Ketil Hanssen-Bauer

• Stangeland, Tormod; Hanssen-Bauer, Ketil & Siqveland, Johan (2026). Prediction of Suicide Attempts Among Adolescents in Acute Mental Health Crisis. Archives of Suicide Research. ISSN 1381-1118. doi: 10.1080/13811118.2026.2714308. Full text in Research Archive
• Ruud, Torleif; Benth, Jurate Saltyte; Hussain, Ajmal; Rugkåsa, Jorun; Dahli, Mina Piiksi & Hanssen-Bauer, Ketil [Show all 11 contributors for this article] (2026). Effects of collaborative care on recognition and management of common mental disorders by general practitioners: a cluster-randomised trial in Norway. BMC Primary Care. 27(1). doi: 10.1186/s12875-026-03227-3. Full text in Research Archive
• Jelin, Elma; Ellingsen-Dalskau, Lina Harvold; Nyland, Camilla Skau; Hanssen-Bauer, Ketil; Siqveland, Johan & Isham, Aleksandra Eriksen [Show all 7 contributors for this article] (2026). Patient experience measurement in mental health and substance dependence inpatient care: development of short versions of validated questionnaires through importance ranking and psychometric testing. Health Services & Outcomes Research Methodology. ISSN 1387-3741. p. 1–17. doi: 10.1007/s10742-026-00374-z. Full text in Research Archive Show summary

  Abstract Background High-quality, patient-centred mental health and substance dependence care relies on robust Patient-Reported Experience Measures (PREMs). Long questionnaires may burden patients and reduce response rates, particularly in vulnerable populations. In Norway, the Psychiatric Inpatient Patient Experience Questionnaire (PIPEQ-CEM) and the Patient Experiences Questionnaire for Interdisciplinary Treatment for Substance Dependence (PEQ-ITSD–CEM) are used to assess inpatient experiences. With the transition to continuous electronic data collection, there is an increasing need for shorter, psychometrically robust, and stakeholderMethods-informed versions of these questionnaires to improve feasibility and sustainability. Methods A three-phase mixed-methods approach was employed to develop short versions: (1) cognitive interviews with patients and health care workers to test ranking and rating exercises, (2) a main survey using ranking method to assess item importance across domains, and (3) an expert-panel consensus meeting to finalize item selection, balancing statistical robustness, patient-centred relevance, and content coverage. Results Ranking was cognitively more demanding, but more efficient for identifying priority items. In the main survey, eighty-eight patients and 104 health care workers participated, and consistency in prioritized items was found across groups. Short versions of PIPEQ-CEM and PEQ-ITSD–CEM each included seven items, representing key dimensions of care. The expert-panel-based selection of final items was informed by psychometric evaluation, stakeholder input, and findings from previous national surveys. Conclusion The shortened versions of PIPEQ-CEM and PEQ-ITSD–CEM are concise, psychometrically robust, and capture key aspects of patient experience prioritized by both patients and health care workers. They offer a practical tool for monitoring and improving service quality, though further validation in diverse clinical and cultural contexts is recommended.

• Sanden, Markus; Bernhardsen, Guro Pauck; Hanssen-Bauer, Ketil; Høye, Anne; Johnsen, Erik & Morken, Gunnar [Show all 8 contributors for this article] (2025). Affective Reactivity to a Single Bout of High-Intensity Interval Training in Schizophrenia: A Randomized Controlled Trial. Schizophrenia Bulletin Open. 7(1). doi: 10.1093/schizbullopen/sgag004. Full text in Research Archive Show summary

  Abstract Background and Hypothesis Affective disturbances are a core feature of schizophrenia, yet patients’ capacity to experience momentary affective shifts in real-world settings remains underexplored. Although consummatory pleasure appears preserved, studies suggest low levels of positive affect and high levels of negative affect in daily life. Physical exercise provides an ecologically valid context for probing short-term affective reactivity. This study examined whether high-intensity interval training (HIIT) elicited greater affective change than an active control condition (ACC), whether baseline symptom levels were associated with affective state, and whether baseline symptoms moderated affective reactivity. Study Design In a randomized controlled trial, 69 outpatients with schizophrenia were randomized to a 12-week intervention involving either supervised HIIT or an ACC involving low-intensity, interactive video gaming. Affective state was assessed immediately before and after the 12th session using the Positive and Negative Affect Schedule (PANAS). Depressive (CDSS), negative symptoms (PANSS-N), and apathy (AES) were measured at baseline. Linear mixed-effects models tested Group × Time effects. Study Results HIIT did not produce significantly greater changes in positive or negative affect than the active control. Across interventions, participants showed increases in positive affect and decreases in negative affect. Higher baseline symptom levels were associated with lower pre-session positive affect. Exploratory analyses indicated that participants with more severe negative symptoms showed greater positive affective gains following HIIT. Conclusions A single session of structured activity, regardless of intensity, was associated with small but measurable affective improvements. These findings highlight the value of accessible activity-based interventions for enhancing affective well-being in schizophrenia.

• Sannes, Annika; Rognli, Erling W; Hanssen-Bauer, Ketil; Torp, Nor Christian; Storfossen, Silje Klundelien & Høstaker, Markus Nordheim [Show all 7 contributors for this article] (2025). Barriers to and Facilitators of Implementation of Internet-Delivered Therapist-Guided Therapy in Child and Adolescent Mental Health Services: Systematic Review and Bayesian Meta-Analysis. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 27. doi: 10.2196/83543. Full text in Research Archive Show summary

  Background: Internet-delivered therapist-guided therapy (e-therapy) represents a promising approach for enhancing accessibility, treatment fidelity, and scalability within child and adolescent mental health services (CAMHS). Objective: This systematic review aimed to (1) identify and synthesize determinants of implementation, specifically barriers to and facilitators of e-therapy in CAMHS structured according to the Consolidated Framework of Implementation Research (CFIR); and (2) provide pooled benchmark estimates of key implementation outcomes for fidelity, cost-effectiveness, and acceptability. Methods: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)–compliant systematic review was performed across PsycINFO, MEDLINE, Web of Science, CINAHL, Embase, Cochrane, and ProQuest Dissertations & Thesis on June 6, 2025—to identify peer-reviewed studies assessing implementation outcomes or determinants of e-therapy in the context of outpatient CAMHS (ages 8‐18 years). Barriers and facilitators were synthesized qualitatively with thematic analysis applying CFIR. A parallel quantitative synthesis of Proctor et al’s taxonomy of implementation outcomes was performed using Bayesian multilevel random-effects meta-analyses to estimate pooled effect sizes and 95% credible intervals (CIs). By combining quantitative benchmarks of implementation success with qualitative insights into contextual determinants, the review provides an integrated understanding of what drives effective e-therapy implementation in CAMHS. Study quality was assessed using the CASP (Critical Appraisal Skills Programme) checklist, Cochrane Risk of Bias tool, and Risk Of Bias In Non-randomized Studies–of Interventions tool. Small study effects were evaluated using funnel plots, sensitivity analyses, and the Egger test. Results: From 50,026 screened reports, 50 studies published between 2007 and 2025 were included: 18 randomized controlled trials, 17 cohort, and 15 qualitative or mixed methods studies. Most studies originated from Western Europe (n=34), Northern America (n=11), and Oceania (n=5), targeting anxiety (n=24) and depression (n=9), through cognitive behavioral therapy–based programs (n=47), with parallel parent content (n=31). Therapist guidance was primarily asynchronous (n=43). Among the 39 studies reporting determinants, common barriers and facilitators were identified across intervention, organization, therapist, and patient domains, structured via CFIR. Pooled implementation outcomes showed modest dropout rates (~20%, CI 14%‐27%), high module completion (~68%, CI 60%‐75%), low therapist time (24 min per wk per patient, 95% CI 19‐28), and high patient satisfaction (24/32 on Client Satisfaction Questionnaire-8, 95% CI 22‐27; and 76% satisfaction rate, 95% CI 62%‐87%), suggesting e-therapy is resource efficient and acceptable if implemented successfully. Conclusions: This review provided the first integrated synthesis of pooled benchmarks for implementation outcomes of e-therapy in CAMHS and modifiable determinants to inform future service planning and scale-up. These findings highlighted service-level enablers, such as leadership anchoring, targeted use, technical stability, structured patient flow, and therapist training, that organizations could prioritize to strengthen sustainable e-therapy implementation in CAMHS.

