Ingeborg Rossow

Concordance of parental and adolescent health behaviors

This paper reports upon an empirical study of health behaviors in adolescents and their parents. The study aimed at assessing: effects of parental health behaviors on that of their adolescent child; whether mothers and fathers health behaviors have additive effects on the respective health behaviors of their child; and whether eventual effects of parental health behaviors decrease with increasing age of the child. The data stemmed from the Norwegian national Health Survey in 1985 and comprised separate interviews with two parents and an adolescent child in 337 families. Results from logistic regression analyses showed that the strongest association found between parental and adolescent health behaviors was for fat intake, and the probability of having a low fat intake was 5 times higher if the mother had a low fat intake than if she did not. With the exception of mothers frequency of exercise, all other parental health behaviors were positively and statistically significantly associated with the corresponding health behavior of their adolescent child. Parental fat intake, smoking behavior and alcohol consumption appeared to have additive effects on the corresponding behaviors of their children. No statistically significant interaction between any of the parental health behaviors and age of the adolescent was found. Hence, the effect of parental health behaviors on that of their adolescent child does not seem to decrease with increasing age of the adolescent. The results are discussed with reference to the functions of modeling.

Prevalence of alcohol and other substances of abuse among injured patients in a Norwegian emergency department

BACKGROUNDnStudies have found a high prevalence of both alcohol and other impairing psychoactive drugs in injured patient populations. The aim of this study was to assess the prevalence of potentially impairing psychoactive substances in all patients admitted to a hospital emergency department with injuries from accidents, assault or deliberate self harm.nnnMETHODSnA total of 1272 patients over 18 years of age, admitted to the hospital within 12h of injury, were included. Presence of alcohol was determined by an enzymatic method and other drugs by liquid chromatography-mass spectrometry (LC-MS) or gas chromatography-mass spectrometry (GC-MS), both highly specific analytical methods for determining recent intake.nnnRESULTSnThere were 510 (40%) women in the sample. Of the patients, 38% of the women and 48% of the men had a positive blood sample for psychoactive substances on admission. The most prevalent psychoactive substance was alcohol (27%) with an average concentration of 1.5 g/kg. A further 21% of patients tested showed use of medicinal drugs, and 9% showed use of illicit substances. Cannabis was the most prevalent illicit drug (6.2%). Diazepam (7.4%) and zopiclone (5.3%) were the most prevalent medicinal drugs. In road traffic accidents, 25% of the car drivers had positive findings, about half of them for alcohol.nnnCONCLUSIONnPsychoactive substances were found in nearly half the patients admitted with injuries. The most common substance was alcohol. Alcohol was particularly related to violence, whereas medicinal drugs were most prevalent in accidents at home.

Alcohol, psychoactive substances and non-fatal road traffic accidents - a case-control study

BackgroundThe prevalence of alcohol and other psychoactive substances is high in biological specimens from injured drivers, while the prevalence of these psychoactive substances in samples from drivers in normal traffic is low. The aim of this study was to compare the prevalence of alcohol and psychoactive substances in drivers admitted to hospital for treatment of injuries after road traffic accidents with that in drivers in normal traffic, and calculate risk estimates for the substances, and combinations of substances found in both groups.MethodsInjured drivers were recruited in the hospital emergency department and drivers in normal conditions were taken from the hospital catchment area in roadside tests of moving traffic. Substances found in blood samples from injured drivers and oral fluid samples from drivers in moving traffic were compared using equivalent cut off concentrations, and risk estimates were calculated using logistic regression analyses.ResultsIn 21.9% of the injured drivers, substances were found: most commonly alcohol (11.5%) and stimulants eg. cocaine or amphetamines (9.4%). This compares to 3.2% of drivers in normal traffic where the most commonly found substances were z-hypnotics (0.9%) and benzodiazepines (0.8%). The greatest increase in risk of being injured was for alcohol combined with any other substance (OR: 231.9, 95% CI: 33.3- 1615.4, pu2009<u20090.001), for more than three psychoactive substances (OR: 38.9, 95% CI: 8.2- 185.0, pu2009<u20090.001) and for alcohol alone (OR: 36.1, 95% CI: 13.2- 98.6, pu2009<u20090.001). Single use of non-alcohol substances was not associated with increased accident risk.ConclusionThe prevalence of psychoactive substances was higher among injured drivers than drivers in normal moving traffic. The risk of accident is greatly increased among drivers who tested positive for alcohol, in particular, those who had also ingested one or more psychoactive substances. Various preventive measures should be considered to curb the prevalence of driving under the influence of psychoactive substances as these drivers constitute a significant risk for other road users as well as themselves.

