Publications by authors named "Helga Ask"

24 Publications

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Genetic Liability for Schizophrenia and Childhood Psychopathology in the General Population.

Schizophr Bull 2021 Feb 9. Epub 2021 Feb 9.

Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.

Genetic liability for schizophrenia is associated with psychopathology in early life. It is not clear if these associations are time dependent during childhood, nor if they are specific across different forms of psychopathology. Using genotype and questionnaire data on children (N = 15 105) from the Norwegian Mother, Father and Child Cohort Study, we used schizophrenia polygenic risk scores to test developmental stability in associations with measures of emotional and behavioral problems between 18 months and 5 years, and domain specificity in associations with symptoms of depression, anxiety, conduct problems, oppositionality, inattention, and hyperactivity at 8 years. We then sought to identify symptom profiles-across development and domains-associated with schizophrenia polygenic liability. We found evidence for developmental stability in associations between schizophrenia polygenic risk scores and emotional and behavioral problems, with the latter being mediated specifically via the rate of change in symptoms (β slope = 0.032; 95% CI: 0.007-0.057). At age 8, associations were better explained by a model of symptom-specific polygenic effects rather than effects mediated via a general psychopathology factor or by domain-specific factors. Overall, individuals with higher schizophrenia polygenic risk scores were more likely (OR = 1.310 [95% CIs: 1.122-1.528]) to have a profile of increasing behavioral and emotional symptoms in early childhood, followed by elevated symptoms of conduct disorder, oppositionality, hyperactivity, and inattention by age 8. Schizophrenia-associated alleles are linked to specific patterns of early-life psychopathology. The associations are small, but findings of this nature can help us better understand the developmental emergence of schizophrenia.
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http://dx.doi.org/10.1093/schbul/sbaa193DOI Listing
February 2021

Genetic contributions to anxiety disorders: where we are and where we are heading.

Psychol Med 2021 Feb 9:1-16. Epub 2021 Feb 9.

Department of Psychology, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany.

Anxiety disorders are among the most common psychiatric disorders worldwide. They often onset early in life, with symptoms and consequences that can persist for decades. This makes anxiety disorders some of the most debilitating and costly disorders of our time. Although much is known about the synaptic and circuit mechanisms of fear and anxiety, research on the underlying genetics has lagged behind that of other psychiatric disorders. However, alongside the formation of the Psychiatric Genomic Consortium Anxiety workgroup, progress is rapidly advancing, offering opportunities for future research.Here we review current knowledge about the genetics of anxiety across the lifespan from genetically informative designs (i.e. twin studies and molecular genetics). We include studies of specific anxiety disorders (e.g. panic disorder, generalised anxiety disorder) as well as those using dimensional measures of trait anxiety. We particularly address findings from large-scale genome-wide association studies and show how such discoveries may provide opportunities for translation into improved or new therapeutics for affected individuals. Finally, we describe how discoveries in anxiety genetics open the door to numerous new research possibilities, such as the investigation of specific gene-environment interactions and the disentangling of causal associations with related traits and disorders.We discuss how the field of anxiety genetics is expected to move forward. In addition to the obvious need for larger sample sizes in genome-wide studies, we highlight the need for studies among young people, focusing on specific underlying dimensional traits or components of anxiety.
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http://dx.doi.org/10.1017/S0033291720005486DOI Listing
February 2021

Genetic Associations Between Childhood Psychopathology and Adult Depression and Associated Traits in 42 998 Individuals: A Meta-analysis.

JAMA Psychiatry 2020 07;77(7):715-728

University of Bristol School of Psychological Science, Bristol, United Kingdom.

Importance: Adult mood disorders are often preceded by behavioral and emotional problems in childhood. It is yet unclear what explains the associations between childhood psychopathology and adult traits.

Objective: To investigate whether genetic risk for adult mood disorders and associated traits is associated with childhood disorders.

Design, Setting, And Participants: This meta-analysis examined data from 7 ongoing longitudinal birth and childhood cohorts from the UK, the Netherlands, Sweden, Norway, and Finland. Starting points of data collection ranged from July 1985 to April 2002. Participants were repeatedly assessed for childhood psychopathology from ages 6 to 17 years. Data analysis occurred from September 2017 to May 2019.

Exposures: Individual polygenic scores (PGS) were constructed in children based on genome-wide association studies of adult major depression, bipolar disorder, subjective well-being, neuroticism, insomnia, educational attainment, and body mass index (BMI).

Main Outcomes And Measures: Regression meta-analyses were used to test associations between PGS and attention-deficit/hyperactivity disorder (ADHD) symptoms and internalizing and social problems measured repeatedly across childhood and adolescence and whether these associations depended on childhood phenotype, age, and rater.

