Reidun Olstad

The Finnmark Study. A prospective population study of the social support buffer hypothesis, specific stressors and mental distress.

Background According to the buffer hypothesis, social support or social network may affect mental health by buffering the negative effect of stress on mental health. Previous studies have mostly been cross-sectional or have been done on selected populations, and the results have been conflicting. Methods The buffer hypothesis was tested in three population-based health surveys which took place in 1987, 1990 and 1993 in five coastal municipalities in Finnmark, Norway. All persons aged 40–62 years and a random sample of those aged 20–39 years were invited, and 77 %, 74 % and 70 % attended the three health surveys, respectively. Those who had attended the health surveys more than once and had answered the key questions about mental health and social network, social support (measured both as instrumental support as well as emotional support) and stress were included in the analyses. Stress was divided into acute stress, (somatic stress, civil stress and work stress) and chronic stress (having a chronic disease, disability pension, being a single parent or providing long term nursing care for someone in the family). Growth curve analyses using mental distress as the dependent variable were used, analysing the interactional effects of various types of stressors and social network or social support. Results When all possible stressors and the sum of social network/social support were taken into consideration, total social support/network buffered the deteriorating effect of total stressor score upon mental health. The effect was weak but significant, and stronger for women than men. When each stressor was analysed separately, only a significant buffer effect of social network could be detected for work stress. For one of the chronic stressors, receiving a disability pension, a buffer effect could be demonstrated for both social network and instrumental support. Conclusion The results provide some support for the buffer hypothesis, and indication of specificity in the interactions between stressor and social network/social support was found. Women, in general, had a larger buffering effect from their social network than men.

Neurotrophic factors in serum following ECT: A pilot study

We examined changes in serum levels of a selection of neurotrophic factors, TSH, HGH and cortisol in conjunction with ECT treatment. Fifteen patients suffering from affective disorders were included, all were treated with antidepressants and psychotherapy and 10 also with ECT. The patients were examined clinically and with blood samples during treatment. Serum levels of cortisol, thyroid stimulating hormone (TSH), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT3), neuropetide Y (NPY) and human growth hormone (HGH) were studied. No significant changes were found in levels of NGF, BDNF, NT3, HGH and TSH. A change in NPY levels was statistically significant, but of uncertain clinical value as it affected only two patients. Levels of cortisol rose significantly during treatment. We did find significant correlations between the base values of NGF and HAM-D scores at inclusion and between the end-values of NT3 and NPY and the HAM-D scores prior to discharge. We were unable to reproduce findings from animal studies suggesting that a range of neurotrophic factors rise during ECT treatment. This may be because of physiological differences between animals and humans or, possibly, a result of the small number of patients included in this pilot study.

The Finnmark study. Social support, social network and mental distress in a prospective population study

Background: Earlier studies on the direct effect of social support and social network upon mental health have mostly been done in cross-sectional studies and the results have been conflicting. Methods: The direct effect of social network and social support upon mental distress was tested in population-based health surveys conducted in 1987, 1990 and 1993. The population consisted of all persons aged 40–62 years and a random sample of persons aged between 20 and 39 years living in five small municipalities in Finnmark, the northernmost county in Norway. The attendance rates were 77%, 74% and 70% for the three health surveys, respectively. All those who had attended the health surveys more than once and answered the key questions about mental distress, social support and social network were selected for analyses (966 persons who attended both the two first health surveys and 1425 persons attending both the two last surveys). A theoretical full cross-lagged panel model was used to search for the predictive effects of time 1 variables (mental distress, social network and social support) upon corresponding subsequent variables. Results: Mental distress, social support and social network at time 1 strongly predicted the corresponding variable at the next time point. Emotional support at time 1 exerted a weak positive effect upon mental distress on the next time point, explaining approximately 1% of the variance. Neither the social network nor instrumental support at time 1 predicted degree of mental distress at the subsequent time point. Conclusion: We conclude that social network and social support have very little direct predictive effect upon mental distress 3 years later in this population.

How are mood and exercise related? Results from the Finnmark study.

Background: Recreational exercise and mood have frequently been correlated in population studies. Although it is often assumed that recreational exercise improves mood, this has not been consistently demonstrated in population studies. Method: The relationship between mood and exercise was studied prospectively in a community sample. A series of synchronous panel models was constructed in two samples (2798 paired observations; sample I =1219, sample II =1498) to examine this relationship in the entire population, for women and men separately, for those with sedentary occupations, for those performing physical labour, and for those who initially showed a more dysphoric mood. Results: Although mood and exercise were correlated, the only directional relationship that could be demonstrated was that recreational exercise had an inconsistently positive effect upon mood in those with sedentary occupations. There was no such relationship between doing physical work and mood. Analyses of those who initially showed higher levels of dysphoria did not uncover any directional relationship between mood and exercise. None of the other subgroups showed any directional effects between mood and recreational exercise, nor did the population as a whole. Conclusion: The relationship between exercise and mood in this population sample appears to be largely correlational in nature. This result suggests the need to take a cautious view of the role played by exercise in promoting mood in the general population.

