Suicide rates among health-care professionals in Norway 1980-2021.

BACKGROUND: Suicide rates have been high in several health-care professions. Suicide rates were described in physicians, dentists, veterinarians, psychologists, pharmacists, nurses, as well as theologians, other graduates and the general population in Norway. METHODS: Data on educational attainment were linked to data on suicide and all-cause mortality from 1980 to 2021. Suicide rates were reported per 100,000 person-years. The total number of person-years included in the study was 66.4 and 67.2 million for males and females, respectively. RESULTS: Between 1980 and 2021, male veterinarians (35.9, 95 % CI 19.3-52.4), physicians (25.7, 21.3-30.2) and nurses (22.2, 16.6-27.7) had higher suicide rates compared others with higher education (11.7, 10.7-12.7). For females, this was the case for psychologists (15.0, 8.2-21.7) and nurses (9.3, 8.3-10.3), vs. others with higher education (5.1, 4.2-6.0). Suicide rates declined over the four decades for most groups. For physicians, suicide rates declined and approached the suicide rate of others with higher education. Suicide rates among physicians increased with age, with physicians over 60 years having twice as high suicide rates compared to others with higher education. LIMITATIONS: The study included only educational status, not current occupation or employment status. This is a descriptive study, with some known risk factors for suicide not accounted for. CONCLUSIONS: Suicide rates for physicians declined over time, but not for nurses. From 2010 to 2021, nurses of both genders was the only group with higher suicide rates compared to other graduates. The increased suicide rates among veterinarians, nurses, female psychologists and elderly physicians are concerning.

Health-related quality of life in patients discharged from hospital after suicide attempt with violent methods compared to self-poisonings.

INTRODUCTION: Suicide attempts by violent methods (VM) can leave the patient with physical and mental trauma affecting health-related quality of life (HRQOL). There is limited knowledge about the impact and HRQOL after a suicide attempt by VM. AIMS: To compare HRQOL in patients after a suicide attempt by VM, both to self-poisonings (SP) and the general population, and the association of hospital anxiety and depression to the HRQOL in the two groups. METHODS: Patients admitted to hospital after a suicide attempt were included in this prospective cohort-study from 2010 to 2015. For HRQOL, Short Form Health Survey (SF-36), and Hospital anxiety and depression scale scores (HADS-A and HADS-D) were assessed during study follow-up. RESULTS: The VM-group scored lower HRQOL for the physical dimensions at 3 months (p<.05), compared to the SP group, and only role limitation physical at 12 months (p<.05). Both groups scored lower HRQOL than the general population (p < .05).At baseline, the VM group scored lower for HADS-A than the SP group (p < .05). Both groups had lower HADS scores one year after (p < .05). In multiple regression analyses, the HADS scores were associated with HRQOL in the VM-group (p < .05). SP group HADS scores were negatively associated with general health, vitality, social functioning, and mental health (p < .05). CONCLUSION: Both groups scored lower for HRQOL than the general population, and the VM group had worse score than the SP group in physical dimensions. Both groups had less symptoms of anxiety and depression over time, but it`s association to HRQOL was strong.

Prevalence of psychological distress in nurses, physicians and leaders working in intensive care units during the COVID-19 pandemic: a national one-year follow-up study.