Results: The sample included 42 998 participants aged 6 to 17 years. Male participants varied from 43.0% (1040 of 2417 participants) to 53.1% (2434 of 4583 participants) by age and across all cohorts. The PGS of adult major depression, neuroticism, BMI, and insomnia were positively associated with childhood psychopathology (β estimate range, 0.023-0.042 [95% CI, 0.017-0.049]), while associations with PGS of subjective well-being and educational attainment were negative (β, -0.026 to -0.046 [95% CI, -0.020 to -0.057]). There was no moderation of age, type of childhood phenotype, or rater with the associations. The exceptions were stronger associations between educational attainment PGS and ADHD compared with internalizing problems (Δβ, 0.0561 [Δ95% CI, 0.0318-0.0804]; ΔSE, 0.0124) and social problems (Δβ, 0.0528 [Δ95% CI, 0.0282-0.0775]; ΔSE, 0.0126), and between BMI PGS and ADHD and social problems (Δβ, -0.0001 [Δ95% CI, -0.0102 to 0.0100]; ΔSE, 0.0052), compared with internalizing problems (Δβ, -0.0310 [Δ95% CI, -0.0456 to -0.0164]; ΔSE, 0.0074). Furthermore, the association between educational attainment PGS and ADHD increased with age (Δβ, -0.0032 [Δ 95% CI, -0.0048 to -0.0017]; ΔSE, 0.0008).

Conclusions And Relevance: Results from this study suggest the existence of a set of genetic factors influencing a range of traits across the life span with stable associations present throughout childhood. Knowledge of underlying mechanisms may affect treatment and long-term outcomes of individuals with psychopathology.
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http://dx.doi.org/10.1001/jamapsychiatry.2020.0527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160753PMC
July 2020

Marriage and cohabiting rates among people with childhood sensorineural hearing loss in a large Norwegian cohort: results from the SHINT and the HUNT study.

Int J Audiol 2020 09 24;59(9):661-665. Epub 2020 Feb 24.

Department of Chronic Diseases and Ageing, Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.

To investigate the association between childhood sensorineural hearing loss (SNHL) and cohabiting/marriage rates in a large Norwegian cohort. This study is based on data from the School Hearing Investigation in Nord-Trøndelag (SHINT), data from the Nord-Trøndelag Health Study (HUNT), and registry data on marital status from Statistics Norway. Marital status is measured yearly from 1975-2015 (marriage) and 1987-2014 (cohabitation). The association between SNHL and marital status was tested using multinomial logistic regression models estimating odds ratios (OR) and 95% confidence intervals (CI), adjusting for age, sex, and education. The total sample comprised 50,022 participants born between 1940 and 1980. SNHL in SHINT of 41 dB or more was defined as moderate-profound ( 216), 26-40 dB as mild ( 294) and 16-25 dB as slight ( 246). There was a significant association between any SNHL and cohabitation (OR = .56, 95% CI = 0.43-0.72) and marriage (OR = .50, 95% CI = 0.40-0.62), between mild SNHL and cohabitation (OR = .58, 95% CI = 0.40-0.86) and marriage (OR = .40, 95% CI = 0.29-0.56), and between moderate-profound SNHL and cohabitation (OR = .43, 95% CI = 0.26-0.71) and marriage (OR = .45, 95% CI = 0.31-0.66). Childhood SNHL reduces the likelihood of cohabitation and marriage.
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http://dx.doi.org/10.1080/14992027.2020.1730009DOI Listing
September 2020

Mechanisms linking parental educational attainment with child ADHD, depression, and academic problems: a study of extended families in The Norwegian Mother, Father and Child Cohort Study.

J Child Psychol Psychiatry 2020 09 19;61(9):1009-1018. Epub 2020 Jan 19.

Norwegian Institute of Public Health, Oslo, Norway.

Background: Low educational attainment in parents is associated with child psychopathology. It is not clear whether the associations are due to risk factors that family members share or due to effects of maternal or paternal education on the offspring. We investigate whether associations between maternal and paternal educational attainment and child symptoms of attention deficit/hyperactivity disorder (ADHD), depression, and academic problems are due to shared genetic factors, shared family environmental factors, or effects of the parental phenotype educational attainment itself.

Methods: This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The sample comprised 34,958 children (17,128 girls) in 28,372 extended-family units. We used data from related nuclear families linked by siblings in the parent generation. We applied a quasi-experimental extended children-of-twins design that included siblings in both generations and took account of nonrandom mating by including partners. Educational attainment was self-reported by mothers and fathers. Mothers reported children's symptoms of ADHD, symptoms of depression, and academic problems by questionnaire when the children were 8 years old.

Results: Children of lowly educated parents scored higher on all outcomes and had an approximate doubling of the risk of high symptom levels. The association between maternal and paternal educational attainment and child symptoms of ADHD and academic problems persisted after controlling for shared genetic and family environmental factors. Phenotypic transmission to depression was weaker and in the best fitting model fully explained by genetic factors shared by the two generations.

Conclusions: Associations between educational attainment of mothers and fathers and child symptoms of ADHD and academic problems could not be ascribed to shared familial risk factors, whereas associations with symptoms of depression could. Parental education or resources and behaviors resulting from low education might be targets of interventions aimed at reducing symptoms of ADHD and academic problems.
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http://dx.doi.org/10.1111/jcpp.13197DOI Listing
September 2020

Incidence of diagnosed pediatric anxiety disorders and use of prescription drugs: a nation-wide registry study.

Eur Child Adolesc Psychiatry 2020 Aug 22;29(8):1063-1073. Epub 2019 Oct 22.

Norwegian Institute of Public Health, P.O. Box 222, Skøyen, 0213, Oslo, Norway.