Acute psychiatric admissions from an out-of-hours Casualty Clinic; how do referring doctors and admitting specialists agree?

BackgroundOver the last decades there has been an increasing pressure on the acute psychiatric wards in Norway. The major contributor to psychiatric acute admissions at the University Hospital of North Norway in the city of Tromsø in 2001 was the GP-based Tromsø Casualty Clinic, only open out-of-hours. We explored all acute psychiatric referrals from Tromsø Casualty Clinic in 2001. The purpose of the study was to characterize the admissions and assess the agreement between the referring doctors and the hospital specialists according to the need for hospitalization, agreement on application of the law and the diagnostic evaluation to assess whether the admissions were appropriate.MethodsRetrospective, record based, descriptive study comprising 101 psychiatric acute referrals from the Tromsø Casualty Clinic to the psychiatric acute wards at the University Hospital of North Norway.ResultsThe specialists accepted all referrals except one, they mostly agreed upon the diagnoses suggested by the referring doctors and they mostly confirmed the application of the law.Seventy-five percent of the admissions took place during weekends, public holidays or nighttimes. Diagnoses of psychoses or suicidal attempts accounted for 76 % of the total referrals. Substance abuse was noted for 43 %, and in 22 % of all admissions the patients had stopped taking their psychopharmacological medication. The police assisted the referring doctors in one third of all admissions, and was the legal representative in 52 out of 59 involuntary admissions. Thirty percent of the admissions were first- time admissions. Thirty-two percent of the hospital stays lasted for three days or less. Median length of stay was 6.5 days.ConclusionThe casualty clinic physicians and the hospital specialists mostly agreed in their evaluation of patients indicating that most of the admissions were appropriate. The police was more often involved in the involuntary admissions than intended in the law. The proportion of patients with substance abuse was significant. Alternative treatment strategies should be developed for non-psychotic patients in need of short-term stays.

The effect of gender in diagnosing early schizophrenia

BackgroundStudies of diagnostic practice confirm that there is a diagnostic delay in diagnosing women with schizophrenia compared to diagnosing men. The aim of the present study was to investigate the diagnostic practice of Norwegian and Russian psychiatrists when it comes to early psychosis, emphasising gender differences. We wanted to study the association between patient gender as such and diagnostic decision-making among psychiatrists.Materials and methodsPsychiatrists in Norway and the Archangels region in Russia were invited to participate in a study of diagnostic practice, and received a written case description of a patient with early psychosis symptoms that could be interpreted as schizophrenia. They were, however, not informed that 50% of them received a female case description and 50% a male case description. Apart from the patient being described as “he” or “she” the stories were identical. Effects of patient gender, clinician gender, age and main area of interest were estimated using logistic regression analysis.ResultsA total of 467 psychiatrists answered the questionnaire. We found that schizophrenia diagnosis was given significantly more often to the male case than to the female case. Our finding remained significant after adjustment for country, clinician gender, age and main area of interest, and is unlikely to be explained by known biases.ConclusionPatient gender in itself affects clinicians’ diagnostic practice regarding schizophrenia, as schizophrenia diagnosis is given significantly more often to a male case description than to a female one, the descriptions being otherwise identical.

Bed utilization in two differently organized community mental health services in Northern Norway: the VELO-project.

BackgroundThe literature on the dynamics between community- and hospital services concerning utilization of psychiatric beds is inconclusive. The Norwegian VELO-project provides an opportunity to study this in a natural experiment. Two service-systems are compared. The “central-bed system” have mainly outpatient- and day-hospital services locally, with psychiatric beds at a central mental hospital. The “local-bed system” have only one outpatient clinic, with beds at three local inpatient units. Also utilization of sheltered homes was studied. Hypotheses were predicted from Goldberg and Huxley’s’ stage theory and the Thornicroft and Tansella’s’ hydraulic model.Materials and methodsThe case-registries of 2005 were linked across service levels by patients’ 11-digit Social Security Number. From 1,865 single treatment episodes, 1,348 continuous courses by 1,253 individual patients were extracted.ResultsFor overall utilization of psychiatric beds there was only a small difference, were the central-bed system utilized 10% less than the other. For utilization of emergency inpatient admissions and acute hospital beds, the rate was more than twice in the central-bed system compared to the other. For utilization of municipalities sheltered homes, the rate was three times higher in the local-bed system.DiscussionThere may be bedrock of need for psychiatric beds regardless of system-organization. Distance may in general be a minor issue for utilization of psychiatric beds, and may primarily interact with patient- or contextual characteristics associated with acute situations. Activity of day-hospital services rather than outpatient consultations may affect utilization of sheltered homes. The main theoretical models are conceptually useful, although more research is needed to specify mechanisms.

