven Principles couple enhancement program delivered in person and online. In Norway, we recruited 490 participants and 242 people for a control group. All were in close relationships. The revised dyadic adjustment scale (RDAS) was used to assess the quality of their relationships before and after program participation, and at 6-month follow-up. Repeated measures ANOVA, t tests, reliable change, and multilevel multiple regression using propensity score matching to control for confounders were used to investigate the effectiveness of the course. The results demonstrate that the Gottman Seven Principles course improves couple relationships and is equally effective whether delivered in person or online. Furthermore, it does not matter whether there are therapists with a clinical background delivering the course, suggesting that the material itself is sufficient.

Partner perceptions are associated with objective sensor-measured adherence to oral appliance therapy in obstructive sleep apnea.

The aims of the present prospective clinical study were to determine objective, sensor-measured adherence to a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify partner-specific adherence-related factors. A total of 77 eligible participants with mild, moderate, or severe OSA and who were non-adherent to continuous positive airway pressure (mean age 56.2 years) participated in the study (32.5% women). The mean (range) observation time between MAD delivery and final follow-up was 8.3 (3.4-16.5) months. The mean apnea-hypopnea index (AHI) was 26.6 events/hr at baseline and 12.5 events/hr at the 8-month follow-up (both p < 0.001). The mean sensor-measured adherence at the 8-month follow-up was 60.1% for ≥4 hr/night of appliance use for ≥5 days/week. Average usage was 6.4 hr/night, when worn. The mean reduction in the AHI was significantly greater in the "good adherence" (Δ 17.4) than the "poor adherence" group (Δ11.0; p < 0.05). From the partner's perspective, the appliance had a positive effect on sharing a bedroom in the good- (55%) compared to the poor-adherence group (25%; p < 0.05) and on their relationship (51.7% versus 17.9%, respectively; p < 0.05). Regression analyses identified the partner's snoring and apneas to be the most significant factor predicting good adherence to MAD (odds ratio 4.4, 95% confidence interval 1.4-14.0). In conclusion, social factors, like partner perceptions, were positively associated with adherence, which indicate that partner's attitudes and support may be a resource that can be utilised to improve adherence in oral appliance treatment of OSA.

Non-consensual and Consensual Non-monogamy in Norway.

The paper sets out to study Norwegians' experiences of non-monogamy. Data were collected by questionnaires in a web sample of 4160 Norwegians (18-89 years). 26.3% of men and 17.8% of women reported that they ever had non-consensual non-monogamy. Consensual non-monogamy was reported by 3%. Compared to participants with no or non-consensual experience, consensual non-monogamy was highly related to relationship intimacy and positive sexual attitudes toward sex and sexuality. At the most recent extradyadic event, 21.5% of heterosexual men and 47.1% of gay/bisexual men reported condom use, which implies a risk for sexually transmitted diseases.

How body concerns, body mass, self-rated health and self-esteem are mutually impacted in early adolescence: a longitudinal cohort study.

BACKGROUND: Impaired self-rated health (SRH) and self-esteem (SE) in adolescents are associated with increased body mass index (BMI). These associations are often studied using cross-sectional designs; we performed a longitudinal cohort survey to examine them. METHODS: A longitudinal cohort study of 1225 Norwegian high school students, with SRH, SE and BMI as primary outcomes. We reported the results from temporal causal and residual change analyses separately, with odds ratios (ORs) and standardised regression coefficients (b) and 95% confidence limits. RESULTS: Body and weight concerns had unfavourable effects on SRH and SE, which both had favourable effects on each other. Increased BMI had unfavourable effects on SRH, but less so on SE. Body and weight concerns impacted SE change only among girls. Paradoxically, the intention of becoming thinner was associated with an increase in BMI, and the intention of becoming fatter predicted a decrease in BMI during the 2 years. SE and SRH were associated with a leaner body after 2 years. CONCLUSIONS: This study confirms that body concerns had unfavourable effects on subjective health, and that positive self-concepts predicted a leaner body. Health promotion strategies built on body acceptance should be increasingly emphasised in clinical and public health practice.

Trends in the utilization of youth primary healthcare services and psychological distress.