• Ruud, Torleif; Rugkåsa, Jorun; Haavet, Ole Rikard; Dahli, Mina Piiksi; Hanssen-Bauer, Ketil & Brekke, Mette [Show all 9 contributors for this article] (2025). A collaborative primary and mental health care model with psychologist and psychiatrist working in GP practices: process evaluation of the implementation, challenges, and sustainability. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13408-y. Full text in Research Archive
• Stangeland, Tormod; Hanssen-Bauer, Ketil; Lynum, Linn Ingunn; Nedberge, Karen Margrethe Walaas & Siqveland, Johan (2025). Assessing the Lethality of Suicide Attempts: Adding Chance of Rescue to Medical Severity. Suicide and Life-Threatening Behaviour. ISSN 0363-0234. 55(5), p. e70058–e70058. doi: 10.1111/sltb.70058. Full text in Research Archive Show summary

  ABSTRACT Introduction Emphasis on medical severity when assessing the lethality of suicide attempts may overlook important contextual factors. We examined if distinguishing between medical severity and chance of rescue improves evaluation and understanding of suicidal mental states. Methods Seventy adolescent inpatients with a recent suicide attempt were interviewed with the Suicide Intent Scale, and clinicians rated the Risk‐Rescue Rating Scale, which provides separate ratings for medical severity (Risk) and chance of rescue (Rescue). They also completed the Interpersonal Needs Questionnaire and Fearlessness about Death scale. Results The lethality components Risk and Rescue were uncorrelated ( r  = −0.02). However, Rescue was significantly negatively correlated with suicidal intent ( r  = −0.46), fearlessness about death ( r  = −0.29), and unmet interpersonal needs ( r  = −0.28), while Risk was only correlated with suicidal intent ( r  = 0.29). In a hierarchical regression model, Rescue was the strongest predictor of suicidal intent. Conclusion Rescue factors, more than medical severity factors, were consistently related to our measures of suicidal mental state. Including the rescue component in lethality assessments may improve both the accuracy of clinical evaluations and our understanding of adolescents' mental state during suicidal crisis.

• Stangeland, Tormod; Hanssen-Bauer, Ketil & Siqveland, Johan (2025). Testing the psychometric properties of the risk-rescue rating scale: a lethality measure for suicide attempts. International Journal of Mental Health Systems. 19(1). doi: 10.1186/s13033-025-00662-0. Full text in Research Archive Show summary

  Health personnel lack a common standard for assessing lethality of suicide attempts. This may lead to inconsistent assessments and unclear reports about suicide attempts. We argue that the Risk-Rescue Rating Scale (RRRS) may help in resolving this problem. It is a measure based on observable indications of the medical danger of a suicide attempt and of the patient’s efforts to avoid or achieve rescue. The instrument is a clinician-rated supplement to self-reports and can be administered in a few minutes and learned in a single brief teaching session. We adapted the RRRS for contemporary use in a Norwegian acute adolescent mental health service clinic. We developed a training program for clinicians, a user manual, and a series of five video-based role-played interview cases for reliability testing. In this study, we recruited 28 clinicians with professional backgrounds typical of Norwegian mental health personnel. They rated five role-played video interviews using the RRRS and the well-established interview instrument the Suicide Intent Scale (SIS) and obtained 140 sets of scores. We estimated the interrater reliability (intraclass correlation coef‑ ficient [ICC]) to be .93 for the RRRS and .94 for the SIS, both excellent levels. Correlation was .80 between the RRRS and SIS items that were similar to the RRRS and .53 for SIS items measuring other topics, indicating good concurrent and discriminant validity. Adopting a common standard for communicating about suicide attempts can improve clini‑ cal practice, and the RRRS may prove to be a reliable and practical candidate for this task.

• Stavnes, Kristin Anne; Ruud, Torleif; Benth, Jurate Saltyte; Hanssen-Bauer, Ketil; Solantaus, Tytti & Hilsen, Marit [Show all 10 contributors for this article] (2023). Norwegian health personnel’s contacts and referrals for children of ill parents: an exploratory cross-sectional multi-centre study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09607-0. Full text in Research Archive Show summary

  Background In 2010, changes were made to the Norwegian Health Personnel Act. This led to all health personnel being obliged to support the patients’ children and families. The aims of this study were to investigate whether health personnel contacted or referred the patients’ children to family/friends or public services. We also investigated if there were factors in the family or the services that increased or decreased the degree of contacts and referrals. In addition the patients were asked whether the law had been a help or even a burden. This study was part of a larger multi-site study of children of ill parents conducted in fve health trusts in Norway. Method We used cross-sectional data from 518 patients and 278 health personnel. The informants completed a questionnaire addressing the law. Data were analyzed by factor analysis and logistic regression. Results The health personnel contacted/referred children to diferent services, but not to the degree desired by their parents. Only a few contacted family/friends, or the school and/or the public health nurse, those representing the helpers who live closest to the child, and thus well situated to participate in help and preventive eforts. The service most often referred to was the child welfare service. Conclusion The results indicate a change in contacts/referrals for children from their parents’ health personnel but also reveal remaining needs for support/help for these children. Health personnel should strive to write more refer‑ rals and take more contacts than the current study suggests, to secure adequate support for children of ill parents in Norway, as intended in The Health Personnel Act.