The aim of this study was to calculate time trends in incidence of diagnosed anxiety disorders, including obsessive-compulsive disorder, and post-traumatic stress disorder, and to examine changes in use of prescribed drugs in the Norwegian pediatric population. Furthermore, we aimed to investigate whether comorbid mental disorders are associated with the use of prescribed drugs. Nation-wide registries with data from 2008 to 2015 were used, covering diagnostic data from primary health care [the Norwegian database for the control and reimbursement of health expenses (KUHR)] and secondary health care [the Norwegian Patient registry (NPR)], and data on prescribed drugs [the Norwegian prescription database, (NorPD)]. Data from the two latter were linked. During the period 2010-2015, 19,154 children and adolescents (61% girls) received a first diagnosis of anxiety disorders in primary care. The corresponding number from secondary care was 17,115 (61% girls). The incidence of diagnosed anxiety disorders increased over time, especially in girls, with an overall raise of ~ 2 per 1000 children across 2010-2015. Anti-anxiety drugs were used by < 12% of diagnosed children and < 25% of diagnosed adolescents, mainly by those with several contacts with the specialist health care system. There was no strong indications of an increase over time. Of other drugs, the most frequently prescribed were hypnotics and psychostimulants. Psychiatric comorbidity (33-55%) contributed to the use of drugs, including anti-anxiety drugs. The incidence of diagnosed anxiety disorders increased from 2010 to 2015, but the percentage using anti-anxiety drugs was stable. Drug use appears to be in line with the Norwegian guidelines.
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http://dx.doi.org/10.1007/s00787-019-01419-0DOI Listing
August 2020

Change in physical activity is not associated with change in mental distress among adolescents: the Tromsø study: Fit Futures.

BMC Public Health 2019 Jul 9;19(1):916. Epub 2019 Jul 9.

Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway.

Background: Previous research shows that physical activity has a protective effect on mental distress in adults, but the relationship is less researched and seems more ambiguous for adolescents. Studies in this field have typically been cross-sectional by design and based on self-reported physical activity measures, which are known to be vulnerable to response bias. The aim of this study was to investigate the relationship between change in objectively assessed physical activity as measured by accelerometer and change in mental distress among adolescents using longitudinal data from The Tromsø Study: Fit Futures.

Method: This study was based on data from 676 upper-secondary school students (mean age 16.23 years at baseline, 45.26% boys) from The Tromsø Study: Fit Futures. Physical activity, mental distress and covariates were measured at baseline (T1) and follow-up (T2) 2 years later. Physical activity was objectively measured with an ActiGraph GT3X accelerometer over 7 days. Mental distress was measured with the Hopkins Symptom Checklist-10 (HSCL-10). Change score variables were computed as the difference between T1 and T2 in number of steps, number of minutes of moderate to vigorous physical activity (MVPA) and mental distress between T1 and T2, and analyzed using linear regression analysis.

Results: Changes in steps per day were not associated with changes in mental distress in neither the crude, partially, nor fully adjusted model. Neither was changes in minutes of MVPA per day. Interaction effects between change in both steps per day and minutes of MVPA and gender were also not statistically significant, nor was the interaction effects between baseline levels of mental distress and physical activity.

Conclusion: The results of our study indicate that for adolescents in the sample, change in physical activity is unrelated to change in mental distress over a two-year period.
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http://dx.doi.org/10.1186/s12889-019-7271-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617649PMC
July 2019

Maternal fever during pregnancy and offspring attention deficit hyperactivity disorder.

Sci Rep 2019 07 2;9(1):9519. Epub 2019 Jul 2.

Norwegian Institute of Public Health, Oslo, Norway.

Maternal fever during pregnancy is associated with several adverse child outcomes. We investigated associations between maternal fever and ADHD among offspring, as well as the sub-dimensions of ADHD - inattention and hyperactivity/impulsivity. Data came from the Norwegian Mother and Child Cohort Study, including more than 114,000 children. Information about children's ADHD diagnoses was obtained from the Norwegian Patient Register. Mothers reported on inattention and hyperactivity/impulsivity symptoms in questionnaires at 8 years. Logistic regression analysis showed that children exposed to maternal fever in the first trimester received an ADHD diagnosis more often than unexposed children (Odds Ratio (OR) = 1.31, 95% confidence interval (CI) = 1.06-1.61). For children exposed twice or more in the first trimester, the OR was 2.64 (CI = 1.36-5.14). Linear regression analysis showed elevated inattention symptoms among children exposed to fever in the first (Cohen's d = 0.09, CI = 0.03-0.15) and second (Cohen's d = 0.05, CI = 0.01-0.09) trimester. Results were similar whether the mother had taken acetaminophen for their fever or not. Hyperactivity/impulsivity symptoms were not related to maternal fever. The results indicate that maternal fever in early pregnancy may be a risk factor for ADHD, and particularly for inattention problems. This risk is neither mitigated nor inflated by use of acetaminophen.
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http://dx.doi.org/10.1038/s41598-019-45920-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606630PMC
July 2019

Association of Gestational Age at Birth With Symptoms of Attention-Deficit/Hyperactivity Disorder in Children.

JAMA Pediatr 2018 08;172(8):749-756

Norwegian Institute of Public Health, Oslo, Norway.

Importance: Preterm birth is associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD); however, it is unclear to what extent this association can be explained by shared genetic and environmental risk factors and whether gestational age at birth is similarly related to inattention and hyperactivity/impulsivity and to the same extent in boys and girls.