BACKGROUND: Psychological distress among young people is increasing in Northern Europe. According to established healthcare utilization theory, this will create a greater need for youth primary healthcare and subsequently lead to more help-seeking behavior by distressed young people. The aim of this study was to investigate the association between the use of youth primary healthcare services and psychological distress in times of increasing mental health problems and increased service need. METHODS: This study consisted of five waves of repeated annual cross-sectional data collected from young people (aged 13-19) living in Norway between 2014 and 2018 (n = 368,579). Population-weighted and design-adjusted generalized linear regression with a log-link was used to examine the use of youth primary healthcare services over time. RESULTS: We found that a large proportion of young people use primary healthcare services and that young people with high levels of psychological distress use primary healthcare services twice as much as their peers with low levels of psychological distress. In addition, between 2014 and 2018 both psychological distress and primary healthcare service utilization increased: psychological distress increased by 5% and total primary healthcare service use increased by 500 consultations per 1000 young people. Overall, psychological distress had a conditional association with youth primary healthcare service use and could account for between 16 and 66% of the change in the use of services between 2014 and 2018, depending on the service type. However, the absolute increase seen in the use of primary healthcare services was mainly driven by young people with low levels of psychological distress as opposed to young people with high psychological distress. This suggest a converging trend. CONCLUSIONS: Our findings suggest that there might be serious barriers between need and help-seeking behavior for young people with high levels of psychological distress and that the pattern of utilization among young people with lower distress may indicate overuse, possibly as an inadvertent consequence of a newly introduced school absence policy. While further research is needed to confirm these findings, our work may inform healthcare providers and policy makers about primary healthcare utilization trends among young people.

Parental death in young adults with divorced compared to non-divorced parents: The effect on prolonged grief and mental health.

This cross-sectional survey compares the risk of mental health problems like poor well-being, complicated and prolonged grief, and mental disorders between young adults experiencing a divorced or non-divorced parent's death. 190 participants were recruited from Facebook via the Danish National Center for Grief. Well-being was measured using WHO-5, prolonged grief using PG-13 and complicated grief using BGQ, and common mental disorders using CMDQ. Findings confirmed deleterious effects on mental health in young adults experiencing parental death, but higher risk, when losing a divorced parent compared to a non-divorced parent, was associated to prolonged grief, complicated grief, bodily distress syndrome, and alcohol misuse.

Family factors predicting self-rated health during early adolescence.

BACKGROUND: Health impairments in adolescents associated with divorce and loss of parental contact are frequently reported. However, other family factors more likely to promote health are less researched. We examined the impact of several family factors on self-rated health (SRH). METHODS: A longitudinal cohort study of 1225 students in high school aged 11 and 13 years in 2011. The students were surveyed at onset and after 2 years with SRH as the outcome measure. We adjusted for sex, age and self-rated socioeconomic status in temporal causal analyses, and adjusted for SRH at onset in residual change analyses, applying an ordinal logistic method. Adjusted analyses with each factor and multivariable models with backward exclusion were performed. We reported the predictive associations with odds ratios and 95% confidence limits. RESULTS: The most decisive factors predicting future positive SRH were linked to confidence in communicating with both parents about bothersome issues, and the experience of parental support with school work. Furthermore, the experience of opinions being taken seriously in the family and the absence of excessive parental expectations predicted SRH positively after 2 years. Divorce had a modest impact on SRH and was mediated by the other factors. Only the absence of contact with fathers moderated the effect that divorce experience had on SRH. We ascertained the causal relationships through residual change analyses. CONCLUSIONS: As SRH in adolescence has an impact on later health and is amendable, it is important, from a public health perspective, to preserve and improve relationships and confidence between children and both parents.

Couple relationship problems-a task for the general practitioner? A cross-sectional survey from Norway.

BACKGROUND: A healthy couple relationship is a predictor of good health. There is a lack of knowledge about what role family and couples counselling should have in general practice. OBJECTIVES: To identify the prevalence of patients who have talked, or want to talk, with their general practitioner (GP) about their couple relationship, to investigate what characterizes these patients and to explore whether they believe that couple relationship problems should be dealt with in general practice. METHODS: We conducted a cross-sectional survey in 70 general practices in Norway during spring 2019. A questionnaire was answered by 2178 consecutive patients (response rate 75%) in GP waiting rooms. Data were examined using frequencies and linear and logistic regression models. RESULTS: We included 2097 responses. Mean age was 49.0 years and 61.3% were women. One in four (25.0%) had already talked with their GP about couple relationship problems, while one in three (33.5%) wanted to talk with their GP about their couple relationship problems. These patients more frequently had experience of divorce, poor self-rated health, an opinion that their couple relationship had a significant impact on their health and lower couple relationship quality when adjusted for age, sex, present marital status and children living at home. We found that 46.4% of patients believed that GPs should be interested in their couple relationship problems. CONCLUSION: Relationship problems are frequently addressed in general practice. GPs should be prepared to discuss this issue to facilitate help for couples earlier than they might otherwise expect.

