Fartein Ask Torvik’s research while affiliated with University of Oslo and other places

Research on mental health has traditionally separated the study of illbeing—disorder and problems—and wellbeing—life satisfaction and positive affect. While previous reviews of studies primarily employing self-report scales indicate that illbeing and wellbeing are distinct yet interconnected constructs, a deeper examination of their relationship is lacking. This perspective article from the PROMENTA Research Center offers a review and synthesis of findings on the joint and distinct nature of illbeing and wellbeing across multiple levels of analysis. Adopting an interdisciplinary approach, we integrate genetic, biological, developmental, psychosocial, societal, cultural, and intervention-based perspectives. Our review reveals substantial genetic overlap and some similar biological underpinnings for illbeing and wellbeing. In contrast, environmental factors and societal changes often have divergent impacts. We propose that future research should systematically assess both positive and negative aspects of mental health to discern their shared and unique determinants, predictors, mechanisms, and consequences.

Partners resemble each other in health and education, but studies usually examine one trait at a time in established couples. Using data from all Norwegian first-time parents (N = 187,926) between 2016–2020, we analyse grade point average at age 16, educational attainment, and medical records of 10 mental and 10 somatic health conditions measured 10 to 5 years before childbirth. We find stronger partner similarity in mental (median r = 0.14) than in somatic health conditions (median r = 0.04), with ubiquitous cross-trait correlations in mental health (median r = 0.13). High grade point average or education is associated with better partner mental (median r = −0.16) and somatic (median r = −0.08) health. Elevated mental health correlations (median r = 0.25) in established couples indicate convergence. Analyses of siblings and in-laws suggest that health similarity is influenced by indirect assortment based on related traits. Adjusting for grade point average or education reduces partner health correlations by 30–40%. These findings have implications for the distribution of risk factors among children, genetic studies, and intergenerational transmission.

Background Mental disorders and physical-health conditions frequently co-occur, impacting treatment outcomes. While most prior research has focused on single pairs of mental disorders and physical-health conditions, this study explores broader associations between multiple mental disorders and physical-health conditions. Methods Using the Norwegian primary-care register, this population-based cohort study encompassed all 2 203 553 patients born in Norway from January 1945 through December 1984, who were full-time residents from January 2006 until December 2019 (14 years; 363 million person-months). Associations between seven mental disorders (sleep disturbance, anxiety, depression, acute stress reaction, substance-use disorders, phobia/compulsive disorder, psychosis) and 16 physical-health conditions were examined, diagnosed according to the International Classification of Primary Care. Results Of 112 mental-disorder/physical-health condition pairs, 96% of associations yielded positive and significant ORs, averaging 1.41 and ranging from 1.05 (99.99% CI 1.00–1.09) to 2.38 (99.99% CI 2.30–2.46). Across 14 years, every mental disorder was associated with multiple different physical-health conditions. Across 363 million person-months, having any mental disorder was associated with increased subsequent risk of all physical-health conditions (HRs:1.40 [99.99% CI 1.35–1.45] to 2.85 [99.99% CI 2.81–2.89]) and vice versa (HRs:1.56 [99.99% CI 1.54–1.59] to 3.56 [99.99% CI 3.54–3.58]). Associations were observed in both sexes, across age groups, and among patients with and without university education. Conclusions The breadth of associations between virtually every mental disorder and physical-health condition among patients treated in primary care underscores a need for integrated mental and physical healthcare policy and practice. This remarkable breadth also calls for research into etiological factors and underlying mechanisms that can explain it.

Young adults from low socioeconomic backgrounds face an increased risk of early mortality. Here we utilize population-wide data from 17 Norwegian birth cohorts (N = 986,573) to assess whether this risk gradient was explained by early-life educational performance, specifically grade point average at 16 years of age. We show that the gradients in both parental education and income largely disappeared when adjusting for school performance in the models. Specifically, among boys, those with the lowest parental education had an unadjusted hazard ratio (HR) of 2.04 (95% confidence interval (CI) 1.86–2.22) compared with peers with the highest parental education, while for girls, the HR was 1.64 (95% CI 1.35–1.93). After adjusting for school performance, these estimates dropped to 0.99 (95% CI 0.79–1.19) for boys and 0.87 (95% CI 0.55–1.19) for girls. Similarly, the mortality risk for those from the lowest parental income quartile decreased from 1.79 (95% CI 1.67–1.91) to 1.25 (95% CI 1.12–1.38) for boys and from 1.63 (95% CI 1.44–1.83) to 1.24 (95% CI 1.03–1.46) for girls. Low educational performance remained strongly associated with early mortality in analyses accounting for unobserved heterogeneity at the family level; boys with a grade point average in the lowest quartile had an HR of 3.04 (95% CI 2.38–3.89), while for girls, the HR was 1.79 (95% CI 1.22–2.63). External causes of death, particularly accidents and poisoning, were most overrepresented among individuals with poor school performance.

During recent decades, parenthood has declined in many Western countries. Simultaneously, mental disorders have become more prevalent. We investigated the link between parenthood and mental health in the entire Norwegian-born population aged 31 to 80 from 2006 to 2019 (n=2,234,087). We used logistic regression models on national register data and included sibling- and twin-matched analyses to address unobserved confounders. Parenthood was associated with a lower risk of mental disorders, including depressive and anxiety disorders. For symptoms related to mental disorders, fathers had a reduced risk, while mothers had a slightly elevated risk. Mental health disparities between parents and non-parents were greater among men than among women and persisted across adulthood, before reducing at older ages. Our main findings were largely consistent in sibling- and twin-matched designs. The disparity between parents and non-parents increased over the study period, suggesting stronger selection into parenthood. Our findings highlight parenthood as a significant indicator of mental health inequalities, with its importance growing over time.