OBJECTIVE: To report and compare psychological distress as symptoms of anxiety, depression and post-traumatic stress among intensive care units' (ICU) nurses, physicians and leaders at 12 months after the baseline survey (spring 2020), during the COVID-19 pandemic in Norway. Furthermore, to analyse which baseline demographic and COVID ICU-related factors have a significant impact on psychological distress at 12 months. DESIGN: Prospective, longitudinal, observational cohort study. SETTING: Nationwide, 27 of 28 hospitals with COVID ICUs in Norway. PARTICIPANTS: Nurses, physicians and their leaders. At 12 month follow-up 287 (59.3%) of 484 baseline participants responded. PRIMARY AND SECONDARY OUTCOME MEASURES: Symptoms of anxiety and depression using the Hopkins Symptoms Checklist-10 (HSCL-10). Symptoms of post-traumatic stress using the post-traumatic stress disease checklist for the Diagnostic and Statistical Manual of Mental Disorders 5 (PCL-5).Demographics (included previous symptoms of anxiety and depression) and COVID ICU-related factors (professional preparations, emotional experience and support) impacting distress at 12 months. RESULTS: Psychological distress, defined as caseness on either or both HSCL-10 and PCL-5, did not change significantly and was present for 13.6% of the participants at baseline and 13.2% at 12 month follow-up. Nurses reported significantly higher levels of psychological distress than physicians and leaders. Adjusted for demographics and the COVID ICU-related factors at baseline, previous symptoms of depression and fear of infection were significantly associated with higher levels of anxiety and depression at 12 months. Previous symptoms of depression, fear of infection and feeling of loneliness was significantly associated with more symptoms of post-traumatic stress. CONCLUSION: One year into the COVID-19 pandemic 13.2% of the ICUs professionals reported psychological distress, more frequently among the nurses. Fear of infection, loneliness and previous symptoms of depression reported at baseline were associated with higher levels of distress. Protective equipment and peer support are recommended to mitigate distress. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov. Identifier: NCT04372056.

Validation of a short version of the Lee fatigue scale in adults living in Norway: a cross-sectional population survey.

BACKGROUND: Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. METHODS: This cross-sectional survey consists of a representative sample from the Norwegian population drawn by The National Population Register in Norway. The study is part of a larger study (NORPOP) aimed at collecting normative data from several questionnaires focused on health in adults living in Norway. Registered citizens between 18 and 94 years of age were randomly selected stratified by age, sex and geographic region. Of the 4971 respondents eligible for the study, 1792 (36%) responded to the survey. In addition to age and sex, we collected responses on a 5-item version of the LFS measuring current fatige severity. The psychometric properties focusing on internal structure and precision of the LFS items were analyzed by a Rasch rating scale model. RESULTS: Complete LFS scores for analyses were available for 1767 adults. Women had higher LFS-scores than men, and adults < 55 years old had higher scores than older respondents. Our analysis of the LFS showed that the average category on each item advanced monotonically. Two of the five items demonstrated misfit, while the three other items demonstrated goodness-of-fit to the model and uni-dimensionality. Items #1 and #4 (tired and fatigue respectively) showed differential item functioning (DIF) by sex, but no items showed DIFs in relation to age. The separation index of the LFS 3-item scale showed that the sample could be separated into three different groups according to the respondents' fatigue levels. The LFS-3 raw scores correlated strongly with the Rasch measure from the three items. The core dimensions in these individual items were very similarly expressed in the Norwegian language version and this may be a threat to the cultural-related or language validity of a short version of the LFS using these particular items. CONCLUSIONS: The study provides validation of a short LFS 3-item version for estimating fatigue in the general population.

Psychological responses and associated factors during the initial lockdown due to the corona disease epidemic (COVID-19) among Norwegian citizens.

BACKGROUND: Ongoing COVID-19 studies pay little attention to the risk or protective factors related to psychological stress. AIMS: This study aims to estimate the prevalence of anxiety, depression and insomnia during the initial phase of the COVID-19 outbreak, and explore factors that might be associated with these outcomes. METHODS: A population-based cross-sectional survey was conducted using snowball-sampling strategy. Participants from 18 years or older filled out an anonymous online questionnaire. RESULTS: A total of 4527 citizens filled out the questionnaire. Prevalence rates were; insomnia 31.8%, anxiety 17.1% and depression 12.5%. Risk factors associated with anxiety, depression and insomnia were being single (OR = 0.75, OR = 0.57, OR = 0.59), unemployed (OR = 0.47, OR = 0.53, OR = 0.73), financial concerns (OR = 1.66, OR = 2.09, OR = 1.80) at risk for complication from COVID-19 (OR = 1.63, OR = 1.68, OR = 1.60), and being generally worried due to the COVID-19 (OR 0 3.06, OR = 1.41, OR = 1.74). CONCLUSION: Being single, unemployed, at risk of health complications, or having concerns because of financial or other consequences of the pandemic are associated with mental health adversities such as anxiety, depression and insomnia during a pandemic lockdown.