Double bereavement, mental health consequences and support needs of children and young adults-When a divorced parent dies.

AIMS AND OBJECTIVES: To explore how children and young adults from divorced families experience double bereavement when they lose a divorced parent with cancer and how the double bereavement influences their mental health consequences and need of support. BACKGROUND: Children and young people who are confronted with the cancer and death of a parent is a highly stressful life event, which is associated with an increased risk of mental health problems, especially when children experience divorced parental cancer and death. DESIGN: Participant observations and interviews with a phenomenological-hermeneutic approach and COREQ standards for reporting qualitative research. METHODS: We conducted 340 hr of participant observations within nine different support groups totalling 27 children and young adults from divorced families and included 28 interviews with participants and relatives. Analyses are based on Ricoeur's theory of interpretation: naïve reading, structural analysis, interpretation and discussion. RESULTS: The experiences with double bereavement identified three main themes: 1. navigating through multiple transitions and disruptions within two family worlds; 2. consequences for mental health including stress overload and disruptions to well-being; and 3. need for accessible support derived from close relationships and professionals within and in-between family worlds. CONCLUSION: Children and young adult's double bereavement includes multiple transitions and disruptions often related to stress overload and mental health problems. Support from close relationships and professionals is experienced as helpful in the prevention and mitigation of mental health problems. RELEVANCE TO CLINICAL PRACTICE: There is a need for targeted accessible support availability to children, young adults and their families when a divorced parent is dying of cancer in clinical practice. Our findings suggest that specific health policies for health professionals should be developed to target improved support for these families.

Divorce and conversational difficulties with parents: Impact on adolescent health and self-esteem.

Background: Divorce experience (DE) may cause health and self-conceptual problems, but these consequences might also be caused by conflicts and lack of conversational confidence (CC) with one or both parents. We investigated how DE impacted CC and how DE and CC impacted health complaints and self-esteem in a two-year longitudinal cohort study. Methods: The study was performed between 2011 and 2013 among 1225 students in junior high school (aged 11 and 13 years in 2011). We used binary logistic analyses to account for how DE impacted CC, and linear regression analyses to examine how DE and CC impacted on subjective health and self-esteem in 2013. Results: The study revealed that former and recent DEs impacted CC with fathers only. The impact was most evident for the more severe forms of conversational difficulties. DE in itself predicted only self-esteem, and CC with parents mediated this association. CC with both mothers and fathers had strong temporal causal associations with the outcomes two years later. Only CC with fathers impacted changes of the health complaints and self-esteem in full-model residual change analyses. Conclusions: The study proves a sex-specific effect on loss of CC between fathers and children after divorce. The impairment of CC has predictive repercussions on the health and self-conception of adolescents in their middle teenage years. From a public-health perspective, preserving the relation and the confidence between children and their fathers after divorce seems an important task.

The Divorced Family-Focused Care Model: A Nursing Model to Enhance Child and Family Mental Health and Well-Being of Doubly Bereaved Children Following Parental Divorce and Subsequent Parental Cancer and Death.

The experience of parental death concomitant with parental divorce occurs for 46% of Danish children and 50% of American children who lose a parent to death. This experience of loss and double bereavement compounds increased risk of mental health problems. The aim of this study was to explore nursing interventions for double bereaved children that promoted their well-being. A phenomenological-hermeneutic approach was used to conduct 20 interviews with nurses in family cancer care. Ricoeur's theoretical framework was followed with naïve reading, structural analysis, and critical interpretation, resulting in the formulation of a new model of nursing care for these children: the Divorced Family-Focused Care Model. Four themes were apparent: (a) collection of information about family structure, (b) assessment of support needs, (c) initiation of well-being support, and (d) coordination and follow-up focused on the child's well-being. The new intervention model has implications for health care education and implementation of health care policies.

Health complaints among adolescents in Norway: A twenty-year perspective on trends.

