Publications by authors named "Øystein Vedaa"

41 Publications

Study protocol: the Norwegian Triple-S Cohort Study - establishing a longitudinal health survey of children and adolescents with experiences of maltreatment.

BMC Public Health 2021 Jun 5;21(1):1082. Epub 2021 Jun 5.

Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway.

Background: Child maltreatment is prevalent and associated with both short- and long-term health problems. Previous studies have established child maltreatment as a risk factor for a wide range of problems over the life course such as mental- and somatic health problems, self-harm, alcohol- and drug abuse and decreased work-life participation. Still, there are few large and well-conducted longitudinal studies focusing on describing prevalence and identifying risk factors and long-term consequences of child maltreatment. The purpose of the current study is to recruit a large number of children and adolescents exposed to maltreatment and follow them long-term.

Methods/design: The current study is a longitudinal cohort study and will use a multi-informant design (child/adolescent, caregiver, and administrative data). Participants will be recruited from the Stine Sofie Centre (SSC), a learning and coping centre for children and adolescents (≤18 years) exposed to maltreatment, which includes physical and emotional abuse, neglect and/or sexual abuse. Questionnaire-based assessments from self-reports (as well as parent-reports) will be carried out at regular time intervals throughout their lives, on topics such as abuse, negative life events, mental and somatic health problems, resilience and coping, satisfaction with health services, social-, family-, and school function, as well as self-harm and substance abuse. Participants will be assessed upon entry to the centre and followed up annually until they reach 18 years and bi-annually after. Given written consent, participants' responses will be linked to relevant national registries in order to examine predictive factors and important outcomes in terms of subsequent health, education, criminal records and work affiliation.

Discussion: This study will examine short- and long-term consequences of child maltreatment across a range of health-related outcomes in a longitudinal perspective. Results from the current study might have implications for the development of preventive and intervention programs related to child maltreatment and the organization and follow-up of the services these children receive. The current study will hopefully contribute with knowledge of risk-factors, short- and long-term health-related and other issues that can contribute to practices aimed at improving the overall life-course for children and adolescents who have experienced childhood maltreatment.
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http://dx.doi.org/10.1186/s12889-021-11125-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8179690PMC
June 2021

The effect of sleep-wake intraindividial variability in digital cognitive behaviour therapy for insomnia: A mediation analysis of a large-scale RCT.

Sleep 2021 May 8. Epub 2021 May 8.

Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.

Study Objectives: Digital Cognitive Behavioural Therapy for Insomnia (dCBT-I) is an effective treatment for insomnia. However, less is known about mediators of its benefits. The aim of the present study was to test if intraindividual variability in sleep (IIV) was reduced with dCBT-I, and whether any identified reduction was a mediator of dCBT-I on insomnia severity and psychological distress.

Methods: In a two-arm randomized controlled trial (RCT), 1720 adults with insomnia (dCBT-I = 867; patient education about sleep = 853) completed the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and sleep diaries, at baseline and 9-week follow-up. Changes in IIV were analysed using linear mixed modelling followed by mediation analyses of ISI, HADS, and IIV in singular sleep metrics and composite measures (Behavioural Indices (BI-Z) and Sleep-disturbance Indices (SI-Z)).

Results: dCBT-I was associated with reduced IIV across all singular sleep metrics, with the largest between-group effect sizes observed for sleep onset latency (SOL). Reduced IIV for SOL and wake after sleep onset had the overall greatest singular mediating effect. For composite measures, SI-Z mediated change in ISI (b = -0.74; 95% Confidence Interval (CI) -1.04 to -0.52; 13.3%) and HADS (b = -0.40; 95% CI -0.73 to -0.18; 29.2%), whilst BI-Z mediated minor changes.

Conclusion: Reductions in IIV in key sleep metrics mediate significant changes in insomnia severity and especially psychological distress when using dCBT-I. These findings offer important evidence regarding the therapeutic action of dCBT-I and may guide the future development of this intervention.
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http://dx.doi.org/10.1093/sleep/zsab118DOI Listing
May 2021

Changes in work schedule affect the prevalence of shift work disorder among Norwegian nurses - a two year follow-up study.

Chronobiol Int 2021 Jun 18;38(6):924-932. Epub 2021 Mar 18.

Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.

This study aimed to explore how changes in the work schedule would affect the prevalence of Shift Work Disorder (SWD) over time. Two-year follow-up data from 1076 nurses participating in the longitudinal SUrvey of Shift work, Sleep and Health among Norwegian nurses (SUSSH) were included in the study. The questionnaires included measures of work-related factors, i.e., work schedule and numbers of night shifts and quick returns (QRs) worked the last year, as well as questions related to SWD according to the ICSD-3 diagnostic criteria at both baseline and at 2-year follow-up. Data were analyzed with paired samples t-tests, chi-square tests, and logistic regression analyses adjusting for sex and age. Terminating night work was the strongest predictor for recovering from SWD from baseline to follow-up (OR 10.91, 95% CI 6.11-19.46). Additionally, changing the work schedule from day work to night work from baseline to follow-up was the strongest predictor for developing SWD in the same period (OR 4.75, 95% CI 2.39-9.47). Reductions in number of nights (more than 10) and QRs (more than 10) worked the last year were associated with recovering from SWD between baseline and follow-up. Nurses who recovered from SWD had significantly reduced the mean number of night shifts worked the last year from 32.3 at baseline to 20.4 at follow-up ( = .001). Furthermore, an increase of more than 10 nights or more than 10 QRs worked the last year between baseline and follow-up predicted developing SWD. Nurses developing SWD between baseline and follow-up had significantly increased the mean number of nights worked the last year from 25.8 at baseline to 31.0 at follow-up ( =-.043). Changes in night work exposure were the strongest predictors for both recovering from or developing SWD from baseline to follow-up. Reducing exposure to night work and QRs were associated with recovering from SWD and increasing exposure to night work and QRs were associated with developing SWD. The results imply that unfavorable work schedules play a role in the development of sleep problems among nurses. These results may be useful when designing healthy working schedules.
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http://dx.doi.org/10.1080/07420528.2021.1896535DOI Listing
June 2021

Locked and lonely? A longitudinal assessment of loneliness before and during the COVID-19 pandemic in Norway.

Scand J Public Health 2021 Mar 1:1403494821993711. Epub 2021 Mar 1.

Department of Mental Health and Suicide, Norwegian Institute of Public Health, Norway.

Aims: There are concerns that lockdown measures taken during the current COVID-19 pandemic lead to a rise in loneliness, especially in vulnerable groups. We explore trends in loneliness before and during the pandemic and differences across population subgroups.

Methods: Data were collected via online questionnaires in June 2020 and four to eight months prior in two Norwegian counties (=10,740; 54% women; age 19-92 years). Baseline data come from the Norwegian Counties Public Health Survey (participation rate 46%, of which 59% took part in a COVID-19 follow-up study).