• Ruud, Torleif; Fjellestad, Ingrid Kyte & Hanssen-Bauer, Ketil (2023). Patient experiences in psychiatric departments for the elderly (PEPDE): development, properties, and use of a brief questionnaire. BMC Psychiatry. 23(1), p. 11–11. doi: 10.1186/s12888-023-04633-y. Full text in Research Archive Show summary

  Background Measuring patient experiences at psychiatric inpatient departments for the elderly need measurements adapted to the situation and challenges of the age group. We did not find any such instrument. The aim of this study then was to develop and document the measurement properties of a reliable and valid questionnaire about experiences of patients without severe neurocognitive disturbances at psychiatric inpatient departments for the elderly, which can be used in quality improvement and research. Methods Aiming for good content validity, we developed a questionnaire with 37 questions based on a review of the literature on important aspects for the elderly in psychiatric inpatient departments and on feedback from elderly patients from other questionnaires developed for use in psychiatric departments for adults. Using this first questionnaire, we collected data from 151 patients in psychiatric departments for the elderly in nine health trusts. We then revised the questionnaire based on comments from patients and interviewers on the questions, and we decided which questions we would keep and which we needed to adjust to improve clarity. This resulted in a final questionnaire of 20 questions. We analyzed the internal structure (factors and their internal consistency) of this final questionnaire based on data collected from a new sample of 96 patients. To test the construct validity of the questionnaire, a sample of 26 service user representatives, clinicians and researchers were asked to sort the questions based on identified factors. Results The final questionnaire consisted of 20 questions giving a valid and reliable measurement tool with four subscales: Patient-centered Interaction, Outcome, Care and Safety, and Information on Rights. Very few unanswered questions indicate that the questionnaire is feasible, as patients seemed to understand the questions and the response scales well. It is desirable that structural validity is confirmed with a larger sample. Conclusion Our final questionnaire “Patient Experiences in Psychiatric Departments for the Elderly” (PEPDE) has adequate measurement properties and seems to be well understood. It can be used as a questionnaire or an interview for quality improvement and research.

• Kan, Zhanna; Søegaard, Erik Ganesh Iyer; Siqveland, Johan; Hussain, Ajmal; Hanssen-Bauer, Ketil & Jensen, Pia [Show all 12 contributors for this article] (2022). Coping, Social Support and Loneliness during the COVID-19 Pandemic and Their Effect on Depression and Anxiety: Patients’ Experiences in Community Mental Health Centers in Norway. Healthcare. 10(5). doi: 10.3390/healthcare10050875. Full text in Research Archive Show summary

  Background: Little is known about psychiatric patients’ experiences during the COVID-19 pandemic. The purpose of this study was to investigate associations of coping strategies, social support and loneliness with mental health symptoms among these patients. Methods: We recruited 164 patients from Community Mental Health Centers in June–July 2020. Participants responded to an online questionnaire on corona-related questions, Brief Coping Orientation to Problems Experience, Crisis Support Scale, a 3-item Loneliness Scale, and Hopkins Symptom Checklist-25. We used linear regression models to investigate associations between these and symptoms of depression and anxiety. Results: Almost 51% were aged 31–50 years and 77% were females. Forty-six (28%) participants reported worsened overall mental health due to the pandemic. The reported rates of clinical depression and anxiety were 84% and 76%, respectively. Maladaptive coping was independently associated with both depression and anxiety symptoms. Loneliness was independently associated with depression symptoms. Conclusions: Patients in Community Mental Health Centers in Norway reported high rates of depression and anxiety symptoms. Many of them reported worsening of their mental health due to the pandemic, even at a time when COVID-19 infections and restrictive measures were relatively low. Maladaptive coping strategies and loneliness may be possible explanations for more distress. Keywords: anxiety; depression; COVID-19; coping; Community Mental Health Centers; loneliness; social support

• Waraan, Luxsiya; Siqveland, Johan; Hanssen-Bauer, Ketil; Czajkowski, Nikolai Olavi; Axelsdottir, Brynhildur & Mehlum, Lars [Show all 7 contributors for this article] (2022). Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta–analysis. Clinical Child Psychology and Psychiatry. ISSN 1359-1045. p. 1–19. doi: 10.1177/13591045221125005. Full text in Research Archive Show summary

  Objective To systematically review and meta-analyze the effectiveness of family therapy compared to other active treatments for adolescents with depressive disorders or suicidal ideation. Method We conducted a systematic search of The Cochrane Central Register of Controlled Trials, Medline, Embase, PsycINFO, AMED, CINAHL and Web of Science and performed two meta-analyses of outcomes for depressive symptoms and suicidal ideation. Results We screened 5,940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group. Nine studies reported outcome measures of depressive symptoms and four reported outcome measures of suicidal ideation. The meta-analysis showed no significant difference between family therapy and active comparison treatments for end-of-treatment levels of depression. For suicidal ideation our meta-analysis showed a significant effect in favour of family therapy over comparison treatments for suicidal ideation. Conclusions Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder. However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.

• Stavnes, Kristin Anne; Ruud, Torleif; Benth, Jurate Saltyte; Hanssen-Bauer, Ketil; Weimand, Bente Margrethe & Solantaus, Tytti [Show all 13 contributors for this article] (2022). Norwegian health personnel’s compliance with new legislation on children of ill parents: an exploratory cross-sectional multicentre study. BMC Health Services Research. 22(1), p. 1–18. doi: 10.1186/s12913-022-08268-9. Full text in Research Archive Show summary

  Background In 2010 the Norwegian Parliament introduced amendments to the Health Personnel Act requiring all health personnel to inform and offer help to their patients’ children and families. We evaluated whether health personnel adhered to their obligations outlined in the Act and investigated whether family and health services characteristics were associated with the degree of compliance with the legislation. Our study was part of a larger Norwegian multi-site study conducted in five health trusts across Norway, assessing the situation for families living with parental illness. Method: A cross-sectional study using quantitative data obtained from 518 patients 246 children and 278 health personnel was performed. All informants completed a questionnaire, including an instrument corresponding to the obligations in the legislation. Descriptive analyses, factor analysis and logistic regression analysis were used. Results: The legislation was only partially implemented in the clinics of the health trusts. Compared to estimates prior to the introduction of the new legislation, the situation had improved somewhat, but much work remains to be done to fulfil the obligations decreed by law. The more time-consuming the obligations were, the less often they were met. The substance abuse and mental health services followed up on their obligations to a greater extent than did the physical health services. Conversely, children of physically ill parents were better informed by their families than were children of parents with mental health and substance abuse disorders. When asked the same questions, reports from health personnel were more positive compared to those of children and patients regarding the legislation’s fulfillment. Conclusion: Data suggest that there has been a change in the support offered to children of ill parents. Additional work is required, however, for the Health Personnel Act to function as fully intended.

• Haavet, Ole Rikard; Benth, Jurate Saltyte; Gjelstad, Svein; Hanssen-Bauer, Ketil; Dahli, Mina Piiksi & Kates, Nick [Show all 7 contributors for this article] (2021). Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office. BMJ Open. 11(12), p. 1–7. doi: 10.1136/bmjopen-2021-050036. Full text in Research Archive Show summary

  Background Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions. Aim To investigate whether shared care with mental health professionals in GP offices increases the detection of youth’s mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician. Design and setting This was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3–8 GP offices. One GP office was randomised to the intervention group and the other to the control group. Method We used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth. Results Over a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients’ regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm. Conclusion Shared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient’s regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group.