PURPOSE: Examine time trends in health complaints among adolescents in Norway between 1994 and 2014 and among population subgroups, e.g., age and gender, as well as their interactions. METHODS: Norwegian data on 11-16-year-olds were drawn from the Health Behaviour in School-aged Children survey (HBSC) and analyzed for 1994 (n = 4,952), 1998 (n = 5,026), 2002 (n = 5,023), 2006 (n = 4,711), 2010 (n = 4,342) and 2014 (n = 3,422). Design adjusted linear regression that accounts for clustering effects was used to examine mean scores of two subscales of the HBSC-symptom checklist: psychological and somatic health complaints. RESULTS: Psychological and somatic health complaints among adolescents in Norway followed somewhat different trajectories, but the mean scores of both types of health complaints appeared to increase during the 20-year period. For psychological health complaints, there was a three-way interaction between age, gender and time, indicating that increasing trends in health complaints depended on both age and gender, in which older adolescent girls had a greater increase over time relative to younger adolescents and boys. CONCLUSIONS: Findings from this study, together with earlier findings, suggest that there has been an increasing trend in health complaints among adolescents in Norway from 1994 to 2014, especially among older adolescent girls. Future research should examine if trends in health complaints also depend on gender and age in other contexts. This will help the planning and implementation of tailored and effective interventions.

Marital Quality and Stress in Pregnancy Predict the Risk of Infectious Disease in the Offspring: The Norwegian Mother and Child Cohort Study.

OBJECTIVES: The aim of this study was to explore the degree to which couples' relationship dissatisfaction and stressful life events during pregnancy predict the risk of infectious disease in the offspring during their first year of life. METHODS: Data were obtained from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health. Pregnant women completed questionnaires in week 30 of pregnancy concerning the couples' relationship satisfaction and stressful life events. In follow-up questionnaires, the women reported whether their children (n = 74,801) had been subject to various categories of infectious disease: the common cold, throat infection, bronchitis, RS virus, pneumonia, pseudocroup, gastric flu, ear infection, conjunctivitis and urinary tract infection. Reports from two age groups of infants were used. Associations between the predictor and outcome variables were assessed via logistic regression and linear regression analyses. RESULTS: Separate logistic regression analyses for each disease and age group showed that prenatal relationship dissatisfaction and stressful life events were significantly associated with all reported categories of infectious disease. After controlling for socioeconomic factors, social support, smoking, breastfeeding, maternal depression, the sex of the offspring, and use of child care, 29 out of 32 tested associations were statistically significant. Finally, multivariate linear regression analyses showed that prenatal relationship dissatisfaction and stressful life events were significantly associated with the frequency, as well as the variety, of infectious disease in the offspring.

Predictors of Postpartum Change in Alcohol Use in Norwegian Mothers.

OBJECTIVE: This study examined the relationship between marital status, family size, and postpartum alcohol use from birth to 36 months postpartum, based on data from the Norwegian Mother and Child Cohort Study. METHOD: Mothers' self-reported alcohol frequency and alcohol units per drinking occasion at 0-3 months, 4-6 months, 18 months, and 36 months postpartum were modeled using linear mixed models for repeated measures. RESULTS: There was a strong main effect of time on alcohol use, with increases in alcohol use from childbirth to 36 months after childbirth. Adjusting for covariates, there were threeway interaction effects for Time × Family Structure × Family Size for alcohol units and alcohol frequency, indicating that a change in alcohol use varied as a function of family structure and family size. Single mothers had a lower increase in frequency of alcohol use but a steeper increase in the number of alcohol units. However, this effect was less pronounced with increasing family size. CONCLUSIONS: The patterns of findings are consistent with a differential opportunity perspective on alcohol use.

Relationship satisfaction reduces the risk of maternal infectious diseases in pregnancy: the Norwegian Mother and Child Cohort Study.

OBJECTIVES: The aims of this study were to explore the degree to which relationship satisfaction predicts the risk of infectious diseases during pregnancy and to examine whether relationship satisfaction moderates the association between stressful life events and the risk of infections. METHODS: This was a prospective study based on data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Pregnant women (n = 67,244) completed questionnaires concerning relationship satisfaction and nine different categories of infectious diseases as well as socioeconomic characteristics and stressful life events. Associations between the predictor variables and the infectious diseases were assessed by logistic regression analyses. A multiple regression analysis was performed to assess a possible interaction of relationship satisfaction with stressful life events on the risk for infectious diseases. RESULTS: After controlling for marital status, age, education, income, and stressful life events, high levels of relationship satisfaction at week 15 of gestation were found to predict a significantly lower risk for eight categories of infectious diseases at gestational weeks 17-30. No significant interaction effect was found between relationship satisfaction and stressful life events on the risk for infections.