Results: Overall loneliness was stable or falling during the lockdown. However, some subgroups, single individuals and older women, reported slightly increased loneliness during lockdown. Interestingly, individuals with low social support and high levels of psychological distress and loneliness before the pandemic experienced decreasing loneliness during the pandemic.

Conclusions:
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http://dx.doi.org/10.1177/1403494821993711DOI Listing
March 2021

Sleep disturbances and first onset of major mental disorders in adolescence and early adulthood: A systematic review and meta-analysis.

Sleep Med Rev 2021 Jun 19;57:101429. Epub 2021 Jan 19.

Universite de Paris, Paris, France; AP-HP Paris Nord, GH Saint-Louis-Lariboisiere-Fernand-Widal, Departement de Psychiatrie et de Medicine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France.

Despite several high-quality reviews of insomnia and incidence of mental disorders, prospective longitudinal relationships between a wider range of sleep disturbances and first onset of a depressive, bipolar, or psychotic disorders during the peak age range for onset of these conditions has not been addressed. Database searches were undertaken to identify publications on insomnia, but also on other sleep problems such as hypersomnia, short sleep duration, self-identified and/or generic 'sleep problems' and circadian sleep-wake cycle dysrhythmias. We discovered 36 studies that were eligible for systematic review and from these publications, we identified 25 unique datasets that were suitable for meta-analysis (Number>45,000; age ∼17). Individuals with a history of any type of sleep disturbance (however defined) had an increased odds of developing a mood or psychotic disorder in adolescence or early adulthood (Odds ratio [OR]:1.88; 95% Confidence Intervals:1.67, 2.25) with similar odds for onset of bipolar disorders (OR:1.72) or depressive disorders (OR:1.62). The magnitude of associations differed according to type of exposure and was greatest for sleep disturbances that met established diagnostic criteria for a sleep disorder (OR: 2.53). However, studies that examined observer or self-rated symptoms, also reported a significant association between hypersomnia symptoms and the onset of a major mental disorder (OR:1.39). Overall study quality was moderate with evidence of publication bias and meta-regression identified confounders such as year of publication. We conclude that evidence indicates that subjective, observer and objective studies demonstrate a modest but significant increase in the likelihood of first onset of mood and psychotic disorders in adolescence and early adulthood in individuals with broadly defined sleep disturbances. Although findings support proposals for interventions for sleep problems in youth, we suggest a need for greater consensus on screening strategies and for more longitudinal, prospective studies of circadian sleep-wake cycle dysrhythmias in youth.
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http://dx.doi.org/10.1016/j.smrv.2021.101429DOI Listing
June 2021

Effects of digital cognitive behavioural therapy for insomnia on insomnia severity: a large-scale randomised controlled trial.

Lancet Digit Health 2020 08;2(8):e397-e406

Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway.

Background: Although several large-scale randomised controlled trials have shown the efficacy of digital cognitive behavioural therapy for insomnia (dCBT-I), there is a need to validate widespread dissemination of dCBT-I using recommended key outcomes for insomnia. We investigated the effect of a fully automated dCBT-I programme on insomnia severity, sleep-wake patterns, sleep medication use, and daytime impairment.

Methods: We did a parallel-group superiority randomised controlled trial comparing dCBT-I with online patient education about sleep. The interventions were available through a free-to-access website, publicised throughout Norway, which incorporated automated screening, informed consent, and randomisation procedures, as well as outcome assessments. Adults (age ≥18 years) who had regular internet access and scored 12 or higher on the Insomnia Severity Index (ISI) were eligible for inclusion, and were allocated (1:1) to receive dCBT-I (consisting of six core interactive sessions to be completed over 9 weeks) or patient education (control group). Participants were masked to group assignment and had no contact with researchers during the intervention period. The primary outcome was the change in ISI score from baseline to 9-week follow-up, assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02558647) and is ongoing, with 2-year follow-up assessments planned.

Findings: Between Feb 26, 2016, and July 1, 2018, 5349 individuals commenced the online screening process, of which 1497 were ineligible or declined to participate, 2131 discontinued the screening process, and 1721 were randomly allocated (868 to receive dCBT-I and 853 to receive patient education). At 9-week follow-up, 584 (67%) participants in the dCBT-I group and 534 (63%) in the patient education group completed the ISI assessment. The latent growth model showed that participants in the dCBT-I group had a significantly greater reduction in ISI scores from baseline (mean score 19·2 [SD 3·9]) to 9-week follow-up (10·4 [6·2]) than those in the patient education group (from 19·6 [4·0] to 15·2 [5·3]; estimated mean difference -4·7 (95% CI -5·4 to -4·1; Cohen's d -1·21; p<0·001). Compared with patient education, the number needed to treat with dCBT-I was 2·7 (95% CI 2·4 to 3·2) for treatment response (ISI score reduction ≥8) and 3·2 (2·8 to 3·8) for insomnia remission (ISI score <8). No adverse events were reported to the trial team.

Interpretation: dCBT-I is effective in reducing the severity of symptoms associated with the insomnia disorder. These findings support the widespread dissemination of dCBT-I. Future research is needed to identify the moderators of response and to improve targeting.

Funding: Norwegian Research Council; Liaison Committee for Education, Research and Innovation in Central Norway.
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http://dx.doi.org/10.1016/S2589-7500(20)30135-7DOI Listing
August 2020

Sleep in the land of the midnight sun and polar night: The Tromsø study.

Chronobiol Int 2021 Mar 29;38(3):334-342. Epub 2020 Nov 29.

Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.

While some diseases and human behaviors fluctuate consistently with season, the extent of seasonal variations in sleep, especially at high latitudes, is less consistent. We used data from a geographic region (69º North) with extremely large seasonal differences in daylight that had the participants blinded for the current study's hypotheses. Data were derived from the Tromsø Study (2015-2016), an ongoing population-based study in Northern Norway comprising citizens aged 40 years and older (n = 21,083, participation = 64.7%). The sleep parameters included bedtime, rise time, sleep onset latency (SOL), and total sleep time. Insomnia was defined according to recent diagnostic criteria (International Classification of Sleep Disorders; ICSD-3). We found some evidence of monthly or seasonal variation in sleep problems. Insomnia was most common during the winter months among men, but not women. No seasonal or monthly effects were observed for sleep duration. SOL was slightly longer during the winter months, but the differences were small and hardly of any clinical relevance. The small or non-existing seasonal variation in sleep and sleep difficulties indicate that extreme seasonal variation in daylight is of little influence on sleep status. The city of Tromsø is a modern city with considerable level of artificial light, which may contribute to the observed rather stabile sleep patterns throughout the year.
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http://dx.doi.org/10.1080/07420528.2020.1845191DOI Listing
March 2021

Short sleep duration and high exposure to quick returns are associated with impaired everyday memory in shift workers.

Nurs Outlook 2021 May-Jun;69(3):293-301. Epub 2020 Oct 27.

Department of Psychosocial Science, University of Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Norway.

Purpose: To investigate the relationship between self-reported everyday memory problems the last month, and: (a) shift work schedule, (b) night shifts and quick returns worked the last year, and (c) sleep duration the last month.