Objectives: To investigate the association between gestational age at birth and symptoms of ADHD in preschool and school-age children after adjusting for unmeasured genetic and environmental risk factors.

Design, Setting, And Participants: In this prospective, population-based cohort study, pregnant women were recruited from across Norway from January 1, 1999, through December 31, 2008. Results of a conventional cohort design were compared with results from a sibling-comparison design (adjusting for genetic and environmental factors shared within families) using data from the Norwegian Mother and Child Cohort Study. Data analysis was performed from October 1, 2017, through March 16, 2018.

Exposures: Analyses compared children and siblings discordant for gestational age group: early preterm (delivery at gestational weeks 22-33), late preterm (delivery at gestational weeks 34-36), early term (delivery at gestational weeks 37-38), delivery at gestational week 39, reference group (delivery at gestational week 40), delivery at gestational week 41, and late term (delivery after gestational week 41).

Main Outcomes And Measures: Maternally reported symptoms of ADHD in children at 5 years of age and symptoms of inattention and hyperactivity/impulsivity at 8 years of age. Covariates included child and pregnancy characteristics associated with the week of delivery and the outcomes.

Results: A total of 113 227 children (55 187 [48.7%] female; 31 708 [28.0%] born at gestational week 40), including 33 081 siblings (16 014 female [48.4%]; 9705 [29.3%] born at gestational week 40), were included in the study. Children born early preterm were rated with more symptoms of ADHD, inattention, and hyperactivity/impulsivity than term-born children. After adjusting for unmeasured genetic and environmental factors, children born early preterm had a mean score that was 0.24 SD (95% CI, 0.14-0.34) higher on ADHD symptom tests, 0.33 SD (95% CI, 0.24-0.42) higher on inattention tests, and 0.23 SD (95% CI, 0.14-0.32) higher on hyperactivity/impulsivity tests compared with children born at gestational week 40. Sex moderated the association of gestational age with preschool ADHD symptoms, and the association appeared to be strongest among girls. Early preterm girls scored a mean of 0.8 SD (95% CI, 0.12-1.46; P = .02) higher compared with their term-born sisters.

Conclusions And Relevance: After accounting for unmeasured genetic and environmental factors, early preterm birth was associated with a higher level of ADHD symptoms in preschool children. Early premature birth was associated with inattentive but not hyperactive symptoms in 8-year-old children. This study demonstrates the importance of differentiating between inattention and hyperactivity/impulsivity and stratifying on sex in the study of childhood ADHD.
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http://dx.doi.org/10.1001/jamapediatrics.2018.1315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142916PMC
August 2018

Effects of Sample Handling and Analytical Procedures on Thyroid Hormone Concentrations in Pregnant Women's Plasma.

Epidemiology 2017 05;28(3):365-369

From the aNorwegian Institute of Public Health, Mental and Physical Health, Oslo, Norway; bDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; cNational Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC; dBiology Department, University of Massachusetts-Amherst, Amherst, MA; and eDivision of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

Background: Maternal thyroid function is a critical mediator of fetal brain development. Pregnancy-related physiologic changes and handling conditions of blood samples may influence thyroid hormone biomarkers. We investigated the reliability of thyroid hormone biomarkers in plasma of pregnant women under various handling conditions.

Methods: We enrolled 17 pregnant women; collected serum and plasma were immediately frozen. Additional plasma aliquots were subjected to different handling conditions before the analysis of thyroid biomarkers: storage at room temperature for 24 or 48 hours before freezing and an extra freeze-thaw cycle. We estimated free thyroid hormone indices in plasma based on T3 uptake.

Results: High correlations between plasma and serum (>0.94) and intraclass correlation coefficients for plasma handling conditions (0.96 to 1.00) indicated excellent reliability for all thyroid hormone biomarkers.

Conclusion: Delayed freezing and freeze-thaw cycles did not affect reliability of biomarkers of thyroid function in plasma during pregnancy. See video abstract at, http://links.lww.com/EDE/B180.
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http://dx.doi.org/10.1097/EDE.0000000000000606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378640PMC
May 2017

Sex differences in genetic and environmental contributions to alcohol consumption from early adolescence to young adulthood.

Addiction 2016 07 27;111(7):1188-95. Epub 2016 Feb 27.

Department of Psychology, University of Oslo, Oslo, Norway.

Aims: To estimate genetic and environmental contributions to alcohol consumption from early adolescence to young adulthood, and test whether gender moderates these effects.

Design: Longitudinal twin cohort design.

Setting: Population-based sample from Norway.

Participants: A total of 2862 male and female twins, aged 14-22 years, were assessed at one (n = 881), two (n = 898) or three (n = 1083) occasions. The percentage of females was between 56 and 63 in the different age groups (in the different waves).

Measurements: Alcohol consumption was measured by two questionnaire items about frequency of alcohol use and frequency of being drunk.

Findings: Additive genetic effects showed low to moderate contributions [proportion estimate, 95% confidence interval (CI) = range from 0.03 (0.00-0.14) to 0.49 (0.37-0.59) in males and from 0.09 (0.00-0.57) to 0.41 (0.24-0.58) in females] from adolescence to young adulthood, while environmental influences shared by twin pairs and contributing to twin similarity were moderate to highly influential during this developmental period [proportion estimate, 95% CI = range from 0.04 (0.00-0.13) to 0.45 (0.26-0.60) in males for shared environment in common with females, from 0.25 (0.09-0.42) to 0.54 (0.06-0.78) for shared environment specific to males and from 0.36 (0.20-0.52) to 0.51 (0.37-0.71) in females]. There was evidence of qualitative sex differences with shared environmental influences being largely sex-specific from middle adolescence onwards.