• Tveit, Ole Gunnar; Ruud, Torleif; Hanssen-Bauer, Ketil; Haavet, Ole Rikard & Hussain, Ajmal (2021). An explorative study of factors associated with treatment in specialized mental health care centers among GP patients in Norway. BMC Health Services Research. 21(1), p. 1–9. doi: 10.1186/s12913-021-06982-4. Full text in Research Archive Show summary

  Background: Effectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers. Methods: Inthisretrospectivecohortstudy,welookedat12monthsofdatafromelectronichealthrecordsfromsix GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency. Results: Wefoundthat4.6%ofallGPpatientsand18.4%oftheGPpatientswithamentalhealthproblemswere treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers. Conclusions: MenweremorelikelytobetreatedinSMHCcentersthanwomen,whichmayimplythattheyhave different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care. Keywords: Psychiatricspecialistservices,Mentalhealthcare,Healthcareutilization,Norway

• Kallander, Ellen Katrine; Weimand, Bente; Hanssen-Bauer, Ketil; Roy, Betty Van & Ruud, Torleif (2020). Factors associated with quality of life for children affected by parental illness or substance abuse. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. doi: 10.1111/scs.12868. Full text in Research Archive Show summary

  Background: There have been inconsistent findings from studies examining factors associated with quality of life (QoL) for children affected by parental illness. Aim: The aim of this study was to explore factors associated with self-reported QoL in children affected by parental illness or parental substance abuse. Design: A cross-sectional multicentre study. Methods: The sample included 246 families with children 8–18 years recruited via ill parents who received treatment for severe physical illness, mental illness or substance abuse in specialised health services. We performed multiple linear regression analyses to examine factors associated with the children’s self-reported QoL. Main outcome measure: KIDSCREEN-27. Results: The children’s self-reported QoL was positively associated with the ill parent’s self-reported physical health, the children’s self-reported social skills, the degree to which other adults took over the ill parent’s responsibilities, provision of sibling care, provision of health care for the ill parent and positive outcome of caregiving. The children’s QoL was negatively associated with the children’s self-reported responsibilities due to parental illness, provision of emotional care for the ill parent, negative outcomes of caregiving and external locus of control. The model explained 63% of the variance (adjusted R2) in children’s total QoL. Study limitations: Sampling bias may have occurred during recruitment. Conclusions: The findings suggest factors of importance for the children’s QoL. Clinicians should assess whether an ill parent’s physical health may influence negatively on their ability to perform daily responsibilities at home and care for their children, and clinicians can use children’s self-reported QoL to identify children who are most negatively affected.

• Bjertnæs, Øyvind Andresen; Iversen, Hilde Karin Hestad; Skudal, Kjersti Eeg; Ali, Warsame Abdullahi & Hanssen-Bauer, Ketil (2020). Are parents’ geographical origin associated with their evaluation of child and adolescent mental health services? Results from a national survey in Norway. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-020-01590-9. Full text in Research Archive Show summary

  The objective was to assess the association between parents’ geographical origin and their evaluation of outpatient child and adolescent mental health services (CAMHS). Data were collected in a national parent’s experience survey of all outpatient CAMHS in Norway in 2017. Following exclusions, 16,143 parents were part of the study, of which 5932 responded (36.1%). Diagnosis and global psychosocial functional level were collected from the National Patient Register. Multilevel regression was used to assess the association between parents’ geographical origin and parent evaluation of the outpatient CAMHS on ten indicators. Sentiment and content analysis was conducted on open-ended comments from parents. The estimated regression coefficients showed that parents born in Eastern Europe scored the services significantly poorer than parents born in Norway on outcome of treatment (− 7.73, p < 0.01), general satisfaction (− 5.53, p < 0.05), ease of getting in contact with health personnel outside of scheduled appointments (− 17.04, p < 0.001), and knowledge of the services that the child has received at the service (− 10.63, p < 0.001). Parents born in Asia/Africa/South America scored the services similar as Norwegian parents on eight of ten indicators, better on one (waiting time) and poorer on one (ease of getting in contact). Sentiment analysis showed that 54% of the comments from parents born in Eastern Europe were negative, compared to 42% for the Norwegian group and 36% for Asia/Africa/South America. The parents’ evaluation of the outpatient CAMHS were partly associated with their geographical origin, with parents born in Eastern Europe reporting poorer experiences than parents born in Norway.

• Kallander, Ellen Katrine; Weimand, Bente; Ruud, Torleif; Becker, Saul; Roy, Betty Van & Hanssen-Bauer, Ketil (2018). Outcomes for children who care for a parent with a severe illness or substance abuse. Child & Youth Services. ISSN 0145-935X. 39(4), p. 228–249. doi: 10.1080/0145935X.2018.1491302. Full text in Research Archive
• Bergman, Hanna; Kornør, Hege; Nikolakopoulou, Adriani; Hanssen-Bauer, Ketil; Soares-Weiser, Karla & Tollefsen, Thomas Kristian [Show all 7 contributors for this article] (2018). Client feedback in psychological therapy for children and adolescents with mental health problems. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD011729.pub2. Full text in Research Archive
• Nyttingnes, Olav; Ruud, Torleif; Norvoll, Reidun; Rugkåsa, Jorun & Hanssen-Bauer, Ketil (2018). A cross-sectional study of experienced coercion in adolescent mental health inpatients. BMC Health Services Research. 18(389). doi: 10.1186/s12913-018-3208-5. Full text in Research Archive Show summary

  Background Involuntary care and coercive measures are frequently present in mental healthcare for adolescents. The purpose of this study was to examine to what extent adolescents perceive or experience coercion during inpatient mental health care, and to examine predictors of experienced coercion. Methods A cross-sectional sample of 96 adolescent inpatients from 10 Norwegian acute and combined (acute and sub-acute) psychiatric wards reported their experienced coercion on Coercion Ladder and the Experienced Coercion Scale in questionnaires. Staff reported use of formal coercion, diagnoses, and psychosocial functioning. We used two tailed t-tests and mixed effects models to analyze the impact from demographics, alliance with parents, use of formal coercion, diagnostic condition, and global psychosocial functioning. Results High experienced coercion was reported by a third of all patients. In a mixed effects model, being under formal coercion (involuntary admission and / or coercive measures); a worse relationship between patient and parent; and lower psychosocial functioning, significantly predicted higher experienced coercion. Twenty-eight percent of the total sample of patients reported a lack of confidence and trust both in parents and staff. Conclusions Roughly one third of patients in the sample reported high experienced coercion. Being under formal coercion was the strongest predictor. The average scores of experienced coercion in subgroups are comparable with adult scores in similar care situations. There was one exception: Adolescents with psychosis reported low experienced coercion and almost all of them were under voluntary care.