Methods: In all, 1,275 nurses completed the Everyday Memory Questionnaire - revised, and answered questions about shift work exposure and sleep duration. We performed multiple linear regression analyses with memory score as dependent variable, and the shift work exposure variables as well as sleep duration as predictors, while adjusting for potential confounders.

Findings: High exposure to quick returns (β = .10, p < .05) and short sleep duration (β = .10, p < .05) were both positively associated with memory problems, whereas shift work schedule, long sleep duration, night shift exposure, and low and moderate exposure to quick returns were not.

Discussion: Frequent insufficient time for rest between shifts as well as short sleep was associated with poorer everyday memory.
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http://dx.doi.org/10.1016/j.outlook.2020.09.008DOI Listing
October 2020

The Association Between Shift Work and Immunological Biomarkers in Nurses.

Front Public Health 2020 14;8:415. Epub 2020 Sep 14.

Department of Psychosocial Science, University of Bergen, Bergen, Norway.

Shift work is associated with several negative health effects. The underlying pathophysiological mechanisms are unclear, but low-grade inflammation has been suggested to play a role. This project aimed to determine whether levels of immunological biomarkers differ depending on work schedule, self-reported sleep duration, self-reported sleep quality, and presence of shift work disorder (study 1). Furthermore, we aimed to determine whether these biomarkers differ after a night of sleep vs. at the end of a night or a day shift (study 2). In study 1, 390 nurses provided blood samples after a night of sleep with the dried blood spot method. In study 2, a subset of 55 nurses also provided blood samples after a day shift and after a night shift. The following biomarkers were measured: interleukin-1alpha, interleukin-1beta, interleukin-4, interleukin-6, interleukin-8, interleukin-10, interleukin-13, monocyte chemoattractant protein-1, interferon-gamma, and tumor necrosis factor-alpha. Multiple linear regressions with adjustment for age, sex and body mass index (study 1) and ANOVAs with repeated measures (study 2) were conducted. In study 1, neither work schedule, number of night shifts, number of quick returns (<11 h between consecutive shifts), sleep duration, poor sleep quality, nor shift work disorder were systematically associated with most of these biomarkers. Compared with day only work, day-evening work was associated with higher levels of IL-1alpha and IL-13, quick returns were associated with higher levels of IL-1beta and MCP-1, short sleep duration (<6 h) was associated with lower levels of IL-1beta and higher levels of TNF-alpha, and long sleep duration (8+ h) was associated with higher levels of IL-13. In study 2, IL-1beta levels were higher (large effect size) both after a day shift (14% increase) and a night shift (75% increase) compared with levels after a night of sleep. Similarly, TNF-alpha levels were higher (moderate-large effect size) after a day shift (50% increase) compared to after a night of sleep. In contrast, MCP-1 levels were lower (large effect size) both after a day shift (22% decrease) and a night shift (12% decrease) compared with after a night of sleep. We found some indications that shift work influenced immunological biomarkers. The results should be interpreted with caution due to limitations, e.g., related to the sampling procedure and to low levels of biomarkers in the blood samples.
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http://dx.doi.org/10.3389/fpubh.2020.00415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521138PMC
April 2021

Trajectories of sleep problems from adolescence to adulthood. Linking two population-based studies from Norway.

Sleep Med 2020 11 8;75:411-417. Epub 2020 Sep 8.

Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research & Innovation, Helse-Fonna HF, Haugesund, Norway.

Study Objective: The aim of the study is to assess stability and predictors of insomnia and sleep duration from adolescence to early adulthood.

Methods: A longitudinal sample of 1257 individuals from three age cohorts were assessed from linked population-based studies, the [email protected] study from 2012 (age 16-18) and the SHoT2018 study (age 22-25). Identical measures of insomnia symptoms and sleep duration were analysed.

Results: The stability of insomnia was high from adolescence to young adulthood, 50% of those with insomnia symptoms in adolescence still had insomnia symptoms six years later (adjusted IRR = 2.01; (CI 95%; 1.5-2.44)). Short sleep duration was also stable, with 67.8% of the adolescents in the lowest sleep duration quartile still remaining in the lowest quartile six years later. The overall rate of insomnia symptoms, long wake after sleep onset (WASO), and oversleeping increased from adolescence to young adulthood. Also, we observed a reduction in sleep efficiency and later rise times. There was no significant change in sleep onset latency (SOL).

Conclusion: Insomnia symptoms and short sleep duration are prevalent during both adolescence and young adulthood. Considerable individual stability and a rising rate of insomnia symptoms were observed over time. These findings underscore the importance of early identification and timely interventions to prevent chronic sleep problems.
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http://dx.doi.org/10.1016/j.sleep.2020.08.035DOI Listing
November 2020

Tinder Use and Romantic Relationship Formations: A Large-Scale Longitudinal Study.

Front Psychol 2020 14;11:1757. Epub 2020 Aug 14.

Department of Psychosocial Science, University of Bergen, Bergen, Norway.

The current paper aims to investigate if Tinder use predicts romantic relationship formation 1 year later and to identify demographic, personality, mental health, and substance use covariates in the relationship between Tinder use and romantic relationship formation. Data were collected by online surveys (two waves) among students in Bergen, Norway. The first survey was administered during fall 2015 (T1). The follow-up took place 1 year later (fall 2016, T2). The sample consisted of the 5253 participants who reported to be single at T1. The surveys included questions about Tinder use, demographics, personality (the Five-Factor Model's personality traits), mental health (i.e., symptoms of depression and anxiety), alcohol use, and use of illegal substances. Bivariate comparisons were conducted to assess differences in demographics, personality traits, mental health, and substance use between Tinder users and non-Tinder users. Further, crude and adjusted binary logistic regressions were employed to investigate if Tinder use at T1 predicted romantic relationship formation at T2, when controlling for relevant covariates. Tinder users differed from non-users on almost all included variables. Compared to non-users, Tinder users were younger and more likely to be men, born in Norway, childless, and non-religious. Tinder users had higher scores on extroversion and agreeableness and lower scores on openness compared to non-users. Further, compared to non-users, Tinder users reported more symptoms of anxiety and were more likely to have hazardous, harmful, or dependent alcohol use and to report use of illegal substances. Compared to non-users, Tinder users had a higher likelihood of having formed a romantic relationship at T2 in the crude model ( < 0.05) and when controlling for demographic ( < 0.05) and mental health ( < 0.05) covariates. However, when controlling for personality, substance use, and all included covariates, the difference in likelihood of romantic relationship formation was no longer significant. In conclusion, the current results suggest that Tinder users have a higher likelihood of forming romantic relationship longitudinally, but that this increased likelihood can be explained by Tinder users' personality and substance use characteristics.
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http://dx.doi.org/10.3389/fpsyg.2020.01757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456855PMC
August 2020

The Effect of Reducing Insomnia Severity on Work- and Activity-Related Impairment.

