[show abstract][hide abstract] ABSTRACT: Mental health problems are often transmitted from one generation to the next. This knowledge has led to changes in Norwegian legislation, making it mandatory to assess whether or not patients have children, and to provide necessary support for the children of mentally ill patients. The main purpose of this study was to evaluate the process of implementing new routines in adult mental health services to identify and support children of mentally ill parents.
The design was a pre-test post-test study. The sample (N = 219 at pre-test and N = 185 at post-test) included mental health professionals in the largest hospital in the region, who responded to a web-based survey on the routines of the services, attitudes within the workforce capacity, worker's knowledge on the impact of parental mental illness on children, knowledge on legislation concerning children of patients, and demographic variables.
The results of this study indicated that some changes are taking place in clinical practice in terms of increased identification of children. Adult mental health services providing support for the children was however not fully implemented as a new practice.
The main finding in this study is that the identification frequency had increased significantly according to self-reported data since the Family Assessment Form was implemented. The increase in self-reported identification behavior is however taking place very slowly. Three years after the legislation was changed to making it mandatory to assess whether or not patients have children, it was still not fully incorporated in the routines of the entire workforce. In terms of support for the families affected by parental mental illness, the changes are not yet significant.
BMC Health Services Research 02/2014; 14(1):58. · 1.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: A meta-analysis was conducted to identify the proportion of comorbid personality disorders (PDs) in patients with eating disorder not otherwise specified (EDNOS) and binge eating disorder (BED). A search identified 20 articles in the period of 1987 to 2010. For EDNOS and BED, the comorbid proportions for any PD were 0.38 and 0.29, respectively; for cluster C PDs, 0.38 and 0.30, respectively (avoidant PD, 0.18 and 0.12, and obsessive-compulsive PD, 0.11 and 0.10, respectively); and for cluster B PDs, 0.25 and 0.11, respectively (borderline, 0.12 and 0.10). This pattern converged with findings on anorexia nervosa and bulimia nervosa, except being lower. Because the comorbidity profiles for EDNOS and BED were highly similar, their underlying PD pathology seems similar. Few moderators were significant, except for interviews yielding lower estimates than that of questionnaires. The variance statistic for any PD comorbidity was wide for EDNOS and narrow for BED, thus partly supporting BED as a distinct eating disorder category and EDNOS as a potentially more severe condition than BED.
The Journal of nervous and mental disease 02/2014; 202(2):119-25. · 1.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: Children and adolescents with intellectual
disabilities have a high risk of developing
mental health problems. This article provides
a brief overview of the current state
of knowledge regarding mental disorders
in this group. The authors argue that
there is a lack of knowledge and research
about such mental disorders in the health
service. There are also few validated
instruments for assessing mental disorders
among children and adolescents
with intellectual disabilities. Implications
for the health service and research field
are discussed with an emphasis on
strengthening ties between research and
Journal of the Norwegian Psychological Association. 01/2014; 51(3):210-215.
[show abstract][hide abstract] ABSTRACT: A meta-analysis was conducted to identify the proportions of comorbid personality disorders (PD) in mood disorders.
We found 122 empirical papers published in the period 1980-2010 on participants having mood disorders in addition to a comorbid PD. Mood disorders were classified as bipolar disorders (BD), major depressive disorders (MDD) and dysthymic disorders (DYS). Several moderators were coded as well.
The risk of having at least one comorbid PD (any PD) was high across all three mood disorders (BD=.42, MDD=.45), but highest in DYS (.60). Cluster B and C PDs were most frequent in BD, while cluster C PDs dominated in MDD and DYS. Among the specific PDs, the paranoid (.11 versus .07/.05), borderline (.16 versus .14/.13), histrionic (.10 versus .06/.06) and obsessive-compulsive (.18 versus .09/.12) PDs occurred more frequently in BD versus MDD/DYS, whereas the avoidant PD (.22 versus .12/.16) was most frequent in DYS versus BD/MDD. Moderator analyses showed higher comorbidity when diagnoses were based on questionnaires versus clinical interviews, DSM-III-R versus DSM-IV, more women were included or the duration of the disorder was longer. Age of onset yielded mixed results.
Blind rating of diagnoses was recorded, but was employed in too few studies to be usable as an indication of diagnostic validity.
Personality disorders are common in mood disorders. Implications of the identified moderators as well as the new DSM-5 diagnostic system are considered.
