Publications
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Skoge, Mari; Støme, Linn Nathalie; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Kværner, Kari Jorunn & Vink, Josina
[Show all 7 contributors for this article]
(2026).
Toward hybrid mental health care: an early health technology assessment based on stakeholder analysis and economic simulations.
International Journal of Technology Assessment in Health Care.
ISSN 0266-4623.
42(1).
doi:
10.1017/S0266462326103985.
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Objectives
Combining digital and traditional treatment elements as part of a hybrid care delivery model may strengthen the sustainability of mental health care. However, implementation problems permeate efforts of digitalizing routine care. The objective of this formative study is to explore current unmet stakeholder needs and the potential value of hybrid care models for the treatment of severe mental disorders, in order to guide further research and inform practical implementation strategies.
Methods
We applied Step Up, an early health technology assessment (eHTA) framework. We performed (a) a template analysis of qualitative data from a stakeholder workshop mapping unmet needs, potential effects of hybrid care models, and conditions relevant for implementation and (b) exploratory economic simulations of the impact of increasing video consultation use in routine services on quantitative sustainability parameters.
Results
The template analysis revealed stakeholder-anticipated value from hybrid care models across all domains: patient, clinician, and next-of-kin user experiences; clinical variables; organizational setup; and economy. Two recommendations for enhancing implementation were identified: promoting nuanced perceptions of digitalized care and developing clinician incentives. The simulations demonstrated that a moderate increase in video consultations may impact clinical capacity, as well as economic and environmental sustainability.
Conclusions
This study provides early decision support concerning hybrid care models during the conceptual stage of service innovation. It reveals that conservative changes toward digitalized practices can create new opportunities for organizing services and have a substantial impact on sustainability parameters. Successful implementation across clinical contexts requires continuous consideration of the clinician user perspective, starting from the conceptual phase.
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Vink, Josina; Romm, Jonathan; Ihler, Henrik Myhre & Romm, Kristin Lie
(2026).
Staying Alive to the Possibilities of Becoming: Designing for Hope in Uncertain Futures.
DIID - Disegno Industriale Industrial Design.
ISSN 1594-8528.
p. 40–57.
doi:
10.30682/diid8826c.
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At the core of designing futures is ‘possibility’, not just predictability. While design has embraced a host of futures methods that explore what ‘might’ or ‘could’ happen, such as scenarios, there remains a tendency to ignore the discomfort that comes with embracing the unknown. A failure to attune to the tolerance for uncertainty of those involved, risks their aversion to the process and proposals of designing futures. The purpose of this research is to understand how designing futures can support actors in staying “alive to the possibilities of becoming” (Barad, 2007, p. 396), with particular regard to navigating their discomfort with uncertainty. Drawing on learnings from two attempts at designing futures within mental healthcare systems in Norway, this paper presents strategies for designing that premise future potentialities as situated within the thick, unfolding present. This research offers a pathway for stewarding emerging potentialities by working intentionally with time as nested and agency as relational to cultivate hope in uncertain futures.
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Skoge, Mari; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Kværner, Kari Jorunn; Støme, Linn Nathalie & Romm, Kristin Lie
(2026).
Exploring Video Consultations Across the Public and Private Sectors in Norway: Semistructured Interview Study.
JMIR Human Factors.
13.
doi:
10.2196/80812.
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Background:
Delivering therapy through video consultations can increase the reach and impact of mental health care services. However, adoption varies, and there is a lack of professional consensus about the usefulness of video consultations in therapy settings.
Objective:
This study aimed to explore mental health professionals’ experiences with and attitudes toward video consultations across different clinical environments in the private and public health care sectors in Norway to inform the design of future digitalized services.
Methods:
In this qualitative study, we recruited leaders and clinicians from public hospitals and private clinics. We conducted semistructured interviews that mapped individual experiences and attitudes concerning video consultations, as well as contextual aspects concerning the participants’ professional environments. We used reflexive thematic analysis with an inductive, essentialist, and experiential orientation to analyze the data.
Results:
A total of 24 mental health professionals (16 from public hospitals and 8 from private clinics) participated. Variations in their attitudes did not follow patterns reflecting the type of service or sector they worked in. Rather, attitudes seemed related to higher-level assumptions rooted in professional culture, societal values, and previous experiences. We generated six themes capturing and structuring the professional perspectives: (1) meta-perspectives on the digitalization of therapeutic rooms, (2) the “how” of service integration, (3) challenging therapist culture, (4) negotiating the limits of the digital therapy room, (5) creating clinical value from the digital format, and (6) adapting techniques and technology in digital therapy sessions.