Behav Sleep Med 2021 Jul-Aug;19(4):505-515. Epub 2020 Jul 30.

Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.

Objective/background: The effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) for alleviating sleep problems is well established. However, few studies have explored its impact on work productivity and activity.

Participants: Seventy-seven currently employed adults with insomnia disorder (59 females) recruited to a randomized trial of digital versus face-to-face CBT-I.

Methods And Materials: The general health version of the Work Productivity and Activity Impairment questionnaire was used to measure absenteeism, presenteeism, total work impairment, and activity impairment. We assessed changes in work productivity and activity pre-to-post-therapy for the total sample and then for subgroups categorized according to response or remission of insomnia disorder (evaluated using the Insomnia Severity Index).

Results: Study participants showed significant improvements in presenteeism ( = .001; Cohen's = 0.46), total work impairment ( < .001; = 0.48), and activity ( < .001; = 0.66), but not absenteeism ( = .51; = 0.084) between baseline and follow-up assessment. Individuals meeting criteria for remission showed significantly greater improvement in presenteeism ( = .002), total work impairment ( < .001), and activity ( = .006), but not absenteeism ( = .064).

Conclusion: This study suggests that the benefits of CBT-I extend beyond improvement in sleep to encompass moderate-to-large improvements in work productivity and activity levels particularly for individuals who achieve remission from insomnia. Given the importance of these behaviors, there is a need for future large-scale randomized trials and cohort studies which should strive to include objective measurement of daytime activity and work performance more frequently.
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http://dx.doi.org/10.1080/15402002.2020.1799792DOI Listing
July 2020

A longitudinal study on the association between quick returns and occupational accidents.

Scand J Work Environ Health 2020 11 7;46(6):645-649. Epub 2020 Jul 7.

Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5018 Bergen, Norway.

Objective This study aimed to investigate how change in the number of quick returns [(QR) <11 hours between consecutive shifts] longitudinally is associated with risk of occupational accidents among nurses. Methods Two-year follow-up data from 1692 nurses participating in the Survey of Shiftwork, Sleep and Health among Norwegian nurses (SUSSH) (mean age 40.2, standard deviation 8.3 years, 91% female) were used. Negative binomial regression analyses were conducted to investigate the association between changes in the number of QR after two years and occupational accidents, controlling for demographics, work factors, and occupational accidents at baseline. Results An increase from having no or a moderate number of QR (1-34 per year) from baseline to the two-year follow-up assessment was associated with an increased risk of occupational accidents, compared to experiencing no change in the number of QR. Those with a moderate number of QR at baseline who experienced an increase after two years had an increased risk of causing harm to patients/others [incident rate ratio (IRR) 8.49, 95% confidence interval (CI) 2.79-25.87] and equipment at work (IRR 2.89, 95% CI 1.13-7.42). Those who had many QR (>34 per year) at baseline but experienced a reduction after two years had a reduced risk of causing harm to themselves (IRR 0.35, 95% CI 0.16-0.73) and patients/others (IRR 0.27, 95% CI 0.12-0.59). Conclusion A fairly consistent pattern was demonstrated in which changes in the number of QR over the two-year follow-up period was associated with a corresponding change in the risk of occupational accidents.
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http://dx.doi.org/10.5271/sjweh.3906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737807PMC
November 2020

Habitual Sleep, Social Jetlag, and Reaction Time in Youths With Delayed Sleep-Wake Phase Disorder. A Case-Control Study.

Front Psychol 2019 12;10:2569. Epub 2019 Nov 12.

Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.

The aim of this study was to explore habitual sleep, social jetlag, and day-to-day variations in sleep (measured as intra-individual standard deviation, ISD) in youths with delayed sleep-wake phase disorder (DSWPD), compared to healthy controls. We also aimed to investigate time of day effects in performance. The sample comprised 40 youths with DSWPD (70.0% female, mean age 20.7 ± 3.1 years) and 21 healthy controls (71.4% female, mean age 21.2 ± 2.2 years). Subjective and objective sleep were measured over 7 days on a habitual sleep schedule by sleep diary and actigraphy recordings. Performance was tested twice with a 12-h interval (22:00 in the evening and 10:00 the following morning) using a simple, 10-min sustained reaction time test (RTT). The results showed later sleep timing in the DSWPD group compared to the controls, but sleep duration, social jetlag, and ISD in sleep timing did not differ between the groups. Still, participants with DSWPD reported longer sleep onset latency (SOL) and poorer sleep efficiency (SE), sleep quality, and daytime functioning, as well as larger ISD in SOL, sleep duration, and SE. The groups had similar evening performances on the RTT, but the DSWPD group performed poorer (slower with more lapses) than the controls in the morning. The poor morning performance in the DSWPD group likely reflects the combined impact of sleep curtailment and circadian variations in performance (synchrony effect), and importantly illustrates the challenges individuals with DSWPD face when trying to adhere to early morning obligations.
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http://dx.doi.org/10.3389/fpsyg.2019.02569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861448PMC
November 2019

Short and long-term effects of unguided internet-based cognitive behavioral therapy for chronic insomnia in morning and evening persons: a post-hoc analysis.

Chronobiol Int 2019 10 1;36(10):1384-1398. Epub 2019 Aug 1.

Department of Health Promotion, Norwegian Institute of Public Health , Bergen , Norway.

A post-hoc analysis comparing morning and evening persons with insomnia on sleep and mental health characteristics was conducted in order to investigate whether an Internet-based cognitive behavioral therapy for insomnia (ICBTi) was effective both for morning and evening persons. Adult patients (N = 178, mean age = 44.8, 67% females) with insomnia were randomized to either ICBTi (N = 92; morning persons = 41; evening persons = 51) or a web-based patient education condition (N = 86; morning persons = 44; evening persons = 42). All patients were assessed with sleep diaries, the Insomnia Severity Index (ISI), the Bergen Insomnia Scale (BIS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the Hospital Anxiety and Depression Scale (HADS) and the Chalder Fatigue Scale (CFQ). Patients were characterized as morning or evening persons based on a median split on the Horne-Östberg Morningness Eveningness Questionnaire. Short and long-term effects of treatment were examined with mixed-model repeated-measures analyses. Morning and evening persons did not differ in terms of age, gender or educational status. At baseline, morning persons had more wake time after sleep onset (= 0.54, < .001) and more early morning awakening (= 0.38, < .05) compared to evening persons, while evening persons reported longer sleep onset latency (= 0.60, < .001), more time in bed (= 0.56, < .001), longer total sleep time (= 0.45, < .01), more fatigue (= 0.31, < .05) and more dysfunctional beliefs and attitudes about sleep (= 0.47, < .01). Despite these differences at baseline, both morning and evening persons receiving ICBTi benefitted more across most measures compared to morning and evening persons who received patient education. For morning persons in the ICBTi group, ISI scores were reduced from 17.3 at baseline to 8.8 (d = 2.48, < .001) at post-assessment, and to 10.0 at 18-month follow up (d = 2.13, < .001). Comparable results were found for evening persons in the ICBTi group, with a reduction in ISI scores from 17.4 at baseline to 8.6 (d = 2.24, < .001) at post-assessment, and to 8.7 at 18-month follow up (d = 2.19, < .001). Similar results were found on the BIS, DBAS, HADS, CFQ and sleep diary data. Despite different insomnia symptomatology between the two groups, the current study suggests that ICBTi is effective across scores on the morningness-eveningness dimension. The study was pre-registered at: ClinicalTrials.gov Identifier: NCT02261272.
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http://dx.doi.org/10.1080/07420528.2019.1647435DOI Listing
October 2019

Insomnia, sleep duration and academic performance: a national survey of Norwegian college and university students.

