Solveig Osborg Ose

User satisfaction with child and adolescent mental health services: impact of the service unit level.

BackgroundChild and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment.MethodThe study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction.ResultsAbout 96−98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2–4% of the variance attributable to the CAMHS level. Parents of patients aged 0–6 years were more satisfied than older patients’ parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings.ConclusionThe results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.

Health and unemployment: 14 years of follow-up on job loss in the Norwegian HUNT study

BACKGROUND Many studies have investigated how unemployment influences health, less attention has been paid to the reverse causal direction; how health may influence the risk of becoming unemployed. We prospectively investigated a wide range of health measures and subsequent risk of unemployment during 14 years of follow-up. METHODS Self-reported health data from 36 249 participants in the Norwegian HUNT2 Study (1995-1997) was linked by a personal identification number to the National Insurance Database (1992-2008). Exact dates of unemployment were available. Coxs proportional hazard models were used to estimate hazard ratios (HR) for the association of unemployment with several health measures. Adjustment variables were age, gender, education, marital status, occupation, lifestyle and previous unemployment. RESULTS Compared to reporting no conditions/symptoms, having ≥3 chronic somatic conditions (HR 1.78, 95% CI 1.46-2.17) or high symptom levels of anxiety and depression (HR 1.57, 95% CI 1.35-1.83) increased the risk of subsequent unemployment substantially. Poor self-rated health (HR 1.36, 95% CI 1.24-1.51), insomnia (HR 1.19, 95% CI 1.09-1.32), gastrointestinal symptoms (HR 1.17, 95% CI 1.08-1.26), high alcohol consumption (HR 1.17, 95% CI 0.95-1.44) and problematic use of alcohol measured by the CAGE questionnaire (HR 1.32, 95% CI 1.17-1.48) were also associated with increased risk of unemployment. CONCLUSION People with poor mental and physical health are at increased risk of job loss. This contributes to poor health amongst the unemployed and highlights the need for policy focus on the health and welfare of out of work individuals, including support preparing them for re-employment.

Social responsibility at company level and inclusion of disabled persons: the case of Norway

This study investigates the relationship between social responsibility and disability policies in a sample of Norwegian enterprises, within the framework of sub-goal two of the agreement on a more inclusive working life (IA agreement). Incorporating elements of corporate social responsibility theory into a Nordic context, our main argument is that the presence of certain workplace arrangements and strategies associated with a social dimension increases the likelihood that employers will have implemented measures aimed at facilitating the inclusion of disabled people in the workplace. The results of the regression analysis generally confirm our expectations: having anchored work with the IA agreement within the general health, safety and environment work and having a regular contact with the Working Life Centres appear to be important organizational resources, significantly influencing the likelihood that enterprises make efforts to include disabled individuals.

Work environment and disability pension – an 18-year follow-up study in a Norwegian working population

Aims: To investigate the associations between work environment indicators and health- related work disability. Methods: A health survey of 5,749 working 40–42-year-old Norwegians from Nordland County were linked to a national register for disability pension during a follow-up of over 18 years. The risk for disability pension following various self-reported physical and psychosocial work environmental exposures (individual and cumulative) were estimated using Cox regression analysis. Results: Both cumulative physical and psychosocial work environmental exposures were associated with an increased risk for disability pension, although this association was attenuated for most variables after adjusting for health and education. An increase in five poor psychosocial work environmental exposures was associated with a 22% increased risk for disability (adjusted hazard ratio, aHR, 1.22, 95% CI 1.04–1.44), whereas a similar increase in five poor physical work environmental exposures was associated with a 29% increased risk (aHR, 1.29, 95% CI 1.16-1.44). There were no indications of statistical interaction between either sex or education and work exposures. Conclusions: People who report a poor work environment are at a higher risk for subsequent work disability. This finding suggests that improving working conditions may be an area of intervention in order to reduce the number of people who leave the labour market with a disability pension.

Rehabilitation time before disability pension

BackgroundThe decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance.MethodsA study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression.ResultsThe rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence.ConclusionsThere is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

Unemployment and initiation of psychotropic medication: a case-crossover study of 2 348 552 Norwegian employees

Objectives The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss, to detect the period of greatest risk. Methods The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A case-crossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions. Results Purchases of all psychotropic drugs increased 1–3 months before job loss. Antidepressants had the highest estimate in the month before job loss (OR 2.68, 95% CIs 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in men. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close-to-baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations. Conclusions Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process.