Correction: Stafseth et al. Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 7010.

In the original publication [...].

Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study.

Background: The COVID-19 pandemic has induced demanding work situations in intensive care units (ICU). The objective of our study was to survey psychological reactions, the disturbance of social life, work effort, and support in ICU nurses, physicians, and leaders. Methods: From May to July 2020, this cross-sectional study included 484 ICU professionals from 27 hospitals throughout Norway. Symptoms of anxiety and depression were measured on Hopkins Symptom Checklist-10 (HSCL-10). Symptoms of post-traumatic stress disorder (PTSD) were measured on the PCL-5. Results: The study population were highly educated and experienced professionals, well prepared for working with COVID-ICU patients. However, 53% felt socially isolated and 67% reported a fear of infecting others. Probable cases of anxiety and depression were found in 12.5% of the registered nurses, 11.6% of the physicians, and 4.1% of the leaders. Younger age and <5 years previous work experiences were predictors for high HSCL-10 scores. Reported symptom-defined PTSD for nurses 7.1%; the leaders, 4.1%; and 2.3% of physicians. Conclusions: ICU health care professionals experienced talking with colleagues as the most helpful source of support. The COVID-ICU leaders reported a significantly higher mean score than physicians and nurses in terms of pushing themselves toward producing high work effort.

Coping, Social Support and Loneliness during the COVID-19 Pandemic and Their Effect on Depression and Anxiety: Patients' Experiences in Community Mental Health Centers in Norway.

Background: Little is known about psychiatric patients' experiences during the COVID-19 pandemic. The purpose of this study was to investigate associations of coping strategies, social support and loneliness with mental health symptoms among these patients. Methods: We recruited 164 patients from Community Mental Health Centers in June-July 2020. Participants responded to an online questionnaire on corona-related questions, Brief Coping Orientation to Problems Experience, Crisis Support Scale, a 3-item Loneliness Scale, and Hopkins Symptom Checklist-25. We used linear regression models to investigate associations between these and symptoms of depression and anxiety. Results: Almost 51% were aged 31-50 years and 77% were females. Forty-six (28%) participants reported worsened overall mental health due to the pandemic. The reported rates of clinical depression and anxiety were 84% and 76%, respectively. Maladaptive coping was independently associated with both depression and anxiety symptoms. Loneliness was independently associated with depression symptoms. Conclusions: Patients in Community Mental Health Centers in Norway reported high rates of depression and anxiety symptoms. Many of them reported worsening of their mental health due to the pandemic, even at a time when COVID-19 infections and restrictive measures were relatively low. Maladaptive coping strategies and loneliness may be possible explanations for more distress.

A comparison between healthcare workers and non-healthcare workers' anxiety, depression and PTSD during the initial COVID -19 lockdown.

Objective: Several studies have found that Healthcare workers are vulnerable to mental health problems during the COVID-19 pandemic. However, few studies have made comparisons of healthcare workers (HCWs) and non-HCWs. The current study aimed to compare mental health problems among HCWs with non-HCWs during the initial lockdown of COVID 19. Study design: A population-based cross-sectional survey. Methods: The survey was conducted by means of an open web link between April and May 2020. Data were collected by self-report. The PTSD Checklist for DSM-5 (PCL-5) was used to assess posttraumatic stress. Results: A total of 4527 citizens answered the questionnaire and 32.1% were HCWs. The majority were female, under 60 years of age, and lived in urban areas. Among the HCWs, the majority were registered nurses working in hospitals. The prevalence were 12.8% vs 19.1% for anxiety, 8.5% vs 14.5% for depression and 13.6% vs 20.9% for PTSD among HCWs and non-HCWs respectively. The highest prevalence's for anxiety and PTSD among HCWs were found for those under 40 years of age and having low education level (<12 years). Conclusion: Mental health problems was significantly lower among HCWs compared to non-HCWs. However, the COVID-19 poses a challenge for HCWs, especially young HCWs and those with low level of education. Providing support, appropriate education, training, and authoritative information to the different members of the HCWs could be effective ways to minimize the psychological effect.