• Harris, Meredith G.; Sparti, Claudia; Scheurer, Roman; Coombs, Tim; Pirkis, Jane & Ruud, Torleif [Show all 10 contributors for this article] (2018). Measurement properties of the Health of the Nation Outcome Scales (HoNOS) family of measures: protocol for a systematic review. BMJ Open. 8(4). doi: 10.1136/bmjopen-2017-021177. Full text in Research Archive Show summary

  Introduction: The Health of the Nation Outcome Scales (HoNOS) for adults, and equivalent measures for children and adolescents and older people, are widely used in clinical practice and research contexts to measure mental health and functional outcomes. Additional HoNOS measures have been developed for special populations and applications. Stakeholders require synthesised information about the measurement properties of these measures to assess whether they are fit for use with intended service settings and populations and to establish performance benchmarks. This planned systematic review will critically appraise evidence on the measurement properties of the HoNOS family of measures. Methods and analysis: Journal articles meeting inclusion criteria will be identified via a search of seven electronic databases: MEDLINE via EBSCOhost, PsycINFO via APA PsycNET, Embase via Elsevier, Cumulative Index to Nursing and Allied Health Literature via EBSCOhost, Web of Science via Thomson Reuters, Google Scholar and the Cochrane Library. Variants of ‘Health of the Nation Outcome Scales’ or ‘HoNOS’ will be searched as text words. No restrictions will be placed on setting or language of publication. Reference lists of relevant studies and reviews will be scanned for additional eligible studies. Appraisal of reliability, validity, responsiveness and interpretability will be guided by the COnsensus-based Standards for the selection of health Measurement INstruments checklist. Feasibility/utility will be appraised using definitions and criteria derived from previous reviews. For reliability studies, we will also apply the Guidelines for Reporting: Reliability and Agreement Studies to assess quality of reporting. Results will be synthesised narratively, separately for each measure, and by subgroup (eg, treatment setting, rater profession/experience or training) where possible. Meta-analyses will be undertaken where data are adequate. Ethics and dissemination Ethics approval is not required as no primary data will be collected. Outcomes will be disseminated to stakeholders via reports, journal articles and presentations at meetings and conferences.

• Jozefiak, Thomas; Hanssen-Bauer, Ketil & Bjelland, Ingvar (2018). Måleegenskaper ved den norske versjonen av Children’s Global Assessment Scale (CGAS). PsykTestBarn. 1(3), p. 1–14. doi: 10.21337/0058. Full text in Research Archive Show summary

  The Children’s Global Assessment Scale (CGAS), was developed by David Shaffer and colleagues at Columbia University, in 1983. The CGAS was adapted from the Global Assessment Scale for adults (GAS), and is scored by clinicians as a measure of a child’s or adolescent’s psychosocial functioning during the month before assessment, on a scale from 1 (lowest functioning) to 100 (superior functioning in all areas). It is recommended for children and adolescents aged 4 to 16/17 years. The CGAS is scored by clinicians, and takes less than 10 minutes to complete. There is no information available whether the Norwegian CGAS was translated according to international procedures, and whether the translated version has been accepted by the original author. The Norwegian Directorate of eHealth states that the CGAS can be used in specialist health services in Norway. It is unknown whether there are additional copyright claims or competence requirements to score the instrument. We included 34 Norwegian articles, of which 19 had more than 100 participants. Most of the participants were children and adolescents aged 6-18 years, but a few follow-up studies into adulthood were also included. The included studies varied considerably with regard to clinical samples, and there were both cross-sectional and longitudinal studies. We found satisfactory evidence for convergent, discriminant, and predictive validity and interrater reliability, somewhat less for sensitivity to change. There was a lack of test-retest reliability studies. We recommend the use of the Norwegian version both in research and clinical practice, provided that clinicians receive adequate training in scoring.

• Kallander, Ellen Katrine; Weimand, Bente; Becker, Saul; Roy, Betty Van; Hanssen-Bauer, Ketil & Stavnes, Kristin Anne [Show all 9 contributors for this article] (2017). Children with ill parents: extent and nature of caring activities. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. 32(2), p. 793–804. doi: 10.1111/scs.12510. Full text in Research Archive Show summary

  Rationale Previous studies have shown that children may take on higher extents of caring activities if their parents are affected by severe illness or disability, especially when their parents lack access to formal and informal care. Aims and objectives This study examined the extent and nature of caring activities done by patients’ children; differences in caring activities between different types of parental illness; factors associated with caring activities. Design An explorative cross-sectional multicentre study. Methods Parents as patients in specialised healthcare services, and their children, were recruited from five health trusts in Norway. The sample included 246 children aged 8–17 years and their 238 parents with severe physical illness (neurological disease or cancer) (n = 135), mental illness (n = 75) or substance abuse (n = 28). Main outcome measure Multidimensional Assessment of Caring Activities (MACA-YC18). Results A large number of children with ill parents are performing various caring activities. Increased caring activities among children due to their parent's illness were confirmed by their parents, especially with regard to personal care. We found no significant differences in the extent of caring activities between illness types, but there were some differences in the nature of these activities. Factors significantly associated with the extent and nature of caring activities were as follows: better social skills and higher external locus of control among the children; and poorer physical parental health. Parent's access to home-based services was limited. Study limitations In recruitment of participants for the study, a sampling bias may have occurred. Conclusion To promote coping and to prevent inappropriate or extensive caring activities among children with ill parents, there is a need for increased access to flexible home-based services adapted to the type of parental illness.

• Furre, Astrid; Falk, Ragnhild Sørum; Sandvik, Leiv; Friis, Svein; Knutzen, Maria & Hanssen-Bauer, Ketil (2017). Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: A nationwide study. Child and Adolescent Psychiatry and Mental Health (CAPMH). 11(1). doi: 10.1186/s13034-016-0136-1. Full text in Research Archive Show summary

  Background The use of restraints in adolescent psychiatric settings requires particular professional, ethical, and legal considerations. The purpose of this study was to investigate whether the number of restraint episodes per patient was related to any of several characteristics of the adolescents. Methods In this nationwide study, we included all adolescents restrained during the period 2008–2010 (N = 267) in Norwegian adolescent acute psychiatric inpatient units. They constitute 6.5% of the adolescents hospitalized in these units in the same period of time. We collected data on the number of restraint episodes they experienced during the study period; Poisson regression was then used to analyze the impact of gender, social, mental health, and treatment characteristics on the frequency of restraint. We developed a risk index for the likelihood of experiencing multiple restraint episodes. Results We found a skewed distribution of restraint episodes in which a small group (18%) of restrained adolescents experienced a majority (77%) of the restraint episodes. A large percentage of the restrained adolescents (36%) experienced only one restraint episode. Risk factors for multiple restraint episodes were female gender, lower psychosocial functioning (Children’s Global Assessment Scale below 35), more and longer admissions, and concomitant use of pharmacological restraint. Except for gender, we used these variables to develop a risk index that was moderately associated with multiple restraint episodes. Conclusions As a small group of patients accounted for a large percentage of the restraint episodes, future research should further investigate the reasons for and consequences of multiple restraint episodes in patients at acute adolescent psychiatric units, and evaluate preventive approaches targeted to reduce their risk for experiencing restraint.