Journal of affective disorders 09/2013; · 3.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examines the relationship between Marcia’s identity statuses and self-esteem measures through techniques of meta-analysis. Global self-esteem, as used here, refers to one’s positive or negative attitudes toward oneself, degree of self-respect, self-worth, and faith in one’s own capacities. Identity theory would predict strong linkages between the development of self-esteem and identity; however, previous research findings have been inconsistent regarding the nature of this relationship. Two conflicting explanatory models are exam- ined here: (a) high self-esteem is linked with ‘‘high’’ identity status (achievement and moratorium) and low self-esteem with ‘‘low’’ identity status (foreclosure and diffusion); and (b) high self-esteem is linked with identity commitment and low self-esteem with lack of identity commitment. The initial database for this investigation consisted of 565 empirical studies of identity status conducted between 1966 and 2005 using the search terms ‘‘identity status,’’ ‘‘identity and Marcia,’’ ‘‘identity and Marcia’s,’’ and ‘‘ego identity’’ to examine the fol- lowing databases: PsycINFO, ERIC, Sociological Abstracts, and Dissertation Abstracts International. Some 35 of these studies addressed the relationship between self-esteem and identity status, with 18 studies providing data that could be used for the purposes of meta-analysis. Results do not provide clear support for either explanatory model, although support exists from categorical measures of identity status that high self-esteem is linked with the committed identity statuses. Possible reasons for the lack of clarity in results are discussed.
Identity: An International Journal of Theory and Research. 08/2013; 13(3):201-213.
[show abstract][hide abstract] ABSTRACT: This investigation was undertaken to examine the relationship between identity status and authoritarianism through techniques of meta-analysis. Identity theory and earlier research have suggested associations between these constructs, but they have not previously been submitted to meta-analysis procedures. This analysis examined the hypothesis that foreclosures would score significantly higher on measures of authoritarianism than achievement, moratorium, or diffusion statuses. An initial database of 565 empirical studies of Marcia’s ident- ity statuses, conducted between 1966–2005, was identified from the PsycINFO, ERIC, Sociological Abstracts, and Dissertation Abstracts International data- bases using the following search terms: ‘‘identity status,’’ ‘‘identity and Marcia,’’ ‘‘identity and Marcia’s,’’ and ‘‘ego identity.’’ Thirteen of these studies examined the relationship between identity status and authoritarianism, and nine (N 1⁄4 861) provided sufficient data for inclusion in the meta-analysis. Hedges’s g was the effect size measure used in analyses, and results showed the mean Hedges’s g for the foreclosure status to be significantly higher than for all other identity statuses. Furthermore, these effect sizes were all large in terms of Cohen’s criteria and were significant. Results are discussed in terms of implications for future research.
Identity: An International Journal of Theory and Research. 08/2013; 13(3):242-252.
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to examine the relationship between identity status and anxiety through techniques of meta-analysis. Early research on identity status and anxiety showed elevated anxiety scores for those in the moratorium status and low anxiety scores among those in the foreclosure status. Later studies reported some gender differences in anxiety scores for particular identity statuses. A total of 565 empirical identity status studies conducted between 1966 and 2005 were identified from PsycINFO, ERIC, Sociological Abstracts, and Dissertation Abstracts International using the following search terms: ‘‘identity status,’’ ‘‘identity and Marcia,’’ ‘‘identity and Marcia’s,’’ and ‘‘ego identity.’’ Some 27 of these studies addressed the relationship between identity status and general anxiety; only 12 of these 27 investigations (N 1⁄4 1,124 participants, primarily university students) provided data that could be examined through techniques of meta-analysis. Effect size differences in anxiety scores for each pair of identity statuses for each gender were determined. Results showed anxiety scores for the identity statuses to be in generally predicted directions, although some gender differences occurred.
Identity: An International Journal of Theory and Research. 08/2013; 13(3):214-227.
[show abstract][hide abstract] ABSTRACT: This investigation examined the relationship between identity status and locus of control through techniques of meta-analysis. Early research has found an association between identity achievement and an internal locus of control and between identity diffusion and an external locus of control. Findings for the relationship between locus of control and the moratorium and foreclosure statuses, however, have been inconsistent. A total of 565 empirical studies of identity status that were conducted between 1966 and 2005 were identified from PsychINFO, ERIC, Sociological Abstracts, and Dissertation Abstracts International using these search terms: ‘‘identity status,’’ ‘‘identity and Marcia,’’ ‘‘identity and Marcia’s,’’ and ‘‘ego identity.’’ Nineteen of these studies addressed the relationship between locus of control and identity status; only five of the studies (N1⁄4711 participants) provided data with satisfactory information to be included in the meta-analysis. Internal and external locus of control scales were correlated with each identity status, and effect sizes were primarily in predicted directions.