Conclusions:
To strengthen the adoption and impact of video consultations, we should direct attention toward higher-level societal and cultural aspects that shape attitudes and practices. We suggest incorporating digitalized therapy in education, facilitating personal experiences with video consultations, increasing the sharing of knowledge between clinical environments, and sparking innovation of both service models and technology.
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Ihler, Henrik Myhre; Lyngstad, Siv Hege; Mørch-Johnsen, Lynn Egeland; Lagerberg, Trine Vik; Melle, Ingrid & Romm, Kristin Lie
(2023).
A transdiagnostic approach to negative symptoms: exploring factor structure and negative symptoms in bipolar disorders.
Frontiers in Psychiatry.
14.
doi:
10.3389/fpsyt.2023.1136097.
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Background Negative symptoms are increasingly recognized as transdiagnostic phenomena, linked to reduced quality of life and functioning, and often caused or worsened by amendable external factors such as depression, social deprivation, side-effects of antipsychotics or substance use. The structure of negative symptoms fits into two dimensions: diminished expression and apathy. These may differ in association with external factors that influence their severity and may thus require different treatment approaches. The dimensions are comprehensively established in non-affective psychotic disorders but are understudied in bipolar disorders. Methods We conducted exploratory and confirmatory factor analyses in a sample of 584 individuals with bipolar disorder to assess the latent factor structure of negative symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), and performed correlational analyses and multiple hierarchical regression analyses to investigate links between the two dimensions of negative symptoms and clinical and sociodemographic correlates. Results The latent factor structure of negative symptoms fits into two dimensions, i.e., diminished expression and apathy. A diagnosis of bipolar type I or a history of psychotic episodes predicted more severe levels of diminished expression. Depressive symptoms were associated with more severe negative symptoms across dimensions, yet 26.3% of euthymic individuals still displayed at least one mild or more severe negative symptom (PANSS score ≥ 3). Discussion The two-dimensional structure of negative symptoms seen in non-affective psychotic disorders reproduces in bipolar disorders indicating similarities in their phenomenology. Diminished expression was associated with a history of psychotic episodes and a diagnosis of BD-I, which may infer closer connections to psychosis liability. We found significantly less severe negative symptoms in euthymic than depressed participants. Nevertheless, more than a quarter of the euthymic individuals had at least one mild negative symptom, demonstrating some degree of persistence beyond depressed states.
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Ihler, Henrik Myhre; Lyngstad, Siv Hege; Gardsjord, Erlend Strand; Widing, Line Hustad; Flaaten, Camilla Bärthel & Åsbø, Gina
[Show all 13 contributors for this article]
(2023).
The trajectory of two negative symptom dimensions in first-episode psychosis and the role of cannabis use: A 10-year follow-up study.
Schizophrenia Research.
ISSN 0920-9964.
252,
p. 317–325.
doi:
10.1016/j.schres.2023.01.024.
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Objective To investigate the trajectories of diminished expression and apathy over 10 years. Further, to explore the effects of baseline- and persistent cannabis use on the development of diminished expression and apathy during follow-up, while controlling other potential sources and predictors of secondary negative symptoms. Methods 351 participants with a first episode of non-affective psychosis were examined at baseline and invited to follow-up at one year and 10 years. The trajectories of diminished expression and apathy were investigated using linear mixed models. Subsequently, cannabis use and other potential predictors and sources of secondary negative symptoms were added to the model to investigate the respective impact on their trajectories. Results The severity of both diminished expression and apathy decreased during the follow-up period after the first episode of psychosis, with the most improvement observed from baseline to 1-year follow-up. Cannabis use at baseline was associated with a long-lasting higher symptom load for diminished expression, but not apathy. Introducing persistent cannabis use to the model further strengthened the association with diminished expression. Conclusion Both cannabis use at baseline and persistent cannabis use after a first episode of psychosis were associated with more severe symptoms of diminished expression. Our results imply a causal relationship between cannabis use and diminished expression and suggest that measures to reduce cannabis use both before and after psychosis onset may reduce expressive negative symptoms.
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Lyngstad, Siv Hege; Lyne, John Paul; Ihler, Henrik Myhre; Meer, Lisette van der; Færden, Ann & Melle, Ingrid
(2023).
Turning the Spotlight on Apathy: Identification and Treatment in Schizophrenia Spectrum Disorders.
Schizophrenia Bulletin.
ISSN 0586-7614.
49(5),
p. 1099–1104.
doi:
10.1093/schbul/sbad070.
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Abstract Among negative symptoms, apathy is central to the impairments in real-life functioning in schizophrenia spectrum disorders (SSD). Thus, optimizing treatment for apathy appears key to improve outcomes. In treatment research, however, negative symptoms are typically studied as a unifactorial construct. We, therefore, aim to shed necessary light on the status of apathy identification and treatment in SSD.