• Furre, Astrid; Sandvik, Leiv; Friis, Svein; Knutzen, Maria & Hanssen-Bauer, Ketil (2016). A nationwide study of why and how acute adolescent psychiatric units use restraint. Psychiatry Research. ISSN 0165-1781. 237, p. 60–66. doi: 10.1016/j.psychres.2016.01.067. Full text in Research Archive
• Kornør, Hege; Jozefiak, Thomas; Hanssen-Bauer, Ketil & Hysing, Mari (2015). Forsvarlig testbruk. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 52(7), p. 600–601. Full text in Research Archive
• Kornør, Hege; Bergman, Hanna; Hanssen-Bauer, Ketil; Soares-Weiser, Karla; Tollefsen, Thomas Kristian & Bjørndal, Arild (2015). Client feedback in psychological therapy for children and adolescents with mental health problems. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD011729. Full text in Research Archive
• Kornør, Hege & Hanssen-Bauer, Ketil (2014). Måleegenskaper ved den norske versjonen av Child Outcome Rating Scale (CORS). PsykTestBarn. 1. Full text in Research Archive Show summary

  CORS ble opprinnelig utviklet i USA i 2003 av Duncan, Miller og Sparks for å måle selvrapporterte terapiresultater. Den norske versjonen kalles «Skala for endringsvurdering – barn og unge (CORS)». Den er oversatt av Anne-Grethe Tuseth, og kan lastes ned fra internett. CORS inneholder fire visuelle analoge skalaer som barn i alderen 6-12 år og/eller deres foresatte besvarer ved å markere hvor på en strek fra trist ansikt til glad ansikt barnet befinner seg. Administrering og skåring tar få minutter, og det stilles ingen kompetansekrav til testbrukere. Vårt systematiske litteratursøk etter dokumentasjon for måleegenskapene ved de skandinaviske versjonene av CORS identifiserte ingen relevante publikasjoner. Det foreligger ingen dokumentasjon for måleegenskapene ved den norske versjonen av CORS. Studier som undersøker måleegenskaper er derfor nødvendig.

• Furre, Astrid; Sandvik, Leiv; Heyerdahl, Sonja; Friis, Svein; Knutzen, Maria & Hanssen-Bauer, Ketil (2014). Characteristics of adolescents subjected to restraint in acute psychiatric units in Norway: A case-control study. Psychiatric Services. ISSN 1075-2730. 65(11), p. 1367–1372. doi: 10.1176/appi.ps.201300429. Full text in Research Archive
• Skarphedinsson, Gudmundur Águst; Hanssen-Bauer, Ketil; Kornør, Hege; Heiervang, Einar; Landrø, Nils Inge & Axelsdottir, Brynhildur [Show all 8 contributors for this article] (2014). Standard individual cognitive behaviour therapy for paediatric obsessive compulsive disorder: A systematic review of effect estimates across comparisons. Nordic Journal of Psychiatry. ISSN 0803-9488. 69(2), p. 81–92. doi: 10.3109/08039488.2014.941395. Full text in Research Archive Show summary

  Background: Previous meta-analyses of paediatric obsessive – compulsive disorder (OCD) have shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT) compared with control conditions than for serotonin reuptake inhibitors (SRIs) compared with placebo. Other factors, such as systematic differences in the provided care or exposure to factors other than the interventions of interest (performance bias) may be stronger confounders in psychotherapy research than in pharmacological research. Aims: These facts led us to review SI-CBT studies of paediatric OCD with the aim to compare the effect estimates across different comparisons, including active treatments. Method: We included only randomized controlled trials (RCTs) or cluster RCTs with treatment periods of 12 – 16 weeks. Outcome was post-test score on the Children ’ s Yale – Brown Obsessive Compulsive Scale (CYBOCS). Results: Thirteen papers reporting from 13 RCTs with 17 comparison conditions were included. SI-CBT was superior to wait-list and placebo therapy but not active treatments. Effect estimates for SI-CBT in wait-list comparison studies were signifi cantly larger than in placebo-therapy comparison studies. In addition, the SI-CBT effect estimate was not signifi cantly different when compared with SRIs alone or combined SRIs and CBT. Conclusions: Performance bias may have infl ated previous effect estimates for SI-CBT when comparison contingencies included wait-list. However, the calculated SI-CBT effect estimate was lower but signifi cant when compared with placebo therapy. The effects of SI-CBT and active treatments were not signifi cantly different. In conclusion, our data support the current clinical guidelines, although better comparisons between SI-CBT and SRIs are needed.

• Hanssen-Bauer, Ketil & Kornør, Hege (2014). Måleegenskaper ved den norske versjonen av Child Session Rating Scale (CSRS). PsykTestBarn. Full text in Research Archive Show summary

  Children Session Rating Scale (CSRS) ble opprinnelig utviklet i USA i 2003 av Duncan, Miller og Sparks for å måle alliansen i psykoterapi med barn innenfor rammen av det de har kalt Klient- og resultatstyrt praksis (KOR). Den norske versjonen av CSRS kalles «Skala for samtalevurdering – barn og unge (CSRS)». Den er oversatt av Anne-Grethe Tuseth, og kan lastes ned fra internett. CSRS inneholder fire visuelle analoge skalaer som barn besvarer ved å markere på en strek fra trist ansikt til glad ansikt. Administrering og skåring tar få minutter, og det stilles ingen kompetansekrav til testbrukere. Vårt systematiske litteratursøk etter dokumentasjon for måleegenskapene ved de skandinaviske versjonene av CSRS identifiserte ingen relevante publikasjoner. Det foreligger ingen dokumentasjon på måleegenskapene ved den norske versjonen av CSRS. Studier som undersøker måleegenskaper er derfor nødvendig.

• Mathiassen, Børge Idar; Brøndbo, Per Håkan; Waterloo, Knut; Martinussen, Monica; Eriksen, Mads & Hanssen-Bauer, Ketil [Show all 7 contributors for this article] (2012). IQ as a predictor of clinician-rated mental health problems in children and adolescents. British Journal of Clinical Psychology. ISSN 0144-6657. 51, p. 185–196. doi: 10.1111/j.2044-8260.2011.02023.x. Full text in Research Archive Show summary

  Objective. Previous studies indicate that low IQ is a substantial risk factor for developing mental health problems. Based on these results, we hypothesized that IQ may predict some of the variance in clinician-rated severity of children's mental health problems measured with the Children's Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). The other aims of this study were to examine if there was any difference in the predictive ability of the different IQ scores of the Wechsler Intelligence Scale for Children, Third edition (WISC-III) and to examine if parent-rated measure of child mental health problems could predict the scores on CGAS and HoNOSCA after controlling for IQ, age, and gender. Methods. In this study, 132 patients at three outpatient clinics in North Norway were assessed with the parent version of the Strength and Difficulties Questionnaire (SDQ), HoNOSCA, CGAS, and with the WISC-III. Results. Hierarchical regression analyses were conducted with HoNOSCA and CGAS as dependent variables. Demographics, WISC-III IQ scores, and SDQ were entered as independent variables. The model with HoNOSCA as the dependent variable predicted 25% of the total variance. The WISC-III full-scale IQ predicted an additional 6% of the variance. The analyses with CGAS as the dependent variable gave no significant results. Conclusion. When a patient has a high HoNOSCA score, an intelligence test in addition to an evaluation of symptoms on mental health should be considered. Future research ought to examine whether HoNOSCA's ability to detect change might be affected by patients IQ.