Identity: An International Journal of Theory and Research. 08/2013; 13(3):253-265.
[show abstract][hide abstract] ABSTRACT: We examined the agreement between diagnoses assigned based on the Development and Well Being Assessment (DAWBA) information collected online, and ordinary day-to-day diagnostic assignment by Child and Adolescent Mental Health Service (CAMHS) clinicians. Diagnoses were compared for 286 patients. Raw agreement for diagnostic categories was 74-90%, resulting in kappa values of 0.41-0.49. Multinomial regression models for 'emotional diagnosis' and 'hyperkinetic/conduct diagnosis' were significant (P < 0.001). Age, gender and number of informants significantly contributed to the explanation of agreement and disagreement. Agreement on mental health diagnoses may be sufficient to replace routine clinical assignment of diagnoses with an online clinical assignment, thereby saving time and resources.
Journal of telemedicine and telecare 03/2013; · 0.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background. A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published.
Methods. A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded.
Results. The rate of any comorbid PD was high across all ADs, ranging from .35 for PTSD to .52 for OCD. Cluster C PDs occurred more than twice as often as cluster A or B PDs. Within cluster C the avoidant PD occurred most frequently, followed by the obsessive-compulsive and the dependent PD. PTSD showed the most heterogeneous clinical picture and social phobia was highly comorbid with avoidant PD. A range of moderators were examined, but most were non-significant or of small effects, except an early age of onset, which in social phobia increased the risk of an avoidant PD considerably. Gender or duration of an AD was not related to variation in PD comorbidity.
Limitations. Blind rating of diagnoses was recorded from the papers as an indication of diagnostic validity. However, as too few studies reported it the validity of the comorbid estimates of PD was less strong.
Conclusions. The findings provided support to several of the proposed changes in the forthcoming DSM-5. Further comorbidity studies are needed in view of the substantial changes in how PDs will be diagnosed in the DSM-5.
Journal of Affective Disorders. 01/2013; 145:143-155.
[show abstract][hide abstract] ABSTRACT: A meta-analysis was conducted to identify the proportion of comorbid personality disorders (PDs) in patients with Eating Disorder Not Otherwise Specified (EDNOS) and Binge Eating Disorder (BED). A search identified 20 papers in the period 1987¬-2010. The comorbid proportions of any PD were .38 and .29 for EDNOS and BED, respectively, and .38 and .30 for cluster C PDs (avoidant PD .18 and .12, and obsessive-compulsive PD .11 and .10, respectively), and .25 and .11 for cluster B PDs (borderline .12 and .10), respectively. This pattern converged with findings on anorexia nervosa and bulimia nervosa, except being lower. As the comorbidity profiles for EDNOS and BED were highly similar, their underlying PD pathology appears similar. Few moderators were significant, except interviews yielding lower estimates than questionnaires. The variance statistic for any PD comorbidity was wide for EDNOS and narrow for BED, thus partly supporting BED as a distinct eating disorder category and EDNOS as a potentially more severe condition than BED.
Journal of Nervous and Mental Disease. 01/2013; in press.
[show abstract][hide abstract] ABSTRACT: Psychotherapy is an effective treatment for mental health disorders, but even with the most efficacious treatment, many patients do not experience improvement. Moderator analysis can identify the conditions under which treatment is effective or whether there are factors that can attenuate the effects of treatment.
In this study, linear mixed model analysis was used to examine whether the Full Scale IQ (FSIQ), Performance IQ (PIQ) and Verbal IQ (VIQ) on the Wechsler Intelligence Scale for Children - Third Edition, moderated outcomes in general functioning and symptom load. A total of 132 patients treated at three outpatient child and adolescent mental health services (CAMHS) were assessed at three different time points. The Children's Global Assessment Scale (CGAS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were used to measure the severity of impairments in general functioning and symptom load. IQ was assessed at the start of treatment.
Moderator analysis revealed that the FSIQ × time interaction predicted changes in CGAS scores (p < .01), and that the PIQ × time interaction predicted changes in HoNOSCA scores (p < .05). The slopes and intercepts in HoNOSCA scores covaried negatively and significantly (p < .05). The same pattern was not detected for the CGAS scores (p = .08).
FISQ and PIQ moderated change in general functioning and symptom load, respectively. This implies that patients with higher IQ scores had a steeper improvement slope than those with lower scores. The patients with the highest initial symptom loads showed the greatest improvement, this pattern was not found in the improvement of general functioning.