Effect of Prepregnancy Alcohol Consumption on Postpartum Relationship Satisfaction and Divorce among Norwegian Mothers.

This study assessed the effect of prepregnancy level of alcohol use among mothers on relationship breakups with young children at 36 months after birth and the extent to which relationship satisfaction (RS) throughout the postpartum period could mediate any association between alcohol use and divorce. The data were part of the Norwegian Mother and Child Cohort Study, and analyses of the present article were based on a total of 69,117 mothers divided into low-, medium-, and high-risk consumption groups. All the three groups experienced a decrease in RS, but the largest effect was observed for the high-risk group. Mothers in this group had 55% higher odds for divorce as compared to the low-risk group. The findings supported a conceptual model whereby the effects of alcohol use on divorce were mediated through lowered RS.

Loneliness, social integration and consumption of sugar-containing beverages: testing the social baseline theory.

OBJECTIVE: Social Baseline Theory (SBT) proposes that close relationships aid in metabolic resource management and that individuals without significant relationships may experience more demands on their own neural metabolic resources on a daily basis when solving problems, remaining vigilant against potential threats and regulating emotional responses. This study tests a hypothesised consequence derived from SBT: relative social isolation leads to increased levels of sugar intake. METHODS: Based on cross-sectional, self-reported data from the Norwegian Mother and Child Cohort Study (N = 90 084), information on social integration and the consumption of both sugar-sweetened and artificially sweetened sodas and juices was obtained from a large number of women in early pregnancy. Multiple regression analyses were conducted to assess whether loneliness, marital status, relationship satisfaction, advice from others than partner, and cohesion at work is associated with consumption of sodas and juices. RESULTS: Perceived loneliness was associated with elevated intake of all sugary beverages, while relationship satisfaction was negatively associated with all sugary beverages. Being married or cohabitating, having supportive friends, and having a sense of togetherness at work were associated with lower intake of two out of three sugar-containing beverages. These associations were significant, even after controlling for factors such as body mass index, weight related self-image, depression, physical activity, educational level, age and income. In comparison, a statistically significant relationship emerged between relationship satisfaction and artificially sweetened cola. No other predictor variables were significantly associated with any type of artificially sweetened beverage. CONCLUSIONS: This study indicates that loneliness and social integration influence the level of consumption of sugary beverages. The results support the hypothesis derived from the Social Baseline Theory that relative social isolation leads to increased levels of sugar intake.

Changes in alcohol use and relationship satisfaction in Norwegian couples during pregnancy.

BACKGROUND: Numerous studies have documented a profound reduction in alcohol use among pregnant women, whereas research on expectant fathers has been scarce. The aim of this study was to measure changes in alcohol consumption from before pregnancy to 17 weeks in gestation for mothers and fathers, differentiating between parents with and without any previous children, and to measure how level and change in alcohol consumption into early pregnancy was associated with relationship satisfaction. METHODS: The data collection was conducted as part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. This cohort now includes 108,000 children, 90,700 mothers and 71,500 fathers recruited from 1999 to 2008. The present study comprises 82 362 couples. Alcohol consumption was assessed using a questionnaire including items about usual drinking frequency, quantities, and number of occasions with heavy episodic drinking (HED). Relationship satisfaction was measured by five items scored on a Likert agreement scale. RESULTS: The findings indicate that both mothers and fathers reduce their drinking significantly during pregnancy. Reduction was apparent for all three measures of alcohol consumption. First-time fathers reduced their alcohol consumption more than experienced fathers, from initially higher levels. The gap between the fathers and their pregnant partner was greater for first-time parents compared to parents with previous children. Drinking pre-pregnancy and relationship satisfaction during pregnancy were weakly related within each partner, whereas no association across partners was observed. CONCLUSIONS: Both expectant mothers and fathers changed their alcohol consumption patterns when expecting a child. Almost all mothers stopped drinking, whereas fathers reduced their drinking to a considerable degree. Relationship satisfaction was only slightly related to their drinking patterns. The findings may have important policy implications, mainly with regard to developing alcohol preventive strategies.