Conclusions: Alcohol consumption from early adolescence to young adulthood appears to be influenced to a small to moderate degree by genetic factors and to a moderate to high degree by shared environmental factors (e.g. rearing influences, shared friends). The shared environmental factors influencing alcohol consumption appear to be largely gender-specific.
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http://dx.doi.org/10.1111/add.13321DOI Listing
July 2016

Associations between parental hearing impairment and children's mental health: Results from the Nord-Trøndelag Health Study.

Soc Sci Med 2015 Dec 10;147:252-60. Epub 2015 Nov 10.

Norwegian Institute of Public Health, Division of Mental Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Department of Psychology, University of Oslo, PO Box 1094, Blindern, N-0317 Oslo, Norway.

Background: Some previous studies indicate that parental hearing loss may have negative consequences in the parent-child relationship. However, most of these studies are qualitative or have apparent methodological shortcomings.

Objective: This study is the first of its kind conducted in a large population-based sample with audiometrically measured hearing loss aimed at investigating the extent to which parental hearing loss affects adolescents' mental health.

Methods: Questionnaires were administered to the adult (>19 years) and adolescent (age 13-19 years) population of Nord-Trøndelag county, Norway (1995-97), which collected information on mental and somatic health, including hearing loss. For adults participating in the study, pure tone audiometry tests were also administered. In total, 4047 fathers and 4785 mothers with self-reported hearing loss data were identified. The corresponding numbers with measured hearing loss data included 4079 fathers and 4861 mothers. The associations between the degrees of self-reported or measured parental hearing loss and the mental health of their adolescent, measured by Hopkins Symptom Check List (SCL) 5, were estimated using generalized estimating equations. After adjusting for several covariates, the mental health symptoms of adolescents were compared by parental hearing loss (i.e., with versus without hearing loss).

Results: Adolescents whose mothers had severe measured or self-reported hearing loss had significantly worse mental health than their counterparts whose mothers did not have a hearing loss. No corresponding effects were found in the adolescents whose mothers had only a slight/moderate hearing loss, neither measured nor self-reported. Paternal slight/moderate self-reported hearing loss was associated with a small significant reduction of mental health in the adolescents, although attenuated when adjusting for paternal distress. No significant effects were detected in the adolescents whose fathers had measured hearing loss.

Conclusion: Severe maternal hearing loss is associated with significantly increased adolescent distress.
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http://dx.doi.org/10.1016/j.socscimed.2015.11.011DOI Listing
December 2015

Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway.

Eur J Epidemiol 2015 Sep 13;30(9):1049-56. Epub 2015 May 13.

Division of Mental Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Nydalen, Oslo, Norway.

The relationship between alcohol consumption and dementia risk is unclear. This investigation estimates the association between alcohol consumption reported in a population-based study in the mid-1980s and the risk for dementia up to 27 years later. The entire adult population in one Norwegian county was invited to the Nord-Trøndelag Health Study during 1984-1986 (HUNT1): 88 % participated. The sample used in this study includes HUNT1 participants born between 1905 and 1946 who completed the questionnaire assessing alcohol consumption. A total of 40,435 individuals, of whom 1084 have developed dementia, are included in the analysis adjusted for age, sex, years of education, hypertension, obesity, smoking, and symptoms of depression. When adjusting for age and sex, and compared to reporting consumption of alcohol 1-4 times during the last 14 days (drinking infrequently), both abstaining from alcohol and reporting consumption of alcohol five or more times (drinking frequently) were statistically significantly associated with increased dementia risk with hazard ratios of 1.30 (95 % CI 1.05-1.61) and 1.45 (1.11-1.90), respectively. In the fully adjusted analysis, drinking alcohol frequently was still significantly associated with increased dementia risk with a hazard ratio of 1.40 (1.07-1.84). However, the association between dementia and abstaining from alcohol was no longer significant (1.15, 0.92-1.43). Equivalent results for Alzheimer's disease and vascular dementia indicated the same patterns of associations. When adjusting for other factors associated with dementia, frequent alcohol drinking, but not abstaining from alcohol, is associated with increased dementia risk compared to drinking alcohol infrequently.
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http://dx.doi.org/10.1007/s10654-015-0029-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584101PMC
September 2015

Common Etiological Sources of Anxiety, Depression, and Somatic Complaints in Adolescents: A Multiple Rater twin Study.

J Abnorm Child Psychol 2016 Jan;44(1):101-14

Centre for Child and Adolescent Mental Health, RBUP Eastern and Southern Norway, Nydalen, P.O box 4623, 0405, Oslo, Norway.