Sleep Med X 2019 Dec 28;1:100005. Epub 2019 Jun 28.

Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.

Objective: The aim of this study was to evaluate the associations between insomnia, sleep duration and self-reported academic performance/failure in a large sample of Norwegian college and university students.

Methods: This cross-sectional survey comprised 50,054 full-time students (69% women) aged 18-35 years (mean age 23.2, standard deviation (SD) = 3.3), with a response rate of 31%. Binary logistic regression analyses were conducted to examine the associations between the independent variables, an approximation of the insomnia disorder and sleep duration, and the dependent variables, failed examinations and delayed study progress.

Results: The results showed that insomnia was associated with a higher risk of failed examinations (adjusted for background variables, odds ratio (OR) = 1.31, 95% confidence interval (CI) 1.25-1.37,  < 0.001) and delayed study progress (OR = 1.32, 95% CI: 1.22-1.42,  < 0.001). A curvilinear relationship between sleep duration and risk of academic failure was demonstrated, where both sleeping less than 5 h, and 10 h or more, were associated with higher odds of failed study examinations, compared to with sleeping 7-9 h (OR = 1.46, 95% CI: 1.33-1.63,  < 0.001 and OR = 1.53, 95% CI: 1.33-1.75,  < 0.001, respectively). Insomnia and deviations from an optimal sleep duration may have notable consequences for academic success in higher education.
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http://dx.doi.org/10.1016/j.sleepx.2019.100005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041108PMC
December 2019

The associations between low-level gaming, high-level gaming and problematic alcohol use.

Addict Behav Rep 2019 Dec 6;10:100186. Epub 2019 May 6.

Department of Psychosocial Science, University of Bergen, PO Box 7807, 5020 Bergen, Norway.

The current study aimed to investigate associations between gaming and different patterns of problematic alcohol use, controlling for important demographics, personality and mental health covariates. Data was collected by an online survey during fall 2016 ( = 5217). Students who had participated in a survey among students in Bergen, Norway, one year earlier were invited to participate. Crude and adjusted binary logistic regression analyses were conducted in order to assess the relationship between different patterns of problematic alcohol use and gaming (i.e. low-level gaming and high-level gaming vs. no gaming) while controlling for important covariates. The different gaming groups were categorised based on the number of symptoms of "gaming addiction" (in total seven) that they endorsed: 4 > symptoms = low-level gaming, 4 ≤ symptoms = high-level gaming. Only 0.2% ( = 11) endorsed all seven symptoms. Low-level gaming was positively associated with patterns of problematic alcohol use in the crude analyses; these associations became non-significant when controlling for demographic variables. High-level gaming was inversely associated with patterns of problematic alcohol use when controlling for demographics, personality, and mental health covariates. The inverse relationship between high-level gaming and problematic alcohol use (when controlling for covariates) suggest that heavy investment in gaming may protect against excessive alcohol use and alcohol-related harm. Possible explanations discussed for the inverse associations include high-level gamers having less available time to drink, intoxication being incompatible with gaming, and/or high-level gamers experiencing sufficient satisfaction/escape and social bonding by gaming, hence having less need for alcohol.
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http://dx.doi.org/10.1016/j.abrep.2019.100186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527943PMC
December 2019

Working hour characteristics and schedules among nurses in three Nordic countries - a comparative study using payroll data.

BMC Nurs 2019 28;18:12. Epub 2019 Mar 28.

Finnish Institute of Occupation Health, FI-00251 Helsinki, Finland.

Background: Organisation of working hour schedules in the Northern European countries are rather similar. EU countries are obliged to adopt national legislation regarding duration of weekly working hours and rest periods. Yet, working hour characteristics and schedules are likely to differ with respect to starting times and duration depending e.g. on culture and tradition. Yet, very little is known about potential differences between shifts and schedules across countries among nursing personel. This knowledge is relevant, since the potential differences in working hour characteristics may influence and possibly explain some of the differences observed in studies of health and safety.The aim of the study was to compare characteristics of working hours and work schedules among nursing personel in three Nordic countries: Denmark, Finland and Norway.

Methods: The study populations included nursing personnel holding a ≥ 50% position at public hospitals in Denmark ( = 63,678), Finland ( = 18,257) or Norway ( = 1538) in 2013. Objective payroll based registry data with information on daily starting and ending times were used to compare working hour characteristics e.g. starting time, duration of shift, and quick returns (< 11 h between two shifts), as well as work schedules e.g. permanent or 3-shift work between the three countries.

Results: Night shifts generally started earlier and lasted longer in Finland (10-11 h starting at 20:00-22:59) than in Norway (10 h starting at 21:00-21:59) and in Denmark (8 h starting at 23:00-23:59). Very long shifts (≥12 h) were more common in Denmark (12%) compared to Finland (8%) and Norway (3%). More employees had many (> 13/year) quick returns in Norway (64%) and Finland (47%) compared to Denmark (16%). The frequency of 3-shift rotation workers was highest in Norway (41%) and lower in Denmark (22%) and Finland (22%). There were few differences across the countries in terms of early morning shifts and (very) long weekly working hours.

Conclusion: Despite similar distribution of operational hours among nurses in the three countries, there were differences in working hour characteristics and the use of different types of work schedules. The observed differences may affect health and safety.
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http://dx.doi.org/10.1186/s12912-019-0332-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438001PMC
March 2019

Short rest between shifts (quick returns) and night work is associated with work-related accidents.

Int Arch Occup Environ Health 2019 08 16;92(6):829-835. Epub 2019 Mar 16.

Department of Psychosocial Science, University of Bergen, Bergen, Norway.

Purpose: The aim of this study was to examine whether less than 11 h between shifts (i.e., quick returns, QRs) and night shifts is associated with self-reported work-related accidents, near accidents or dozing off at work in a sample of nurses.

Methods: The study was based on cross-sectional data from 1784 nurses (response rate = 60%; mean age = 40.1 years, SD = 8.4; 91% female). Negative binomial regression analyses were conducted to investigate the association between the shift exposures, and eight different self-reported work-related items on accidents, near accidents and dozing off at work, controlling for demographics and work factors.