• Hanssen-Bauer, Ketil & Welander-Vatn, Audun (2012). Måleegenskaper ved den norske versjonen av Edinburgh Postnatal Depression Scale (EPDS). PsykTestBarn. 2(3). Full text in Research Archive Show summary

  Beskrivelse. Edinburgh Postanatal Depression Scale (EPDS) ble utviklet i England og publisert i 1987 av John Cox og medarbeidere. Det foreligger to norske oversettelser. Rettighetshaver har godkjent Eberhard-Grans oversettelse. Denne ble uavhengig oversatt tilbake til engelsk og sammenlignet med originalen. The Royal College of Psychiatrists i England er rettighetshaver for engelsk og norsk versjon. EPDS måler depressive symptomer hos barselkvinner og er et selvutfyllingsskjema med 10 spørsmål som besvares på ca 5 minutter. Det kan brukes av helsepersonell som har fått opplæring. Litteratursøk. Vi inkluderte 13 relevante artikler fra 11 norske studier, fire artikler fra fire svenske studier, men vi fant ingen relevante danske artikler. Ni av de norske artiklene rapporterte gjennomsnittsskårer og standardavvik på EPDS for gravide og/eller barselkvinner, hvorav en studie også for kvinner som ikke var gravide eller i barsel. Psykometri. Dokumentasjonen av kriterievaliditeten er svak, siden den er undersøkt i bare én studie (n = 310), og måleegenskapene til referansestandarden, PRIME-MD, er ukjente. Studien viste at for EPDS ≥ 10 er det ingen falske negative, men med 3 % forekomst av alvorlig depresjon er andelen falske positive svært høy (81 %). EPDS har god begrepsvaliditet, basert på høye korrelasjonskoeffisienter med MADRS (r = 0,78) og SCL-25 (r = 0,80) undersøkt i en og samme studie (n = 310). God intern konsistens (Chronbachs α) undersøkt i 5 studier: α gj.sn. = 0,83 (min 0,81; max 0,86); n varierte fra 310 til 2816 i psykometristudiene med gj.sn. 1697. God test-retest reliabilitet undersøkt i en studie: r = 0,74; n = 310. Konklusjon. EPDS har god reliabilitet, men validitet er bare undersøkt i en studie som fant svakheter i diagnostisk presisjon. Det er behov for flere studier av kriterievaliditet hvor EPDS sammenlignes med best mulig depresjonsdiagnostikk.

• Mathiassen, Børge Idar; Brøndbo, Per Håkan; Waterloo, Knut; Martinussen, Monica; Eriksen, Mads & Hanssen-Bauer, Ketil [Show all 7 contributors for this article] (2012). IQ as a moderator of outcome in severity of children's mental health status after treatment in outpatient clinics. Child and Adolescent Psychiatry and Mental Health (CAPMH). 6(22). doi: 10.1186/1753-2000-6-22. Full text in Research Archive Show summary

  Background: Psychotherapy is an effective treatment for mental health disorders, but even with the most efficacious treatment, many patients do not experience improvement. Moderator analysis can identify the conditions under which treatment is effective or whether there are factors that can attenuate the effects of treatment. Methods: In this study, linear mixed model analysis was used to examine whether the Full Scale IQ (FSIQ), Performance IQ (PIQ) and Verbal IQ (VIQ) on the Wechsler Intelligence Scale for Children – Third Edition, moderated outcomes in general functioning and symptom load. A total of 132 patients treated at three outpatient child and adolescent mental health services (CAMHS) were assessed at three different time points. The Children’s Global Assessment Scale (CGAS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were used to measure the severity of impairments in general functioning and symptom load. IQ was assessed at the start of treatment. Results: Moderator analysis revealed that the FSIQ × time interaction predicted changes in CGAS scores (p < .01), and that the PIQ × time interaction predicted changes in HoNOSCA scores (p < .05). The slopes and intercepts in HoNOSCA scores covaried negatively and significantly (p < .05). The same pattern was not detected for the CGAS scores (p = .08). Conclusions: FISQ and PIQ moderated change in general functioning and symptom load, respectively. This implies that patients with higher IQ scores had a steeper improvement slope than those with lower scores. The patients with the highest initial symptom loads showed the greatest improvement, this pattern was not found in the improvement of general functioning.

• Richter, Jörg & Hanssen-Bauer, Ketil (2012). Måleegenskaper ved den norske versjonen av Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). PsykTestBarn. 1(1). Full text in Research Archive Show summary

  Beskrivelse. Kliniker skal fylle ut HoNOSCA ut fra sin vurdering av barn og unges (3–18 år) psykiske problemer og symptomer. HoNOSCA er laget for å evaluere behandlingstiltak i psykisk helsevern for barn og unge. Den originale engelske versjonen ble utviklet av Gowers, Harrington og Whitton og publisert i 1998. Den ble oversatt til norsk i 2001 av Ketil Hanssen-Bauer og uavhengig oversatt tilbake av Torill Ueland. Den norske oversettelsen er godkjent av Simon Gowers (originalens førsteforfatter og leder av The HoNOSCA Team ved University of Liverpool). HoNOSCA er underlagt Crown copyright i Storbritannia. Norsk versjon er fritt tilgjengelig på websiden til RBUP øst og sør. HoNOSCA består av 15 skalaer som hver skåres fra 0 (ikke et problem) til 4 (alvorlig til svært alvorlig problem). Tretten av de 15 skalaene summeres til totalskår som uttrykker klinisk alvorlighetsgrad. Det tar mindre en 10 minutter å fylle ut HoNOSCA. HoNOSCA bør skåres av personer med klinisk kompetanse i barn og unges psykiske helse. Opplæring på 2 ½ time er anbefalt. Litteratursøk. Fem publikasjoner fra fire norske studier og en publikasjon fra en dansk studie er inkludert i vurderingen. De norske publikasjoner rapporterte: reliabilitet basert på 20 vignetter (169 skårere) og 30 pasienter (3 skårere); tverrnasjonal (Norge, Danmark, England, New Zealand og Australia) reliabilitet basert på de samme 20 vignettene (30 skårere); validitet ved sammenligning med relevante spørsmål i ASEBAs spørreskjemaer for foreldre, lærere og ungdommer (CBCL, TRF og YSR) for 153 polikliniske pasienter; prospektive data fra 192 pasienter innlagt i ungdomspsykiatriske akuttavdelinger. Den danske publikasjonen rapporterte en prospektiv valideringsstudie som sammenlignet HoNOSCA med Global Assessment of Psychosocial Disability (GAPD) basert på 173 pasienter. Psykometri. Inter-rater reliabilitet varierte sterkt mellom de forskjellige skalaene både for vignetter og pasienter, men reliabilitet av HoNOSCA totalskår var god for vignetter og tilfredsstillende for pasienter. Meningsfulle gruppeforskjeller og meningsfulle moderate korrelasjoner med korresponderende skaler fra andre standardiserte metoder (ASEBA) indikerer god samtidig og kriterievaliditet av den norske HoNOSCA versjonen. Konklusjon. Dokumentasjonen av validitet og reliabilitet for den norske HoNOSCA versjonen er god men bare basert på studier av én hovedforsker. Flere uavhengige pykometriske studier er ønskelig. Resultater viser at norsk HoNOSCA har gode psykometriske egenskaper, spesielt akseptabel til god inter-