Higher Suicide Intent in Patients Attempting Suicide With Violent Methods Versus Self-Poisoning.

Background: Suicidal intent for patients attempting suicide using violent methods (VMs) is assumed to be higher than for those using self-poisoning (SP), which may explain the higher mortality observed in follow-up studies. However, this has not been studied prospectively. Aims: We aimed to compare patients attempting suicide using VMs with those using SP regarding suicidal intent, suicidal ideation, depression, and hopelessness during hospital stay and after 1 year. Methods: Patients hospitalized after suicide attempt by VMs (n = 80) or SP (n = 81) completed the Beck scales for Suicide Intent, Suicide Ideation, Depression Inventory, and Hopelessness on admission and at the 12-month follow-up. Results: On admission, those using VMs had higher suicidal intent than those using SP (M = 16.2 vs. 13.3, p < .001), but lower depression scores (M = 22.2 vs. 26.8, p < .05). No significant differences were found in suicidal ideation (M = 20.1 vs. 23.1) or hopelessness (M = 10.1 vs. 11.9). At 12-month follow-up, depression scores decreased significantly for both groups, while hopelessness decreased only for the SP group. Limitations: The statistical power achieved was lower than intended. Conclusion: The higher levels of suicidal intent, but lower levels of depression, may indicate more impulsivity among people attempting suicide using VMs. Suicidal ideation was relatively stable.

Sexual Assault and the Association With Health, Quality of Life, and Self-Efficacy in the General Norwegian Population.

The lifetime prevalence of sexual assault was examined in a representative sample of the general Norwegian adult population (n = 1,792), in addition to the association between sexual assault and health, quality of life, and general self-efficacy. Respondents completed questionnaires assessing these factors. Overall, 6.7% (n = 120) of the respondents (10.9% of women and 1.9% of men) reported an experience of sexual assault. Respondents in the sexual assault group reported significantly worse mental and physical health as well as poorer quality of life and lower self-efficacy, compared with those without sexual assault experience. The most prevalent mental problems in the sexual assault group were depression (61.7%), sleep problems (58.3%), eating disorders (26.7%), and posttraumatic stress disorder symptoms at a clinical level (25.0%). The most prevalent physical problems were chronic pain (47.5%) and musculoskeletal disease (30.8%). The proportions of physical and mental health problems were not significantly different between male and female victims. Results indicated that having experienced sexual assault during one's life appears to be associated with lifetime occurrence of multiple health problems for both genders and reduces a person's perceived general self-efficacy and quality of life.

Healthcare professionals in COVID-19-intensive care units in Norway: preparedness and working conditions: a cohort study.

OBJECTIVE: To survey the healthcare professionals' background and experiences from work with patients with COVID-19 in intensive care units (ICUs) during the first wave of the COVID-19 pandemic in Norway. DESIGN: Observational cohort study. SETTING: COVID-ICUs in 27 hospitals across Norway. PARTICIPANTS: Healthcare professionals (n=484): nurses (81%), medical doctors (9%) and leaders (10%), who responded to a secured, web-based questionnaire from 6 May 2020 to 15 July 2020. PRIMARY AND SECONDARY MEASURES: Healthcare professionals': (1) professional and psychological preparedness to start working in COVID-ICUs, (2) factors associated with high degree of preparedness and (3) experience of working conditions. RESULTS: The age of the respondents was 44.8±10 year (mean±SD), 78% were females, 92% had previous ICU working experience. A majority of the respondents reported professional (81%) and psychological (74%) preparedness for working in COVID-ICU. Factors significantly associated with high professional preparedness for working in COVID-19-ICU in a multivariate logistic model were previous ICU work experience (p<0.001) and participation in COVID-ICU simulation team training (p<0.001). High psychological preparedness was associated with higher age (p=0.003), living with spouse or partner (p=0.013), previous ICU work experience (p=0.042) and participation in COVID-ICU simulation team training (p=0.001). Working with new colleagues and new professional challenges were perceived as positive in a majority of the respondents, whereas 84% felt communication with coworkers to be challenging, 46% were afraid of being infected and 82% felt discomfort in denying access for patient relatives to the unit. Symptoms of sweating, tiredness, dehydration, headache, hunger, insecurity, mask irritation and delayed toilet visits were each reported by more than 50%. CONCLUSIONS: Healthcare professionals working during the first wave of COVID-ICU patients in Norway were qualified and prepared, but challenges and potential targets for future improvements were present. TRIAL REGISTRATION NUMBER: NCT04372056.