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Bjella, Thomas; Høegh, Margrethe Collier; Olsen, Stine Holmstul; Aminoff, Sofie Ragnhild; Barrett, Elizabeth Ann & Ueland, Torill
[Show all 14 contributors for this article]
(2022).
Developing "MinDag" - an app to capture symptom variation and illness mechanisms in bipolar disorder.
Frontiers in Medical Technology.
4.
doi:
10.3389/fmedt.2022.910533.
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Introduction: The illness course of bipolar disorder (BD) is highly heterogeneous with substantial variation between individuals with the same BD subtype and within individuals over time. This heterogeneity is not well-delineated and hampers the development of more targeted treatment. Furthermore, although lifestyle-related behaviors are believed to play a role in the illness course, such mechanisms are poorly understood. To address some of these knowledge gaps, we aimed to develop an app for collection of multi-dimensional longitudinal data on BD-relevant symptoms and lifestyle-related behaviors.
Methods: An app named MinDag was developed at the Norwegian Center for Mental Disorders Research in Oslo, Norway. The app was designed to tap into selected areas: mood, sleep, functioning/activities (social, occupational, physical exercise, leisure), substance use, emotional reactivity, and psychotic experiences. Ethical, security and usability issues were highly prioritized throughout the development and for the final app solution. We conducted beta- and pilot testing to eliminate technical problems and enhance usability and acceptability.
Results: The final version of MinDag comprises six modules; three which are presented for the user once daily (the Sleep module in the morning and the Mood and Functoning/Activities modules in the evening) and three which are presented once weekly (Substance Use, Emotional Reactivity, and Psychotic Experiences modules). In general, MinDag was well received in both in the beta-testing and the pilot study, and the participants provided valuable feedback that was taken into account in the final development. MinDag is now in use as part of the research protocol at the NORMENT center and in a specialized treatment unit for BD at Oslo University Hospital in Norway.
Discussion: We believe that MinDag will generate unique longitudinal data well suited for capturing the heterogeneity of BD and clarifying important unresolved issues such as how life-style related behavior may influence BD symptoms. Also, the experiences and knowledge derived from the development of MinDag may contribute to improving the security, acceptability, and benefit of digital tools in mental health.
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Ihler, Henrik Myhre; Lagerberg, Trine Vik; Lyngstad, Siv Hege; Melle, Ingrid & Romm, Kristin Lie
(2021).
Exploring the relationship between recency and frequency of cannabis use and diminished expression and apathy as two dimensions of negative symptoms in first episode psychosis. A one-year follow-up study.
Schizophrenia Research.
ISSN 0920-9964.
doi:
10.1016/j.schres.2021.08.004.
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The association between cannabis use and negative symptoms remains unclear because of inconsistent results in existing studies. In this study we aimed to investigate the association between different aspects of cannabis use and 1) diminished expression and 2) apathy as a two-dimensional model of negative symptoms in a sample of 460 participants with first-episode psychosis. Data were collected on relevant clinical and demographic factors including diagnostics and habits of drug use at baseline, with a follow-up assessment after 12-months. We found an association between the frequency of cannabis use two years prior to baseline and the severity of diminished expression and apathy at baseline, while only the association to diminished expression held after controlling for potential clinical and demographic confounders. Frequency of cannabis use at baseline also had a significant effect on the development of diminished expression over the 12-month follow-up period. In conclusion, this study suggests that the frequency of cannabis use contributes to the severity of diminished expression at baseline, and to the progression of diminished expression after 12-months follow-up. Our findings also imply a dose-response relationship between frequency of use and severity of symptoms and add evidence to an association between cannabis use and negative symptoms.
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Ihler, Henrik Myhre; Meyrel, Manon; Hennion, Vincent; Maruani, Julia; Gross, Gregory & Geoffroy, Pierre A.
[Show all 10 contributors for this article]
(2020).
Misperception of sleep in bipolar disorder: an exploratory study using questionnaire versus actigraphy.
International journal of bipolar disorders.
doi:
10.1186/s40345-020-00198-x.