Using Excel and Word to Structure Qualitative Data

Applied social science projects that involve many interviews produce a vast amount of data or text that is difficult to structure and analyze systematically. Computer-assisted qualitative data analysis software is too advanced and sophisticated when all we want is to sort and structure the text. A new method, using Microsoft Word and Excel, has been developed. The method produces a flexible Word document of interview data separated into logical chapters and subchapters. All text is coded, and the codes correspond with headings in the final document. Systematic manual coding ensures that all the content is coded, not just words or terms that are extracted from the text. After several years of using and refining the method, both in projects with relatively few interviews and in those with more than 100, I believe that the method is efficient when there are four or more interviews. The method is also suitable for coding and structuring answers to open-ended questions in Web-based surveys. The coding may be performed by a supervised research assistant or a multidisciplinary analytical team, depending on the complexity of the problem. The purpose of the method is not to quantify qualitative data but only to sort and structure large amounts of unstructured data. The method consists of 10 steps, screenshots of which are included in the paper.

Psychosocial working conditions and sickness absence in a general population: a cohort study of 21,834 workers in Norway (The HUNT Study).

Objective: To examine the associations between psychosocial working conditions and sickness absence. Methods: Data for 21,834 employed adults from the Nord-Trøndelag Health Study (HUNT) were linked to the sickness benefit register and sickness absence during 1 year after survey participation was analyzed with logistic regression. Results: A one unit change on a 0 to 3 self-reported job demand scale was associated with a fully adjusted 24% and 25% increased odds of sickness absence in men and women, respectively. A one unit change on a 0 to 3 scale for self-reported support at work was associated with a fully adjusted 13% and 17% reduced odds of sickness absence in men and women, respectively. Conclusions: The results of this study indicate that demands, and to some extent support, at work might influence sickness absence—also when adjusting for a detailed categorization of occupations.

Transferring psychiatric specialist services to local authorities—Characteristics of the patients involved

Abstract Background: To obtain more co-ordinated services, better co-operation between the services and more efficient use of resources, a pilot project for transferring some district psychiatric centres (DPCs) to large municipalities is planned by the Norwegian government. Systematic knowledge about the patients involved is needed when clinical needs and standards, funding, and political agendas are discussed. This study identifies the clinical, socio-demographic, and behavioural characteristics of patients who need services from both the municipality and the DPC. Method: A national mapping of patients in specialist mental health services was conducted in 2012/2013, including 65% of all inpatients (n = 2358) and 60% of all outpatients (n = 23 124). The need for services was assessed by each patient’s clinician. Results: It was found that 74% of inpatients and 43% of outpatients needed one or more services from the municipality, usually involving housing, mental health treatment/therapy, or economic support according to their clinicians. These were typically patients with severe mental illness, young inpatients, older outpatients and persons with low education and weak social networks. Only small differences in the need for municipal services were found between patients in hospitals and DPCs. Conclusions: Many of the patients in specialist mental health services, especially the inpatients, needed services from municipal social and health services. Because these patients had the most severe mental illnesses and were the most socially deprived, a stronger integration of service levels would potentially benefit these patients most. The pilot project should be evaluated to identify the consequences for patients, staff, quality of services, and costs of transferring services to a lower system level.

Employees’ drug purchases before and after organizational downsizing: a natural experiment on the Norwegian working population (2004–2012)

Objectives This study investigated the association between organizational downsizing and purchases of prescribed drugs by private sector employees in Norway. Methods A natural experiment was constructed using individual-level employer and employee data linked to the national prescription database for the period 2004-2012. The study population comprised 144 089 employees who had been exposed to major downsizing in the same period. Random effects logistic regression models were used to investigate relative changes in drug purchases (antidepressants, hypnotics/sedatives, anxiolytics, and anti-psychotics, as well as anti-obesity, anti-diabetic, cardiovascular, and thyroid drugs, anti-inflammatory drugs, opioids, and analgesics/antipyretics) in the five-year-period before and after exposure to downsizing. Results Compared with the situation three years before exposure, the odds ratios (OR) of purchasing psychotropic drugs one year after exposure increased for antidepressants (OR 1.44, 95% CI 1.34-1.55), hypnotics/sedatives (OR 1.39, 95% CI 1.29-1.49), anxiolytics (OR 1.32, 95% CI 1.22-1.43), and antipsychotics (OR 1.34, 95% CI 1.19-1.52). Similar associations were found for cardiovascular, anti-diabetic, and thyroid drugs. Stratified analyses showed that the odds of purchasing psychotropic, anti-diabetic, and cardiovascular drugs in the years around downsizing was more pronounced in men compared with women. Elevated odds were also found for employees in the oldest age group and those with less than tertiary education. Conclusions Exposure to organizational downsizing increased the odds of purchasing prescribed psychotropic, cardiovascular, anti-diabetic, and thyroid drugs. The clinical implications of these results might be systematic involvement from medical personnel and occupational health services in workforce reduction processes.