Treating patients with opioid overdose at a primary care emergency outpatient clinic: a cost-minimization analysis.

BACKGROUND: Treating patients with acute poisoning by substances of abuse in a primary care emergency clinic has previously been shown to be a safe strategy. We conducted an economic evaluation of this strategy compared to hospital treatment, which is the usual strategy. METHODS: Assuming equal health outcomes, we conducted a cost-minimization analysis. We constructed a representative opioid overdose patient based on a cohort of 359 patients treated for opioid overdose at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) from 1.10.2011 to 30.9.2012. Using a health care system perspective, we estimated the expected resources used on the representative patient in primary care based on data from the observed OAEOC cohort and on information from key informants at the OAEOC. A likely course of treatment of the same patient in a hospital setting was established from information from key informants on provider procedures at Drammen Hospital, as were estimates of hospital use of resources. We calculated expected costs for both settings. Given that the treatments usually last for less than one day, we used undiscounted cost values. RESULTS: The estimated per patient cost in primary care was 121 EUR (2018 EUR 1.00 = NOK 9.5962), comprising 97 EUR on personnel costs and 24 EUR on treatment costs. In the hospital setting, the corresponding cost was 612 EUR, comprising 186 EUR on personnel costs, 183 EUR on treatment costs, and 243 EUR associated with intensive care unit admission. The point estimate of the cost difference per patient was 491 EUR, with a low-difference scenario estimated at 264 EUR and a high-difference scenario at 771 EUR. CONCLUSIONS: Compared to hospital treatment, treating patients with opioid overdose in a primary care setting costs substantially less. Our findings are probably generalizable to poisoning with other substances of abuse. Implementing elements of the OAEOC procedure in primary care emergency clinics and in hospital emergency departments could improve the use of health care resources.

Use of Alcohol and Addictive Drugs During the COVID-19 Outbreak in Norway: Associations With Mental Health and Pandemic-Related Problems.

Background: The outbreak of COVID-19 has had a major impact on people's daily life. This study aimed to examine use of alcohol and addictive drugs during the COVID-19 outbreak in Norway and examine their association with mental health problems and problems related to the pandemic. Methods: A sample of 4,527 persons responded to the survey. Use of alcohol and addictive drugs were cross-tabulated with sociodemographic variables, mental health problems, and problems related to COVID-19. Logistic regression analyses were used to examine the strength of the associations. Results: Daily use of alcohol was associated with depression and expecting financial loss in relation to the COVID-19 outbreak. Use of cannabis was associated with expecting financial loss in relation to COVID-19. Use of sedatives was associated with anxiety, depression, and insomnia. Use of painkillers was associated with insomnia and self-reported risk of complications if contracting the coronavirus. Conclusion: The occurrence of mental health problems is more important for an understanding of the use of alcohol and addictive drugs during the COVID-19 outbreak in Norway, compared to specific pandemic-related worries.

Concerns in the Norwegian Population during the Initial Lockdown Due to the COVID-19 Pandemic.