Somatic complaints in children and adolescents may be considered part of a broader spectrum of internalizing disorders that include anxiety and depression. Previous research on the topic has focused mainly on the relationship between anxiety and depression without investigating how common somatic symptoms relate to an underlying factor and its etiology. Based on the classical twin design with monozygotic and dizygotic twins reared together, our study aimed to explore the extent to which the covariation between three phenotypes in adolescent girls and boys can be represented by a latent internalizing factor, with a focus on both common and specific etiological sources. A population-based sample of twins aged 12-18 years and their mothers and fathers (N = 1394 families) responded to questionnaire items measuring the three phenotypes. Informants' ratings were collapsed using full information maximum likelihood estimated factor scores. Multivariate genetic analyses were conducted to examine the etiological structure of concurrent symptoms. The best fitting model was an ACE common pathway model without sex limitation and with one substantially heritable (44%) latent factor shared by the phenotypes. Concurrent symptoms also resulted from shared (25%) and non-shared (31%) environments. The factor loaded most on depression symptoms and least on somatic complaints. Trait-specific influences explained 44% of depression variance, 59% of anxiety variance, and 65% of somatic variance. Our results suggest the presence of a general internalizing factor along which somatic complaints and mental distress can be modeled. However, specific influences make the symptom types distinguishable.
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http://dx.doi.org/10.1007/s10802-015-9977-yDOI Listing
January 2016

Genetic and environmental influences on adolescents' smoking involvement: a multi-informant twin study.

Behav Genet 2015 Mar 21;45(2):171-80. Epub 2015 Jan 21.

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway,

Studying monozygotic and dizygotic adolescent twin pairs of both sexes reared together, the present study examined the extent to which the variance in smoking involvement is attributable to genetic and environmental effects, and to what extent there are sex differences in the etiology. Questionnaire data on how often the adolescent had ever smoked tobacco was collected from a population-based twin sample consisting of seven national birth cohorts (ages 12-18), their mothers, and their fathers (N = 1,394 families). The data was analyzed with multivariate genetic modeling, using a multi-informant design. The etiological structure of smoking involvement was best represented in an ACE common pathway model, with smoking defined as a latent factor loading onto all three informants' reports. Estimates could be set equal across sexes. Results showed that adolescent lifetime smoking involvement was moderately heritable (37 %). The largest influence was from the shared environment (56 %), while environmental effects unique to each twin had minimal influence (7 %).
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http://dx.doi.org/10.1007/s10519-015-9706-xDOI Listing
March 2015

Mental health and wellbeing in spouses of persons with dementia: the Nord-Trøndelag Health Study.

BMC Public Health 2014 May 1;14:413. Epub 2014 May 1.

Division of Mental Health, Norwegian Institute of Public Health, P,O, Box 4404, Nydalen N-0403 Oslo, Norway.

Background: Caring for a spouse diagnosed with dementia can be a stressful situation and can put the caregiving partner at risk of loss of mental health and wellbeing. The main aim of this study was to investigate the relationship between dementia and spousal mental health in a population-based sample of married couples older than 55 years of age. The association was investigated for individuals living together with their demented partner, as well as for individuals whose demented partner was living in an institution.

Methods: Data on dementia were collected from hospitals and nursing homes in the county of Nord-Trøndelag, Norway. These data were combined with data on spousal mental health, which were collected in a population-based health screening: the Nord-Trøndelag Health Study (HUNT). Of 6,951 participating couples (>55 years), 131 included one partner that had been diagnosed with dementia.

Results: Our results indicate that after adjustment for covariates, having a partner with dementia is associated with lower levels of life satisfaction and more symptoms of anxiety and depression than reported by spouses of elderly individuals without dementia. Spouses living together with a partner diagnosed with dementia experienced moderately lower levels of life satisfaction (0.35 standard deviation [SD]) and more symptoms of depression (0.38 SD) and anxiety (0.23 SD) than did their non-caregiving counterparts. Having a partner with dementia that resided in a nursing home was associated with clearly lower life satisfaction. Compared with non-caregivers, these spouses reported lower levels of life satisfaction (1.16 SD), and also more symptoms of depression (0.38 SD), and more symptoms of anxiety (0.42 SD).

Conclusions: Having a partner with dementia is associated with loss of mental health and reduced life satisfaction. The risk of adverse mental health outcomes is greatest after the partner's nursing home admission.
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http://dx.doi.org/10.1186/1471-2458-14-413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041138PMC
May 2014

Genetic and environmental causes of variation in adolescent anxiety symptoms: a multiple-rater twin study.

J Anxiety Disord 2014 May 15;28(4):363-71. Epub 2014 Apr 15.

Department of Psychology, Faculty of Social Sciences, University of Oslo, P.O. Box 1094, Blindern, 0317 Oslo, Norway.

Heritability estimates for adolescent anxiety vary across studies, partly depending on who is rating the symptoms. The goal of our study was to estimate genetic and environmental influences using a multi-informant design with responses from a population-based sample of adolescent twins, their mothers and their fathers (N=1394 families). Results from multivariate biometrical modeling indicated quantitative, but no qualitative sex differences in etiology. The best fitting model was an AE Common Pathway model, defining anxiety as a latent factor common to all informants. This model offers error free estimates of genetic and environmental influences explaining the latent factor variance. Variation in the latent factor was highly genetic, with heritability estimates of 65% for boys and 74% for girls. Non-shared environmental effects explained the remaining variance. In addition, there were significant rater-specific genetic and environmental effects for both sexes. The observed rater differences underline the importance of using several informants when studying adolescent anxiety.
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http://dx.doi.org/10.1016/j.janxdis.2014.04.003DOI Listing
May 2014

Non-random mating and convergence over time for mental health, life satisfaction, and personality: the Nord-Trøndelag Health Study.