Results: The number of QRs during a year was positively associated with seven of the eight items on work-related accidents, near-accidents and dozing off at work, and number of night shifts was positively associated with five items. Some of the key findings were that QRs were associated with nurses causing harm to themselves (incidence rate ratio [IRR] = 1.009; 95% CI = 1.005-1.013), causing harm to patients/others (IRR = 1.006; 95% CI = 1.002-1.010) and causing harm to equipment (IRR = 1.004; 95% CI = 1.001-1.007); while night shifts were associated with nurses involuntarily dozing off at work (IRR = 1.015; 95% CI = 1.013-1.018), dozing off while driving to/from work (IRR = 1.009; 95% CI = 1.006-1.011), and harming patients/others (IRR = 1.005; 95% CI = 1.001-1.009).

Conclusion: QRs and night shifts were both associated with the self-reported work-related accidents, near-accidents and dozing off at work. Studies that can establish the causal relationship between QRs and accidents are called for.
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http://dx.doi.org/10.1007/s00420-019-01421-8DOI Listing
August 2019

Long-Term Effects of an Unguided Online Cognitive Behavioral Therapy for Chronic Insomnia.

J Clin Sleep Med 2019 01 15;15(1):101-110. Epub 2019 Jan 15.

Norwegian University of Science and Technology, Department of Mental Health, Faculty of Medicine and Health Sciences, Trondheim, Norway.

Study Objectives: The aim of this study was to test the efficacy of fully automated Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) 18 months after the intervention period on sleep, daytime functioning, and beliefs about sleep for adults with chronic insomnia.

Methods: Participants in this study had participated in a randomized controlled trial comparing the efficacy of unguided Internet CBT-I with web-based patient education. Participants who had received Internet CBT-I (n = 95) completed online questionnaires and online sleep diaries 18 months after the intervention period. We used linear mixed models to study changes from baseline to postassessment and to 18-month follow-up, and a separate mixed-models analysis to study changes from postassessment to 18-month follow-up.

Results: Mean age of the participants was 45.5 years (standard deviation = 12.6) and 64% were females. Sixty-six participants (70%) completed the 18-month follow-up assessment. There were significant improvements from baseline to 18-month follow-up on the Insomnia Severity Index (ISI) (Cohen = 2.04 [95% confidence interval (CI) 1.66-2.42]) and the Bergen Insomnia Scale (BIS) ( = 1.64 [95% CI 1.30-1.98]), levels of daytime fatigue ( = 0.85 [95% CI 0.59-1.11]), psychological distress ( = 0.51 [95% CI 0.29-0.73]), and beliefs about sleep ( = 1.44 [95% CI 1.15-1.73]). Moderate to large effect size improvements were also shown on the diary-derived sleep variables. All improvements from baseline to postassessment were essentially maintained to 18-month follow-up.

Conclusions: Unguided Internet CBT-I appears to have sustained effects on sleep, daytime functioning, and beliefs about sleep up to 18 months after the intervention period.

Clinical Trial Registration: This study presents long-term follow-up data of a previous clinical trial. Registry: ClinicalTrials.gov, Title: Internet-based Treatment for Insomnia in Norway, Identifier: NCT02261272, URL: https://clinicaltrials.gov/ct2/show/NCT02261272.
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http://dx.doi.org/10.5664/jcsm.7580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329541PMC
January 2019

Patients with delayed sleep-wake phase disorder show poorer executive functions compared to good sleepers.

Sleep Med 2019 02 24;54:244-249. Epub 2018 Nov 24.

Department of Global Public Health and Primary Care, University of Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Norway.

Objective: Delayed Sleep-Wake Phase Disorder (DSWPD) is associated with negative outcomes, including reduced daytime performance and difficulties with treatment adherence. These outcomes are mediated by executive functions (EF). In this study, we investigated whether patients with DSWPD report inferior EF compared to a control group. The study consisted of 40 patients diagnosed with DSWPD (12 males, mean age 20.7 (±3.1)) and 20 healthy controls (six males, 21.3 (±2.2), p = 1.00) between 16 and 25 years (p = 0.42).

Methods: Behavior Rating Inventory of Executive Function-Adult version Self-Report (BRIEF-A) was used for adults ≥18 years (DSWPD n = 28; controls n = 17) whereas Behavior Rating Inventory of Executive Function Self-Report Version (BRIEF-SR) was used for assessment of EF in adolescents <18 years (DSWPD n = 12; controls n = 3). Independent samples t-tests were used to compare patients to controls.

Results: The total group of patients with DSWPD scored significantly poorer compared to the control group on the main indexes; Behavioral Regulation Index (BRI) (p = <0.0005), Metacognition Index (MI) (p = <0.0005), and Global Executive Composite (GEC) (p = <0.0005). The adult group with DSWPD scored significantly poorer than the adult control group on eleven of the twelve BRIEF-A scales. Among patients <18 years, the DSWPD-group scored significantly poorer than the control group on 8 of the 13 BRIEF-SR-scales.

Conclusion: Patients with DSWPD reported significantly poorer EF compared to controls. Assessment of EF in patients with DSWPD can be valuable for understanding the consequences of the disorder regarding treatment tailoring and adherence.
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http://dx.doi.org/10.1016/j.sleep.2018.10.035DOI Listing
February 2019

Sleep patterns and insomnia in young adults: A national survey of Norwegian university students.

J Sleep Res 2019 04 4;28(2):e12790. Epub 2018 Dec 4.

Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.

The aim of this study was to describe sleep patterns and rate of insomnia according to diagnostic criteria in college and university students, as well as to examine potential changes in sleep problems from 2010 to 2018. Data stemmed from a national student health survey from 2018 for higher education in Norway (the SHoT study), which invited all 162,512 fulltime students in Norway. A total of 50,054 students (69.1% women) aged 18-35 years were included, yielding a response rate of 30.8%. Sleep parameters, reported separately for weekdays and weekends, included calculations of bedtime, rise time, sleep duration, sleep-onset latency, wake after sleep onset, sleep need and sleep deficit. Insomnia was defined according to the Diagnostic and Statistical Manual of Mental Disorders (5th edn) criteria. For the trend analysis, we used one item measuring difficulties initiating and/or maintaining sleep, over three time points (2010, 2014 and 2018). The results from 2018 showed large weekday-weekend differences across most sleep parameters. Both male and female students obtained a mean sleep duration in the lower end of the normal range on weekdays (7:24 hr), but met their own sleep need and sleep recommendations at weekends (8:25 hr). The overall prevalence of insomnia was 34.2% in women and 22.2% in men. There was a substantial increase in sleep problems from 2010 (22.6%) to 2018 (30.5%), which was especially pronounced in women. We conclude that sleep problems are both prevalent and increasing among students. This warrants attention as a public health problem in this population.
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http://dx.doi.org/10.1111/jsr.12790DOI Listing
April 2019

Long working hours are inversely related to sick leave in the following 3 months: a 4-year registry study.

Int Arch Occup Environ Health 2019 May 7;92(4):457-466. Epub 2018 Nov 7.

Department of Psychosocial Science, University of Bergen, Christiesgt 12, 5015, Bergen, Norway.