Although concern affects one's welfare or happiness, few studies to date have focused on peoples' concerns during the initial COVID-19 lockdown. The aim of the study was to explore concerns in the Norwegian populations according to gender and age, and identify which concerns were most prominent during the lockdown. A population-based cross-sectional online survey using snowball-sampling strategies was conducted, to which 4527 adults (≥18 years) responded. Questions related to concerns had response alternatives yes or no. In addition, they were asked which concern was most prominent. Nearly all the 4527 respondents (92%) reported that they were concerned: 60.9% were generally concerned about the pandemic, 83.9% were concerned about family and friends, 21.8% had financial concerns, and 25.3% expected financial loss. More women were concerned about family and friends than males, (85.2% vs. 76.2%, p < 0.001), whereas more men expected financial loss (30.4% vs. 24.4%y, p = 0.001). Younger adults (<50 years) had more financial concerns than older adults (25.9% vs. 10.5%, p < 0.001). Being concerned about family and friends was the most prominent concern and was associated with; lower age (OR 0.79), female gender (OR 1.59), and being next of kin (2.42). The most prominent concern for adults 70 years or older was being infected by COVID-19. In conclusion, women and younger individuals were most concerned. While adults under 70 years of age were most concerned about family and friends and adults 70 years or older were most concerned about being infected by COVID-19.

Suicide Thoughts and Attempts in the Norwegian General Population during the Early Stage of the COVID-19 Outbreak.

The aim of the study was to examine the prevalence of suicide thoughts and attempts during the early stage of the COVID-19 outbreak and examine pandemic-related factors associated with suicide thoughts in the general Norwegian population. A sample of 4527 adults living in Norway were recruited via social media. Data related to suicide thoughts and attempts, alcohol use, pandemic-related concerns, and sociodemographic variables were collected. Associations with suicide thoughts were analyzed with logistic regression analysis. In the sample, 3.6% reported suicide thoughts during the last month, while 0.2% had attempted suicide during the same period. Previous suicide attempts (OR: 11.93, p < 0.001), lower age (OR: 0.69, p < 0.001), daily alcohol use (OR: 3.31, p < 0.001), being in the risk group for COVID-19 complications (OR: 2.15, p < 0.001), and having economic concerns related to the pandemic (OR: 2.28, p < 0.001) were associated with having current suicide thoughts. In addition to known risk factors, the study suggests that aspects specific to COVID-19 may be important for suicidal behaviors during the pandemic.

Concerns Related to the COVID-19 in Adult Norwegians during the First Outbreak in 2020: A Qualitative Approach.

Concerns related to the first outbreak of the COVID-19 pandemic in the Norwegian population are studied in a cross-sectional web-survey conducted between 8 April and 20 May 2020. The qualitative thematic analysis of the open-ended question "Do you have other concerns related to the pandemic?", followed a six-step process. Concerns from 1491 informants were analyzed, 34% of women and 30% of men (p = 0.05) provided concerns. Respondents with higher educational level reported concerns more often (86% vs. 83%, p = 0.022). The qualitative analysis revealed five themes-society, health, social activities, personal economy and duration-and 13 sub-themes, mostly related to the themes "society" and "health" (724 and 704, respectively). Empathy for others was prominent, for society (nationally and globally), but also concerns related to infecting others and family members at risk for developing serious illness if infected. The responses to the open-ended question yielded additional information, beyond the information obtained from questions with pre-categorized response options, especially related to concerns about society and health. Themes arising from the qualitative analysis shed light on what are important concerns for people during the pandemic and this may serve as targeted measures for the authorities.

Optimists' and pessimists' self-reported mental and global health during the COVID-19 pandemic in Norway.