Nonsuicidal self-harm and suicide attempts in adolescents: differences in kind or in degree?

PurposeThe purpose of the present study was to measure the prevalence of self-harm (SH) behaviours and examine potential differences in characteristics among adolescents reporting on self-harm (SH), depending on whether they had attempted suicide (SA), performed nonsuicidal self-harm (NSSH), or both.MethodsCross-sectional survey of 11,440 adolescents aged 14–17xa0years in the city of Oslo, Norway. Responses regarding measures of lifetime SH and risk factors were collected. The response rate was 92.7xa0%. Data were analysed by segregating SH responses into the categories of NSSH, SA, and NSSHxa0+xa0SA.ResultsAmong all respondents, 4.3xa0% reported NSSH, 4.5xa0% reported SA, 5.0xa0% reported both NSSH and SA, and 86.2xa0% reported no SH. The group reporting to have engaged in both behaviours comprised more girls and reported more suicidal ideation, problematic lifestyles, poorer subjective health, and more psychological problems compared with the other groups. The four groups could be distinguished by one discriminant function that accounted for most of the explained variance.ConclusionsOur findings suggest that NSSH and SA are parts of the same dimensional construct in which suicidal ideation carries much of the weight in adolescents from a school-based sample. They also indicate the group of adolescents who seems to alternate between NSSH and SA is more burdened with mental ill-health and behavioural problems compared with others. These adolescents should therefore be targeted by clinicians and school health personnel for identification and provision of adequate help and services.

Use of health services following self-harm in urban versus suburban and rural areas: a national cross-sectional study

Objectives This study examines whether there is a difference between urban versus suburban and rural adolescents in their use of health services following two types of self-harm distinguished as self-harm with or without suicide intent. Setting A nationwide cross-sectional school survey of 11u2005406 Norwegian adolescents aged 13–19u2005years in 73 Norwegian junior and senior high schools. Participants Adolescents who reported self-harm and provided valid responses to a follow-up question about having received subsequent help or treatment (n=959) were included in the study. Adolescents were divided into urban versus suburban and rural depending on: (1) the location of municipalities where they attended school and (2) the place of residence. Associations between urban versus suburban and rural areas and the use of health services following self-harm were assessed in those who self-harmed with and without suicide intent. Primary outcome measure Use of health services following self-harm. Results 1 in 4 adolescents reported using health services following self-harm. Adolescents reporting self-harm with suicide intent were more likely to use health services than those who self-harmed without suicide intent. Following self-harm without suicide intent, adolescents in urban areas were four times more likely to use health services than adolescents in suburban and rural areas. There was no statistically significant area difference in the use of health services following self-harm with suicide intent. Conclusions This study found a geographical variation in the use of health services following self-harm without suicide intent, but not following self-harm with suicide intent. Differences in perception of self-harm and help-seeking behaviour between areas and different accessibility to services are suggested as possible explanations. There is a need to better understand how the interplay between individual characteristics and accessibility to services influences adolescents’ use of health services following self-harm. We suggest that multilevel models are a valuable approach to achieve this goal.

Heavy episodic drinking and deliberate self-harm in young people: a longitudinal cohort study

AIMnTo assess the association between heavy episodic drinking (HED) and deliberate self-harm (DSH) in young people in Norway.nnnDESIGN, SETTING, PARTICIPANTS AND MEASUREMENTSnWe analysed data on past-year HED and DSH from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (cumulative response rate: 68.1%, nu2009=u20092647). Associations between HED and DSH were obtained as odds ratios and population-attributable fractions (PAF) applying fixed-effects modelling, which eliminates the effects of time-invariant confounders.nnnFINDINGSnAn increase in HED was associated with an increase in risk of DSH (ORu2009=u20091.64, Pu2009=u20090.013), after controlling for time-varying confounders. The estimated PAF was 28% from fixed-effects modelling and 51% from conventional modelling.nnnCONCLUSIONnData on Norwegian youths show a statistically significant association between heavy episodic drinking and deliberate self-harm.

Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study

BackgroundStudies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact.MethodsData on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rateu2009=u200992.7%) of 11,440 adolescents aged 14–17xa0years who participated in a school survey in Oslo, Norway.ResultsAdolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (ORu2009=u20099.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non–suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood.ConclusionsIn this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and adolescent psychiatric services, naturally reflecting the core tasks of the services, confirming that they represents an important area for interventions that aim to reduce self-harming behaviour. Such interventions should include systematic screening for early recognition of self-harming behaviours, and treatment programmes tailored to the needs of teenagers with a positive screen. Possible barriers to receive mental health services for adolescents with immigrant backgrounds should be further explored.

Chain of care for patients with intentional self-harm: An effective strategy to reduce suicide rates?

Chain of care for patients with intentional self-harm was important in the Norwegian national action plan to prevent suicide. In this study there were two aims: (1) to calculate the potential effects of chain of care on reducing suicide rates, and (2) to assess whether suicide rates decreased more in areas where chain of care had been implemented than in other areas. We observed no differences in changes in suicide rates between areas with and without the intervention. The calculated potential effects of chain of care on national suicide rates were very small, even under unrealistically favorable conditions.

Collaboration between general hospitals and community health services in the care of suicide attempters in Norway: a longitudinal study.

BackgroundThe aim of this paper was to study the collaboration between emergency departments (EDs) in general hospitals and community health services (CHS) in Norway when providing psychosocial care and aftercare to patients treated in EDs following a suicide attempt. We wanted to explore the extent to which quality indicators at the hospital level measured in 1999 and 2006 could predict the presence or absence of a chain of care structure in the CHS in 2006.MethodsData were collected through structured interviews with informants from 95% of all general hospitals in Norway in 1999 and 2006, and informants from CHS, in a stratified sample of Norwegian municipalities in 2006 (n = 47).ResultsIn 15 of the 47 municipalities (32%), the CHS reported having a chain of care structure in 2006. A discriminant function analysis revealed that the hospitals that in 1999 had: (a) a collaboration agreement with aftercare providers, and (b) written guidelines, including a quality assurance system, were significantly more likely to have municipalities with a chain of care structure in their catchment area in 2006.ConclusionsHospitals and municipalities self-reported provision of aftercare services for patients treated after a suicide attempt was markedly below the recommendations given in national standards. Systems at the hospital level for the management and care of patients admitted after a suicide attempt and systematic collaboration between hospitals and aftercare providers seem to be important elements in the long-term maintenance of continuity of care for suicide attempters.

Studying psychoactive substance use in injured patients: Does exclusion of late arriving patients bias the results?

BACKGROUNDnMost studies of the prevalence of psychoactive substances in injured emergency department patients have excluded those who arrive more than 6h after injury. This may cause a selection bias. The aim of this study was: (1) to describe the characteristics of patients who arrive more than 6h after injury, compared to patients who arrive sooner (2) to examine whether self-report can add to the assessment of alcohol use when the patient is assessed more than 6h after injury.nnnMETHODSnBlood sample analysis and self-report data were used to assess the prevalence of psychoactive substances in injured patients admitted to an emergency department within 48 h of injury (n=1611). Discriminant function analysis was used to assess group differences.nnnRESULTSnThe patients who arrived more than 6h after injury differed significantly from those who arrived earlier in several respects. They more often screened positive for hypnotics; they were older, they were more likely to have had a fall and they were more often injured at home and at night. Self reported use of alcohol showed good consistency with blood sample screening within 6h of injury and could therefore be used to assess alcohol use more than 6h after injury.nnnCONCLUSIONSnPatients who arrive more than 6h after injury differ significantly from those who arrive earlier. Future studies on the prevalence of psychoactive substances in emergency departments could expand the inclusion window.