Behav Genet 2013 Mar 22;43(2):108-19. Epub 2012 Dec 22.

Division of Mental Health, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403 Oslo, Norway.

Earlier studies have shown evidence for various sources of observed spousal similarity regarding different traits and characteristics. We explored the relative contribution of non-random mating and convergence to spouse similarity with respect to global mental health, life satisfaction, optimism, and type A personality. We used population-based data collected for the Nord-Trøndelag Health Study (1984-1986) and prospective registry information about when and with whom people entered into marriage/cohabitation between 1970 and 2000 for 19,599 married/cohabitating couples and 1,551 future couples that entered into marriage/cohabitation during the 16 years after data collection. Couples were categorized by interval between data collection and entry into marriage/cohabitation. Age-adjusted polychoric correlations calculated for each group were used as the dependent variables in non-linear, segmented regression analysis, with time since or until marriage/cohabitation as the independent variable. Initial correlations between partners-to-be were low to moderate, typically around one-half of the values estimated in existing couples, indicating both non-random mating and early convergence. There appeared to be moderate divergence during the first 20 years of marriage/cohabitation and moderate convergence during the rest of life.
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http://dx.doi.org/10.1007/s10519-012-9578-2DOI Listing
March 2013

Psychological distress and subjective well-being in partners of somatically ill or physically disabled: the Nord-Trøndelag Health Study.

Scand J Psychol 2012 Dec;53(6):475-82

Norwegian Institute of Public Health, Division of Mental Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway.

This study investigated the cross-sectional associations between various somatic conditions in one partner and the level of distress and well-being in the spouse. The study is based on survey data from the Norwegian Nord-Trøndelag Health Study, HUNT II (1995-1997). A sample of 9,797 married or cohabiting couples with valid data on subjective well-being (SWB), psychological distress (Hopkins Symptom Check List (SCL)-10) and somatic illness were identified. Regression analyses stratified by sex were conducted with SCL-10 and SWB scores as dependent variables and a joint somatic score as predictor, including; stroke, cancer, angina, myocardial infarction and physical disability (PD). The contribution of each somatic condition was also explored. Spouses of persons previously diagnosed with at least one somatic condition scored significantly lower on SWB and significantly higher on SCL-10 than spouses of healthy persons, though effect sizes were small. The effect seems to be at least partly mediated by the ill partner's psychological distress. Of the specific conditions, PD had the most significant contribution for both genders, though an association between male angina and spousal distress/SWB was also demonstrated.
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http://dx.doi.org/10.1111/sjop.12009DOI Listing
December 2012

Paternal and maternal alcohol abuse and offspring mental distress in the general population: the Nord-Trøndelag health study.

BMC Public Health 2012 Jun 18;12:448. Epub 2012 Jun 18.

Division of Mental Health, Norwegian Institute of Public Health, PO BOX 4404, Nydalen, N-0403, Oslo, Norway.

Background: The degree to which parental alcohol abuse is a risk factor for offspring mental distress is unclear, due to conflicting results of previous research. The inconsistencies in previous findings may be related to sample characteristics and lack of control of confounding or moderating factors. One such factor may be the gender of the abusing parent. Also, other factors, such as parental mental health, divorce, adolescent social network, school functioning or self-esteem, may impact the outcome. This study examines the impact of maternal and paternal alcohol abuse on adolescent mental distress, including potentially confounding, mediating or moderating effects of various variables.

Methods: Data from the Nord-Trøndelag Health Study (HUNT), a Norwegian population based health survey, from 4012 offspring and their parents were analyzed. Parental alcohol abuse was measured by numerical consumption indicators and CAGE, whereas offspring mental distress was measured by SCL-5, an abbreviated instrument tapping symptoms of anxiety and depression. Statistical method was analysis of variance.

Results: Maternal alcohol abuse was related to offspring mental distress, whereas no effect could be shown of paternal alcohol abuse. Effects of maternal alcohol abuse was partly mediated by parental mental distress, offspring social network and school functioning. However, all effects were relatively small.

Conclusions: The results indicate graver consequences for offspring of alcohol abusing mothers compared to offspring of alcohol abusing fathers. However, small effect sizes suggest that adolescent offspring of alcohol abusing parents in general manage quite well.
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http://dx.doi.org/10.1186/1471-2458-12-448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484056PMC
June 2012

Non-random mating and convergence over time for alcohol consumption, smoking, and exercise: the Nord-Trøndelag Health Study.

Behav Genet 2012 May 18;42(3):354-65. Epub 2011 Oct 18.

Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.

Spouses tend to have similar lifestyles. We explored the degree to which spouse similarity in alcohol use, smoking, and physical exercise is caused by non-random mating or convergence. We used data collected for the Nord-Trøndelag Health Study from 1984 to 1986 and prospective registry information about when and with whom people entered marriage/cohabitation between 1970 and 2000. Our sample included 19,599 married/cohabitating couples and 1,551 future couples that were to marry/cohabitate in the 14-16 years following data collection. All couples were grouped according to the duration between data collection and entering into marriage/cohabitation. Age-adjusted polychoric spouse correlations were used as the dependent variables in non-linear segmented regression analysis; the independent variable was time. The results indicate that spouse concordance in lifestyle is due to both non-random mating and convergence. Non-random mating appeared to be strongest for smoking. Convergence in alcohol use and smoking was evident during the period prior to marriage/cohabitation, whereas convergence in exercise was evident throughout life. Reduced spouse similarity in smoking with relationship duration may reflect secular trends.
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http://dx.doi.org/10.1007/s10519-011-9509-7DOI Listing
May 2012

Parental alcohol use and adolescent school adjustment in the general population: results from the HUNT study.