BACKGROUND: The COVID-19 pandemic represents a global health crisis. How well people cope with this situation depends on many factors, including one's personality, such as dispositional optimism. The aim of the study was to investigate: 1) optimists' and pessimists' concerns during lockdown, and mental and global health; 2) whether pessimists without known risk factors more often than optimists report being at risk for COVID-19. PARTICIPANTS AND PROCEDURE: A snowball sampling strategy was used; 4,527 people, 18 years or older, participated in a survey on a variety of mental health conditions and COVID-19 worries. In addition, they completed the Life Orientation Test-Revised (LOT-R). Optimism was defined by LOT-R f ≥ 17. RESULTS: Fewer optimists than pessimists reported that they were worried about COVID-19, respectively 51.2% vs. 66.8%, p < .001. Among those reporting none of the known somatic risk factors, more pessimists than optimists (14.3% vs. 9.1%, p < .001) considered themselves at risk of a fatal outcome from COVID-19. Significantly fewer optimists reported that they had anxiety (5.1%), depression (3.4%), suicidal ideation (0.7%) and insomnia (19.3%) during the COVID-19 outbreak than pessimists (24.7% anxiety, 18.4% depression, 5.4% suicidal ideation, 39.8% insomnia, all p < .001). Optimists reported better global health than pessimists (87.2 vs. 84.6, p < .001). CONCLUSIONS: Optimists were generally less worried about the COVID-19 pandemic than pessimists and reported better mental and global health during lockdown. Pessimists more often than optimists reported being at risk for COVID-19 without reporting known risk factors.

Variability and stability of coping styles among breast cancer survivors: A prospective study.

OBJECTIVES: We aimed to examine: (1) the long-term association between coping styles and psychological distress, (2) if women diagnosed with breast cancer have a predominant coping style, (3) stability of coping styles, (4) predictors of changes in coping styles, (5) if maladaptive coping adversely impacts disease-free survival (DFS). METHODS: This prospective study included women diagnosed with primary breast cancer during 2006-2009. Patients completed questionnaires for the Norwegian Mini-Mental Adjustment to Cancer scale, which includes positive attitude (PA), helplessness/hopelessness (HH), anxious preoccupation (AP), and avoidance (AV), and the Hospital Anxiety and Depression Scale at diagnosis and 1, 3, and 5 years postdiagnosis. RESULTS: Two hundred and ninety-three of 367 women (79.8%) completed the questionnaires at all time points. Anxiety and depression were moderately to strongly correlated with HH and AP coping styles (r = 0.31 to r = 0.69) at all time points. The predominant coping style was PA (23.4-29.9%). Stability for PA and cognitive AV styles was found at the group level, but not at an individual level. Chemotherapy and comorbidity were predictors for HH, AP, and AV 5 years postdiagnosis (p < 0.05). Maladaptive coping was not associated with DFS. CONCLUSIONS: HH and AP were associated with higher psychological distress at all times. Group level coping remained stable over time for PA and AV. Coping style stability at an individual level was not observed. Having received chemotherapy and experienced adverse events affected coping at 5 years postdiagnosis. Maladaptive coping was not associated with DFS.

Post-Traumatic Stress Disorder and Associated Factors during the Early Stage of the COVID-19 Pandemic in Norway.

The COVID-19 outbreak and the sudden lockdown of society in March 2020 had a large impact on people's daily life and gave rise to concerns for the mental health in the general population. The aim of the study was to examine post-traumatic stress reactions related to the COVID-19 pandemic, the prevalence of symptom-defined post-traumatic stress disorder (PTSD), and factors associated with post-traumatic stress in the Norwegian population during the early stages of the COVID-19 outbreak. A survey was administered via social media channels, to which a sample of 4527 adults (≥18 years) responded. Symptom-defined PTSD was measured with the PTSD Checklist for the DSM-5. The items were specifically linked to the COVID-19 pandemic. We used the DSM-5 diagnostic guidelines to categorize participants as fulfilling the PTSD symptom criteria or not. Associations with PTSD were examined with single and multiple logistic regression analyses. The prevalence of symptom-defined PTSD was 12.5% for men and 19.5% for women. PTSD was associated with lower age, female gender, lack of social support, and a range of pandemic-related variables such as economic concerns, expecting economic loss, having been in quarantine or isolation, being at high risk for complications from COVID-19 infection, and having concern for family and close friends. In conclusion, post-traumatic stress reactions appear to be common in the Norwegian population in the early stages of the COVID-19 outbreak. Concerns about finances, health, and family and friends seem to matter.