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Background The concept of misperception of sleep refers to the estimated discrepancy between subjective and objective measures of sleep. This has been assessed only in a few prior studies in individuals with Bipolar Disorder (BD) as compared to Healthy Controls (HC) and with mixed results. Methods We assessed a sample of 133 euthymic individuals with BD and 63 HC for retrospective subjective (Pittsburgh Sleep Quality Index) and objective (21 days of actigraphy recording) measures of total sleep time, sleep latency and sleep efficiency. We first investigated the correlations between these subjective and objective measures in the two groups. We then compared individuals with BD and HC for the absolute values of the differences between subjective and objective sleep parameters, used as a proxy of the magnitude of misperception of sleep. Finally, we undertook regression analyses to assess associations between clinical groups, core demographics, clinical factors and misperception of sleep. Results The correlation coefficients between subjective and objective measures of sleep did not differ between groups (total sleep time: rho = .539 in BD and rho = .584 in HC; sleep latency: rho = .190 in BD and rho = .125 in HC; sleep efficiency: rho = .166 in BD and rho = .222 in HC). Individuals with BD did not differ from HC in the magnitude of misperception of total sleep time, sleep latency nor sleep efficiency. Individuals with BD type 1 misperceived their sleep efficiency significantly more than individuals with BD type 2, with no further difference between BD type 1 and BD type 2 regarding sleep latency and sleep duration misperceptions. Three factors (age, symptoms of obstructive sleep apnea, and mild depressive symptoms), were the main contributors to the magnitude of misperception of sleep. Conclusions Misperception of sleep was not associated with a diagnosis of BD. In this sample, mild depressive symptoms, older age, or symptoms of obstructive sleep apnea may be related to greater sleep misperception. In that case, the reliability of subjective measures may decrease as the misperception of sleep increases. This study may help guide clinicians in selecting the best approach for assessing sleep (objective versus subjective measures) in individuals with BD.
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Lyngstad, Siv Hege; Gardsjord, Erlend Strand; Engen, Magnus Johan; Haatveit, Beathe; Ihler, Henrik Myhre & Wedervang-Resell, Kirsten
[Show all 9 contributors for this article]
(2020).
Trajectory and early predictors of apathy development in first-episode psychosis and healthy controls: a 10-year follow-up study.
European Archives of Psychiatry and Clinical Neuroscience.
ISSN 0940-1334.
doi:
10.1007/s00406-020-01112-3.
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Apathy is prevalent in first-episode psychosis (FEP) and associated with reduced global functioning. Investigations of the trajectory of apathy and its early predictors are needed to develop new treatment interventions. We here measured the levels of apathy over the first 10 years of treatment in FEP and in healthy controls (HC). We recruited 198 HC and 198 FEP participants. We measured apathy with the Apathy Evaluation Scale, self-report version, psychotic symptoms with the Positive and Negative Syndrome Scale, depression with the Calgary Depression Scale for Schizophrenia, functioning with the Global Assessment of Functioning Scale, and also estimated the duration of untreated psychosis (DUP). The longitudinal development of apathy and its predictors were explored using linear mixed models analyses. Associations to functioning at 10 years were investigated using multiple hierarchical linear regression analyses. In HC, mean apathy levels were low and stable. In FEP, apathy levels decreased significantly during the first year of treatment, followed by long-term stability. High individual levels of apathy at baseline were associated with higher apathy levels during the follow-up. Long DUP and high baseline levels of depression predicted higher apathy levels at follow-ups. The effect of DUP was persistent, while the effect of baseline depression decreased over time. At 10 years, apathy was statistically significantly associated with reduced functioning. The early phase of the disorder may be critical to the development of apathy in FEP.
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Lauritzen, Lise Mari; Schei, Edvin; Ihler, Henrik Myhre; Roald, Madicken Victoria Söderlind; Akre, Victoria & Havnes, Ingrid Amalia
(2026).
Piloting a social supervision model in psychiatric placements: A focus group protocol with medical students, residents, and training coordinators (SUPPORT).
doi:
10.1016/j.mex.2026.103847.
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Støme, Linn Nathalie; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Romm, Kristin Lie; Skoge, Mari & Kvaerner, Kari Jorunn
(2025).
Slik lykkes vi med digitalisering i mental helse.
Dagens medisin.
ISSN 1501-4290.
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Å dele gode resultater på tvers av helseforetakene og ha tydelige gevinstrealiseringsmål vil være avgjørende for å drive digitaliseringen fremover.
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Romm, Kristin Lie; Skoge, Mari; Ihler, Henrik Myhre; Kvaerner, Kari Jorunn; Støme, Linn Nathalie & Aminoff, Sofie Ragnhild
(2025).
How to Draw a Better Future for Video Consultations in Mental Health Care.
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Skoge, Mari; Aminoff, Sofie Ragnhild; Ihler, Henrik Myhre; Kvaerner, Kari Jorunn; Støme, Linn Nathalie & Romm, Kristin Lie
(2025).
Behind the screen: a qualitative study exploring video consultations across the public and private sectors in Norway.
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Published
Feb. 20, 2026 3:33 PM
- Last modified
Feb. 20, 2026 3:33 PM