A comparative study of diagnostic practice in psychiatry in Northern Norway and Northwest Russia.

BackgroundThe co-operation between psychiatrists in Norway and Russia is increasing. The object of this study was to find out whether there were differences in diagnostic practice of psychiatrists in both countries, to look at the nature of the differences and to examine whether these differences affected diagnostic quality.MethodThirty medical doctors working at psychiatric hospitals in both countries diagnosed 12 clinical case vignettes selected from a wide spectre of psychiatric disorders.ResultsThe Russian clinicians used a larger range of diagnoses than the Norwegians. The Russians tended to diagnose schizophrenia and schizophrenia-like disorders in cases that presented psychotic syndromes, and somatoform disorders in cases that presented agoraphobia. The Norwegians tended to evaluate affective aspects in preference to psychotic symptoms in the case of schizoaffective disorder and overestimate the degree of depression. In general, the Russians had lower total score of correct answers than the Norwegians.ConclusionIn spite of the limitations due to minor differences in the data collection phase in the two countries, the study clearly demonstrates differences in diagnostic practice between the countries.

Decentralization matters – Differently organized mental health services relationship to staff competence and treatment practice: the VELO study

BackgroundThe VELO study is a comparative study of two Community Mental Health Centres (CMHC) in Northern Norway. The CMHCs are organized differently: one has no local inpatient unit, the other has three. Both CMHCs use the Central Mental Hospital situated rather far away for compulsory and other admissions, but one uses mainly local beds while the other uses only central hospital beds. In this part of the study the ward staffs level of competence and treatment philosophy in the CMHCs bed units are compared to Central Mental Hospital units. Differences may influence health service given, resulting in different treatment for similar patients from the two CMHCs.Methods167 ward staff at Vesterålen CMHCs bed units and the Nordland Central Mental Hospital bed units answered two questionnaires on clinical practice: one with questions about education, work experience and clinical orientation; the other with questions about the philosophy and practice at the unit. An extended version of Community Program Philosophy Scale (CPPS) was used. Data were analyzed with descriptive statistics, non-parametric test and logistic regression.ResultsWe found significant differences in several aspects of competence and treatment philosophy between local bed units and central bed units. CMHC staff are younger, have shorter work experience and a more generalised postgraduate education. CMHC emphasises family therapy and cooperation with GP, while Hospital staff emphasise diagnostic assessment, medication, long term treatment and handling aggression.ConclusionThe implications of the differences found, and the possibility that these differences influence the treatment mode for patients with similar psychiatric problems from the two catchment areas, are discussed.

Between health care and social security--psychiatric patients and the disability pension system in Norway and Russia.

BackgroundThe official statistics of persons with mental disorders who are granted disability pension (DP) in Russia and Norway indicate large differences between the countries.MethodsThis qualitative explorative hypothesis-generating study is based on text analysis of the laws, regulations and guidelines, and qualitative interviews of informants representing all the organisational elements of the DP systems in both countries.ResultsThe DP application process is initiated much later in Norway than in Russia, where a 3 year occupational rehabilitation and adequate treatment is mandatory before DP is granted. In Russia, two instances are responsible for preparing of the medical certification for DP, a patients medical doctor (PD) and a clinical expert commission (CEC) while there is one in Norway (PD). In Russia, the Bureau of Medical-Social Expertise is responsible for evaluation and granting of DP. In Norway, the local social insurance offices (SIO) are responsible for the DP application. Decisions are taken collectively in Russia, while the Norwegian PD and SIO officer often take decisions alone. In Russia, the medical criterion is the decisive one, while rehabilitation and treatment criteria are given priority in Norway. The size of the DP in Norway is enough to cover of subsistences expenditure, while the Russian DP is less than the level required for minimum subsistence.ConclusionThere were noteworthy differences in the time frame, organisation model and process leading to a DP in the two countries. These differences may explain why so few patients with less severe mental disorders receive a DP in Russia. This fact, in combination with the size of the DP, may hamper reforms of the mental health care system in Russia.