Purpose: The aim of this study was to investigate the effects of long working hours (≥ 12 h shifts) on sick leave using objective records of shift work exposure and of sick leave.

Methods: A total of 1538 nurses (mean age 42.5, SD 12.0; response rate 42%) participated. Payroll and archival sick leave data over a 4-year period were retrieved from employers' records and aggregated over every third calendar month. A multilevel negative binomial model was used to investigate the effects of exposure to long working hours, on subsequent sick leave rates the following 3 months. Covariates included prior sick leave, number of shifts worked, night and evening shifts, personality, and demographic characteristics.

Results: Exposure to long working hours was associated with fewer sick leave days in the subsequent 3 months [adjusted model, incidence rate ratio (IRR) = 0.946, 95% CI 0.919-0.973, p < 0.001]. The interaction long working hours by a number of work days showed that sick leave days the subsequent 3 months was higher by long shifts when number of shifts was high compared to when number of shifts was low [adjusted model, IRR 1.002, 95% CI 1.000-1.004, p < 0.05].

Discussion: Long working hours was associated with fewer sick leave days. The restorative effects of extra days off with long working hours are discussed as possible explanations to this relationship.
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http://dx.doi.org/10.1007/s00420-018-1372-xDOI Listing
May 2019

Overcoming insomnia: protocol for a large-scale randomised controlled trial of online cognitive behaviour therapy for insomnia compared with online patient education about sleep.

BMJ Open 2018 08 30;8(8):e025152. Epub 2018 Aug 30.

Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.

Introduction: Insomnia is a major public health concern. While cognitive behaviour therapy for insomnia (CBT-I) is acknowledged as the best available intervention, there are unanswered questions about its wider dissemination, socioeconomic benefits and its impact on health resource utilisation. The aim of this randomised controlled trial (RCT) is to investigate the effectiveness of a fully automated online version of CBT-I compared with online patient education about sleep (PE). Outcome measures comprise changes in symptoms of insomnia, time off work due to sick leave as well as medication and health resource utilisation. Also, we will examine (i) putative mediators of the effects of CBT-I on insomnia severity and (ii) selected potential psycho-bio-social moderators of the effects of the interventions.

Methods And Analysis: A parallel-group RCT will be conducted in a target sample of about 1500 adults recruited across Norway. Participants will complete an online screening and consent process. Those who meet eligibility criteria will be randomised to receive direct access to fully automated online CBT-I or to an online PE programme. The primary outcome is change in insomnia severity immediately postintervention; secondary outcomes are change in daytime functioning and other sleep measures postintervention and at 6-month and 24-month follow-up. Objective data from national registries will be obtained at two time points (1 year and 2 years post-treatment), allowing a mirror image study of preintervention and postintervention rates of sick leave, and of medication and healthcare utilisation by condition.

Ethics And Dissemination: The study protocol was approved by the Regional Committee for Medical and Health Research Ethics in South East Norway (2015/134). Findings from the RCT will be disseminated in peer-reviewed publications and conference presentations. Exploratory analyses of potential mediators and moderators will be reported separately. User-friendly outputs will be disseminated to patient advocacy and other relevant organisations.

Trial Registration Number: NCT02558647; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2018-025152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119451PMC
August 2018

Internet-delivered cognitive-behavioral therapy for insomnia and comorbid symptoms.

Internet Interv 2018 Jun 21;12:11-15. Epub 2018 Feb 21.

Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.

Background: Cognitive-behavioral therapy for insomnia (CBTi) is considered the standard treatment. The internet has proven to be a useful and successful tool of providing CBTi. However, few studies have investigated the possible effect of unguided internet-delivered CBTi (ICBTi) on comorbid psychological symptoms and fatigue.

Methods: Based on a randomized controlled trial, we investigated whether unguided ICBTi had an effect on comorbid psychological symptoms. Adults with insomnia ( = 181; 67% women; mean age 44.9 years [SD 13.0]) were randomized to ICBTi ( = 95) or to an online patient education condition ( = 86) for a nine-week period.

Results: The results from mixed linear modelling yielded medium to large between-group effect sizes from pre- to post-treatment for symptoms of anxiety or depression ( = -0.57; 95% CI = 0.79-0.35) and fatigue ( = 0.92; 95% CI = 1.22-0.62). The ICBTi group was reassessed at a 6-month non-randomized follow-up, and the completing participants had on the average a significant increase (from the post-assessment) on symptoms of anxiety or depression, while the reduction in symptoms of fatigue (on post-assessment) was maintained. However, due to high dropout attrition and no control group data, caution should be made regarding the long-term effects. In conclusion, the present findings show that unguided ICBTi positively influence comorbid symptoms in the short-term, thereby emphasizing the clinical relevance of unguided ICBTi.

Trial Registration: ClinicalTrials.gov identifier: NCT02261272.
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http://dx.doi.org/10.1016/j.invent.2018.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096334PMC
June 2018

Recurrent cannabis use among Norwegian students: Prevalence, characteristics, and polysubstance use.

Nordisk Alkohol Nark 2017 Dec 21;34(6):497-510. Epub 2017 Nov 21.

University of Bergen, Norway.

Background: Research on cannabis has focused on lifetime use or regular/heavy use (i.e., daily or almost daily). Regular, albeit not necessarily daily, cannabis use has received less scientific attention.

Objectives: This study aims to identify demographic and personality factors associated with recurrent cannabis use (i.e., cannabis usage 5 to 50 times in the last six months) and to investigate the relationship between cannabis use and use of other substances.

Methods: Public and private university students ( = 11,236) in Bergen, Norway, participated in an online survey during autumn 2015. Binary logistic regression was run to identify individual characteristics related to recurrent cannabis use. Chi-square tests were conducted to investigate differences in substance use (alcohol, nicotine, and illicit drugs) between recurrent cannabis users and cannabis abstainers/low-frequency users.

Results: A total of 4.0% of the students reported recurrent cannabis use. Students born in North America, non-Christians (compared to non-religious students), and men were more likely to be recurrent users. Recurrent cannabis users scored higher on extroversion and intellect/imagination compared to abstainers/low-frequency users. Male and female recurrent cannabis users had somewhat different characteristics (e.g., agreeableness scores were negatively associated with recurrent use among females but not among males). Recurrent cannabis use was overall strongly associated with polysubstance use.

Conclusions: The prevalence of recurrent cannabis use among Norwegian students is low. Recurrent cannabis use seems more prevalent among individuals marked by extroversion and intellect/imagination, which supports the notion of cannabis use as a social activity for individuals identifying themselves as outgoing and unconventional. Cannabis use among students seems strongly associated with use of other substances, suggesting that cannabis should not be considered a replacement drug.
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http://dx.doi.org/10.1177/1455072517743427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450846PMC
December 2017

Disclosure and Exposure of Alcohol on Social Media and Later Alcohol Use: A Large-Scale Longitudinal Study.

Front Psychol 2017 1;8:1934. Epub 2017 Nov 1.