Background: Lower parental income is associated with more psychiatric disorders among offspring, but it is unclear if this association reflects effects of parental income (social causation) or shared risk factors (social selection). Prior research finds contradictory results, which may be due to age differences between the studied offspring. Methods: Here, we studied the entire Norwegian population aged 10 to 40 between 2006 and 2018 (N = 2,468,503). By linking tax registries to administrative health registries, we describe prevalence rates by age, sex, and parental income rank. Next, we used kinship-based models with extended families of twins and siblings to distinguish direct effects of parents from shared genetic and environmental risk factors. Results: We show that lower parental income rank was associated with more psychiatric disorders at all ages from age 10 to 40 (r between -.06 and -.15). The kinship-based models indicated that direct effects of parental income played a large role (38%) in explaining the parent-offspring correlation among adolescents, while shared risk factors accounted for the entire parent-offspring correlation among adults. Conclusion: Our findings indicate that social causation plays a significant role during adolescence, while social selection fully explains the parent-offspring association in adulthood.

How many primary-care encounters are devoted to mental-health conditions compared with physical-health conditions? Here we analyzed Norway’s nationwide administrative primary-care records, extracting all doctor–patient encounters occurring during 14 years (2006–2019) for the population aged 0–100 years. Encounters were recorded according to the International Classification of Primary Care. We compared the volume of mental-health encounters against volumes for conditions in multiple different body systems. A total of 4,875,722 patients generated 354,516,291 encounters. One in 9 encounters (11.7%) involved a mental-health condition. Only musculoskeletal conditions accounted for a greater share of primary-care physicians’ attention. The volume of mental-health encounters in primary care equaled encounters for infections, cardiovascular and respiratory conditions and exceeded encounters for pain, injuries, metabolic, digestive, skin, urological, reproductive and sensory conditions. Primary-care physicians frequently treat complex mental-health conditions in patients of every age. These physicians may have a more important role in preventing the escalation of mental-health problems than heretofore appreciated.

Children born to parents with fewer years of education are more likely to have depression, anxiety, and attention-deficit hyperactivity disorder (ADHD), but it is unclear to what extent these associations are causal. We estimated the effect of parents’ educational attainment on children’s depressive, anxiety, and ADHD traits at age 8 years, in a sample of 40,879 Norwegian children born in 1998–2009 and their parents. We used within-family Mendelian randomization, which employs genetic variants as instrumental variables, and controlled for direct genetic effects by adjusting for children’s polygenic indexes. We found little evidence that mothers’ or fathers’ educational attainment independently affected children’s depressive, anxiety, or ADHD traits. However, children’s own polygenic scores for educational attainment were independently and negatively associated with these traits. Results suggest that differences in these traits according to parents’ education may reflect direct genetic effects more than genetic nurture. Consequences of social disadvantage for children’s mental health may however be more visible in samples with more socioeconomic variation, or contexts with larger socioeconomic disparities than present-day Norway. Further research is required in populations with more educational and economic inequality and in other age groups.

The positive relation between mental health and educational attainment is well-established, yet the extent to which cognitive abilities influence this gradient or independently predict mental health outcomes remains unclear. In this study, we investigated the association between adolescent cognitive abilities, educational attainment, and adult mental health. Cognitive ability was ascertained in Norwegian military conscript test data (N = 272,351; mean age 17.8 years; males only), whereas mental disorders were ascertained using the Norwegian register of primary care diagnoses received between the age of 36–40. Higher cognitive abilities were associated with a monotonically decreasing risk of developing all the studied mental disorders except bipolar disorder. The association held even when comparing the cognitive abilities of brothers raised in the same family, attesting that cognitive ability and mental disorders are not associated because both arise from the same family background circumstances. Similarly, individuals with higher educational attainment had fewer mental health disorders. The association between low cognitive abilities and the risk of mental disorders was notably stronger in males with low educational attainment, compared to those with high educational attainment. These individuals may be an underutilized target group for mental-disorder prevention.

Partners tend to have similar levels of education. Previous studies indicate that this is likely due to some form of indirect assortative mating but there is not a consistent understanding of this process. Understanding indirect assortment is crucial for resolving the role of nature and nurture in education. We attribute previous inconsistencies to idiosyncratic models and inconsistent use of relevant terms. In this paper, we develop a new framework for understanding indirect assortative mating and provide updated definitions of key terms. We then develop a model (the iAM-ACE-model) that can use partners of twins and siblings to distinguish the degree of assortment on genetic, social, and individual characteristics. We also expand this model to include children of twins and siblings (the iAM-COTS model), allowing us to explain parent-offspring similarity while accounting for indirect assortative mating and gene-environment correlations. We apply the models on educational attainment using 1,529,144 individuals in 209,792 extended families from Norwegian registry data and the Norwegian Twin Registry. The analysis suggests that partner similarity in educational attainment can be explained by strong assortment on sibling-shared environmental factors, with only moderate assortment on genetic factors. The implied genotypic correlation between partners ( r = .33) is comparable to earlier studies, and higher than expected under direct assortment. Most of the parent-offspring correlation ( r = .33) was attributable to passive genetic transmission (62%), with the rest attributable to passive environmental transmission (23%) and direct phenotypic transmission (15%). Environmental transmission was estimated lower in alternative models that assumed direct assortment, but these did not fit the data well.