BMC Public Health 2011 Sep 19;11:706. Epub 2011 Sep 19.

Division of Mental Health, Norwegian Institute of Public Health, 0403 Oslo, Norway.

Background: This study investigates the relationship between parental drinking and school adjustment in a total population sample of adolescents, with independent reports from mothers, fathers, and adolescents. As a group, children of alcohol abusers have previously been found to exhibit lowered academic achievement. However, few studies address which parts of school adjustment that may be impaired. Both a genetic approach and social strains predict elevated problem scores in these children. Previous research has had limitations such as only recruiting cases from clinics, relying on single responders for all measures, or incomplete control for comorbid psychopathology. The specific effects of maternal and paternal alcohol use are also understudied.

Methods: In a Norwegian county, 88% of the population aged 13-19 years participated in a health survey (N = 8984). Among other variables, adolescents reported on four dimensions of school adjustment, while mothers and fathers reported their own drinking behaviour. Mental distress and other control variables were adjusted for. Multivariate analysis including generalized estimation equations was applied to investigate associations.

Results: Compared to children of light drinkers, children of alcohol abusers had moderately elevated attention and conduct problem scores. Maternal alcohol abuse was particularly predictive of such problems. Children of abstainers did significantly better than children of light drinkers. Controlling for adolescent mental distress reduced the association between maternal abuse and attention problems. The associations between parental reported drinking and school adjustment were further reduced when controlling for the children's report of seeing their parents drunk, which itself predicted school adjustment. Controlling for parental mental distress did not reduce the associations.

Conclusions: Parental alcohol abuse is an independent risk factor for attention and conduct problems at school. Some of the risk associated with mothers' drinking is likely to be mediated by adolescent mental distress. Despite lowered adjustment on the externalizing dimensions, children of alcohol abusers report that they enjoy being at school as much as other children.
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http://dx.doi.org/10.1186/1471-2458-11-706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182935PMC
September 2011

Mental disorder and caregiver burden in spouses: the Nord-Trøndelag health study.

BMC Public Health 2010 Aug 26;10:516. Epub 2010 Aug 26.

Norwegian Institute of Public Health, Division of Mental Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway.

Background: Researchers generally agree that mental disorder represents a burden to the family. The present study concerns the subjective burden of living with a person with mental disorder, more specifically the association between mental disorder in the index person and subjective well-being and symptoms of anxiety and depression in the spouse.

Methods: Data were obtained from questionnaires administered to the adult population of Nord-Trøndelag County, Norway during the period 1995-1997. The present study is based on a subsample where 9,740 couples were identified. Subjective burden in spouses of persons with mental disorder was compared with subjective burden in spouses of persons without mental disorder, using analysis of variance (ANOVA). All analyses were stratified by sex.

Results: Adjusting for several covariates, spouses of persons with mental disorder scored significantly lower on subjective well-being and significantly higher on symptoms of anxiety and depression compared to spouses of index persons without mental disorder. Although highly significant, the effect sizes were moderate, corresponding to a difference in standard deviations ranging from .34 - .51.

Conclusions: Our study supports the notion that there is an association between mental disorder in one partner and subjective burden in the spouse, but not to the same extent that have been reported in earlier studies, as our results do not indicate that a large proportion of the spouses reach a symptom level of anxiety and depression that reflects clinical mental disorder.
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http://dx.doi.org/10.1186/1471-2458-10-516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936431PMC
August 2010

Impact of hearing impairment on spousal mental health: the Nord-Trøndelag Health Study.

Eur J Public Health 2010 Jun 3;20(3):271-5. Epub 2009 Nov 3.

Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.

Background: Previous studies indicate that hearing loss have negative emotional implications also on spouses of the hearing impaired persons. We sought to assess the relationship between hearing impairment and spousal mental health in the general population.

Methods: Pure tone audiometry and questionnaires were administered to the adult population of Nord-Trøndelag County, Norway (1996-97). In the age group between 20 and 44 years, the number of cases with hearing impairment was very low; thus, this age group was excluded from analyses. In total, 8607 couples with women over 44 years and 9530 couples with men over 44 years were identified. Associations between measured and self-reported hearing impairment and spousal self-reported symptoms of anxiety and depression, and subjective well-being were estimated. Stratified by sex and adjusting for several covariates, mental health in spouses of persons with hearing impairment was compared with that of spouses of persons with normal hearing using the general linear model.

Results: Audiometrically measured hearing was not significantly associated with spousal mental health. Moderate relations between self-reported hearing and spousal mental health were observed.

Conclusion: Contrary to previous results based on self-reported hearing loss, our results based on audiometry did not indicate severe loss of mental health among spouses of persons with impaired hearing.
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http://dx.doi.org/10.1093/eurpub/ckp176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899895PMC
June 2010