Department of Psychosocial Science, University of Bergen, Bergen, Norway.

This article aims to investigate whether alcohol-related disclosure and exposure on social media can predict later alcohol use, and to identify covariates in these relationships. Data were collected by online surveys (two waves) among students in Bergen, Norway. The first survey was administered in fall 2015. The follow-up took place during fall 2016. A total of 5,217 students participated in both waves. The surveys included questions about demographics, personality, alcohol use, alcohol-related cognitions (e.g., attitudes and norms), social media use, and disclosure and exposure of alcohol on social media. Bivariate comparisons were conducted to assess differences in alcohol use between the frequent (i.e., monthly or more often) disclosure and exposure groups and low-frequent disclosure and exposure groups. Crude and adjusted linear regressions were employed to investigate if disclosure and exposure of alcohol could predict later alcohol use, when controlling for a range of covariates. Compared to the low-frequent disclosure and exposure groups, participants which frequently disclosed or were frequently exposed to alcohol-related content had higher alcohol use at baseline and 1 year later ( < 0.001), when no covariates were controlled for. Frequent disclosure of content reflecting positive aspects of alcohol predicted stable or slightly increased alcohol use at Time 2 ( < 0.01), even when all covariates (i.e., demographics, personality, alcohol use, alcohol-related cognitions, and social media use) were controlled for. In conclusion, frequent disclosure and/or exposure to alcohol-related content predicted alcohol use over time. Alcohol disclosure/exposure on social media could for the most part not predict later alcohol use when baseline alcohol use was controlled for. High alcohol use and alcohol disclosure/exposure on social media appear to be strongly intertwined, which hampers identification of directionality between alcohol use and disclosure/exposure. Disclosing content reflecting positive aspects of alcohol was the only independent variable that could predict further alcohol use when other factors, like baseline alcohol use, were held constant. This finding suggests that disclosure of alcohol content reflecting positive aspects of alcohol might have a self-enhancing effect on the sharers' further alcohol consumption, or that disclosing such content could indicate lenient alcohol-related cognitions not detected by the current measurements.
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http://dx.doi.org/10.3389/fpsyg.2017.01934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672553PMC
November 2017

Who is watching user-generated alcohol posts on social media?

Addict Behav 2018 03 14;78:131-137. Epub 2017 Nov 14.

Department of Psychosocial Science, University of Bergen, Bergen, Norway.

Aim: To examine students' exposure to user-generated alcohol content on social media, and identify characteristics (i.e. demographics, personality traits, alcohol use, alcohol-related cognitions, and social media factors) associated with monthly or more frequent exposure.

Method: College/university students (N=11,236) in Bergen, Norway, completed a web-survey measuring exposure to alcohol on social media - both frequency and interpretations of alcohol content. The survey included questions regarding demographics, personality, alcohol-related cognitions, and general use of social media and alcohol. Binary logistic regressions were run to identify characteristics associated with monthly or more frequent exposure to alcohol-related posts on social media.

Results: A total of 96.7% had been exposed to alcohol-related posts, exposure to posts with a positive valence of alcohol were more frequently reported than exposure to content with a negative valence of alcohol. Reports of monthly or more frequent exposure to alcohol on social media were associated with a range of characteristics, among these younger age, being native Norwegian, lower extroversion and higher agreeableness and self-monitoring scores, higher alcohol use, stronger descriptive norms for alcohol use among online-friends, and more frequent logins to social media.

Conclusions: Students' potential inflated alcohol norms (originating from social media) should be addressed. The results suggest that exposure may be determined by high alcohol use and membership in demographical groups associated with high alcohol use, an increased attentiveness towards others' behavior, and excessive social media use. Future studies investigating the relationship between alcohol exposure on social media and later alcohol use should control for such factors.
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http://dx.doi.org/10.1016/j.addbeh.2017.11.023DOI Listing
March 2018

Alcohol use among Norwegian students: Demographics, personality and psychological health correlates of drinking patterns.

Nordisk Alkohol Nark 2017 Oct 26;34(5):415-429. Epub 2017 Jun 26.

University of Bergen, Norway.

Aims: This study investigates demographic, personality, and psychological health correlates of different drinking patterns.

Design: Students at the four largest institutions of higher education in Bergen municipality were invited via email to complete an internet-based questionnaire. The final sample size was 11,236 (39.4%), mean age 24.9 years ( = 6.5), and 63.3% were women. The survey included the Alcohol Use Disorder Identification Test (AUDIT) and questions about demographics, personality traits, and symptoms of depression and anxiety. Binary logistic regressions were used to identify correlates of different drinking patterns.

Results: A total of 53.0% of the students had an AUDIT score of or above 8 (i.e., hazardous drinking). Being native Norwegian, male, single, without children, non-religious, extroverted, unconscientious, and less open to experience were associated with higher AUDIT scores, drinking frequently, and binge drinking. Having parents with high alcohol or drug use increased the odds of engaging in binge drinking, but this factor was not associated with frequent drinking. Students scoring higher on neuroticism and openness were less likely to report problematic alcohol usage.

Conclusions: A majority of the students reported alcohol habits that are associated with harm if they persist. This emphasises the need to examine the long-term consequences of students' alcohol use.
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http://dx.doi.org/10.1177/1455072517709918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450855PMC
October 2017

Sleep difficulties and academic performance in Norwegian higher education students.

Br J Educ Psychol 2017 Dec 31;87(4):722-737. Epub 2017 Aug 31.

Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.

Background: Sleep difficulties are common among university students and may detrimentally affect academic outcomes. Despite this, remarkably little information is currently available during this critical developmental period of early adulthood, and thus, the direct effect on measurable domains of academic ability and proficiency is equivocal.

Aims: To evaluate the associations between difficulties initiating and maintaining sleep (DIMS) and subjective and objective academic performance in a large sample of university students.

Sample: A total of 12,915 students who participated in large student survey in Norway from 24 February 2014 to 27 March 2014. DIMS was assessed by the Hopkins Symptoms Checklist (HSCL-25), and academic outcomes included failed examinations, delayed study progress, and school-related self-efficacy (General Self-Efficacy Scale).

Results: Difficulties initiating and maintaining sleep was independently associated with increased odds for poor school performance for all academic outcomes. Reporting 'extreme' DIMS was associated with increased odds of reporting delayed study progress (adjusted odds ratio [OR] = 1.25, 95% CI 1.01-1.57, p < .05), increased odds for having failed several examinations (adjusted OR = 1.91, 95% CI 1.56-2.34, p < .001), and being in the lowest self-efficacy quartile (adjusted OR = 4.94, 95% CI: 4.04-6.03, p < .001).

Conclusions: Self-reported sleep difficulties are associated with poorer objective markers of academic outcomes as well as poorer self-rated academic proficiency among higher education students. Amelioration of sleep difficulties may improve overall academic performance and health outcomes in affected students.
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http://dx.doi.org/10.1111/bjep.12180DOI Listing
December 2017