Child and Adolescent Psychiatry and Mental Health 06/2012; 6(1):22.
[show abstract][hide abstract] ABSTRACT: Previous studies indicate that low IQ is a substantial risk factor for developing mental health problems. Based on these results, we hypothesized that IQ may predict some of the variance in clinician-rated severity of children's mental health problems measured with the Children's Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). The other aims of this study were to examine if there was any difference in the predictive ability of the different IQ scores of the Wechsler Intelligence Scale for Children, Third edition (WISC-III) and to examine if parent-rated measure of child mental health problems could predict the scores on CGAS and HoNOSCA after controlling for IQ, age, and gender.
In this study, 132 patients at three outpatient clinics in North Norway were assessed with the parent version of the Strength and Difficulties Questionnaire (SDQ), HoNOSCA, CGAS, and with the WISC-III.
Hierarchical regression analyses were conducted with HoNOSCA and CGAS as dependent variables. Demographics, WISC-III IQ scores, and SDQ were entered as independent variables. The model with HoNOSCA as the dependent variable predicted 25% of the total variance. The WISC-III full-scale IQ predicted an additional 6% of the variance. The analyses with CGAS as the dependent variable gave no significant results.
When a patient has a high HoNOSCA score, an intelligence test in addition to an evaluation of symptoms on mental health should be considered. Future research ought to examine whether HoNOSCA's ability to detect change might be affected by patients IQ.
British Journal of Clinical Psychology 06/2012; 51(2):185-96. · 1.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aircraft accidents and incidents associated with visual flight into instrument weather conditions continue to account for a significant proportion of fatalities involving general aviation aircraft. The aim of this study was to examine pilot recounts of flights involving inadvertent or deliberate flight into Instrument Meteorological Conditions (IMC). Of the 251 responses that were examined, 145 pilots indicated that they had entered IMC inadvertently during a visual flight, while 93 had done so deliberately. Amongst non instrument-rated pilots, two cohorts were identified whereby pilots who deliberately entered instrument conditions tended to have experienced the conditions previously, possess a comparatively greater tolerance of risk, experienced less anxiety during the event recounted, and perceive the risks associated with the transition into instrument conditions as relatively lower than those pilots whose entry into instrument conditions was inadvertent. These results are interpreted as confirmation of the need to address the problem of visual flight into instrument conditions from a number of different perspectives, taking into account experience and individual differences in risk tolerance.
[show abstract][hide abstract] ABSTRACT: The main purpose of this study was, firstly, to evaluate the effect of an intervention aimed at improving interprofessional collaboration and service quality, and secondly, to examine if collaboration could predict burnout, engagement and service quality among human service professionals working with children and adolescents. The intervention included the establishment of local interprofessional teams and offering courses. The sample was recruited from six different small municipalities in Northern Norway (N = 93) and a comparison group from four similar municipalities (N = 58). Participation in the project increased the level of collaboration in the intervention group significantly (Hedges' g = 0.36), but not the perceived level of service quality. Hierarchical regression analyses were used to test a model for predicting burnout, engagement and perceived service quality using work-related factors, including collaboration as predictors. Both burnout and engagement were predicted by job demands and resources after controlling for demographic variables and participation in the project. Service quality was mostly predicted by collaboration. Increasing collaboration seems possible by introducing practice-based changes; however, this intervention did not have the desired effect on perceived service quality.
Journal of Interprofessional Care 01/2012; 26(3):219-25. · 1.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study examined the agreement between diagnoses and severity ratings assigned by clinicians using a structured web-based interview within a child and adolescent mental health outpatient setting.
Information on 100 youths was obtained from multiple informants through a web-based Development and Well-Being Assessment (DAWBA). Based on this information, four experienced clinicians independently diagnosed (according to the International Classification of Diseases Revision 10) and rated the severity of mental health problems according to the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Children's Global Assessment Scale (C-GAS).
Agreement for diagnosis was κ=0.69-0.82. Intra-class correlation for single measures was 0.78 for HoNOSCA and 0.74 for C-GAS, and 0.93 and 0.92, respectively for average measures.
Agreement was good to excellent for all diagnostic categories. Agreement for severity was moderate, but improved to substantial when the average of the ratings given by all clinicians was considered. Therefore, we conclude that experienced clinicians can assign reliable diagnoses and assess severity based on DAWBA data collected online.
Clinical Practice and Epidemiology in Mental Health 01/2012; 8:16-21.