• Garratt, Andrew M; Bjertnæs, Øyvind Andresen; Holmboe, Olaf & Hanssen-Bauer, Ketil (2011). Parent experiences questionnaire for outpatient child and adolescent mental health services (PEQ-CAMHS Outpatients): reliability and validity following a national survey. Child and Adolescent Psychiatry and Mental Health (CAPMH). 5. doi: 10.1186/1753-2000-5-18. Full text in Research Archive Show summary

  Background: Development and evaluation of the PEQ-CAMHS Outpatients, a parent completed questionnaire to measure experiences of outpatient child and adolescent mental health services (CAMHS) in Norway. Methods: Literature review, parent interviews, pre-testing and a national survey of 17,080 parents of children who received care at one of the 86 outpatient CAMHS in Norway in 2006. Telephone interviews were conducted with a random sample of non-respondents. Levels of missing data, factor structure, internal consistency and construct validity were assessed. Results: 7,906 (46.0%) parents or primary caregivers responded to the questionnaire. Low levels of missing data suggest that the PEQ-CAMHS is acceptable. The questionnaire includes three scales supported by the results of factor analysis: relationship with health personnel (8 items), information and participation (4 items), and outcome (3 items). Item-total correlations were all above 0.6 and Cronbach's alpha correlations ranged from 0.88-0.94. The results of comparisons of scale scores with several variables relating to global satisfaction, outcome, cooperation, information, involvement and waiting time support the construct validity of the instrument. Conclusions: The PEQ-CAMHS Outpatients questionnaire includes important aspects of outpatient CAMHS from the perspective of the parent. It has evidence for data quality, internal consistency and validity and is recommended in surveys of parent experiences of these services. Future research should assess test-retest reliability and further tests of construct validity that include clinical data are recommended.

• Holmboe, Olaf; Iversen, Hilde Hestad & Hanssen-Bauer, Ketil (2011). Determinants of parents' experiences with outpatient child and adolescent mental health services. International Journal of Mental Health Systems. 5. doi: 10.1186/1752-4458-5-22. Full text in Research Archive Show summary

  Few studies have investigated how demographic, clinical and organizational characteristics influence parents' experiences with child and adolescent mental health services (CAMHS). The objective of this study was to determine the effects of these characteristics on parents' experiences using data from a large national postal survey. A questionnaire was mailed to 17,871 parents or other primary caregivers whose children were attending 1 of the 86 outpatient CAMHS in Norway in 2006. Multiple regression analysis was used to explore the associations between demographic, clinical and organizational characteristics, and three scales of parents' experiences. The questionnaire was completed by 7906 parents (46%). Organizational characteristics such as involvement of the parents in treatment and accessibility to the clinic explained most of the variation in all three scales of parents' experiences. Although the effects of demographic and clinical characteristics of the children in some instances were statistically significant, they only accounted for a small amount of the total explained variance. Accessibility to the clinic and involvement of the parents in treatment are much stronger predictors of parental experiences with outpatient CAMHS than are demographic and clinical variables. Accessibility and involvement are at least partly influenced by the clinics themselves, and hence parental satisfaction may be enhanced by making the clinics more accessible and by involving the parents/caregivers in the treatment.

• Hanssen-Bauer, Ketil; Heyerdahl, Sonja; Hatling, Trond; Jensen, Gunnar Hal; Olstad, Pål Marius & Stangeland, Tormod [Show all 7 contributors for this article] (2011). Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome. International Journal of Mental Health Systems. 5. doi: 10.1186/1752-4458-5-1. Full text in Research Archive Show summary

  Background: Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods: We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score) were analysed with a regression model. Results: The sample comprised 192 adolescents admitted during one year (response rate 87%). Mean age was 15.7 years (range 10-18) and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4). The largest groups of main diagnostic conditions were affective (28%) and externalizing (26%) disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA) at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement) in the HoNOSCA total score was 5.1 (SD 6.2), with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission. Conclusions: Acute psychiatric in-patient units for adolescents effectively meet important needs for young people with suicidal risks or other severe mental health problems. These units may act in suicide prevention, stabilizing symptom severity at a lower level within a short stay. It is important to explore the differences in outcome, compulsory admissions, and length of stay between units.

• Hanssen-Bauer, Ketil; Langsrud, Øyvind; Kvernmo, Siv & Heyerdahl, Sonja (2010). Clinician-rated mental health in outpatient child and adolescent mental health services: associations with parent, teacher and adolescent ratings. Child and Adolescent Psychiatry and Mental Health (CAPMH). 29(4). doi: 10.1186/1753-2000-4-29. Full text in Research Archive Show summary

  Background: Clinician-rated measures are used extensively in child and adolescent mental health services (CAMHS). The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a short clinician-rated measure developed for ordinary clinical practice, with increasing use internationally. Several studies have investigated its psychometric properties, but there are few data on its correspondence with other methods, rated by other informants. We compared the HoNOSCA with the well-established Achenbach System of Empirically Based Assessment (ASEBA) questionnaires: the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR). Methods: Data on 153 patients aged 6-17 years at seven outpatient CAMHS clinics in Norway were analysed. Clinicians completed the HoNOSCA, whereas parents, teachers, and adolescents filled in the ASEBA forms. HoNOSCA total score and nine of its scales were compared with similar ASEBA scales. With a multiple regression model, we investigated how the ASEBA ratings predicted the clinician-rated HoNOSCA and whether the different informants' scores made any unique contribution to the prediction of the HoNOSCA scales. Results: We found moderate correlations between the total problems rated by the clinicians (HoNOSCA) and by the other informants (ASEBA) and good correspondence between eight of the nine HoNOSCA scales and the similar ASEBA scales. The exception was HoNOSCA scale 8 psychosomatic symptoms compared with the ASEBA somatic problems scale. In the regression analyses, the CBCL and TRF total problems scores together explained 27% of the variance in the HoNOSCA total scores (23% for the age group 11-17 years, also including the YSR). The CBCL provided unique information for the prediction of the HoNOSCA total score, HoNOSCA scale 1 aggressive behaviour, HoNOSCA scale 2 overactivity or attention problems, HoNOSCA scale 9 emotional symptoms, and HoNOSCA scale 10 peer problems; the TRF for all these except HoNOSCA scale 9 emotional symptoms; and the YSR for HoNOSCA scale 9 emotional symptoms only. Conclusion: This study supports the concurrent validity of the HoNOSCA. It also demonstrates that parents, teachers and adolescents all contribute unique information in relation to the clinician-rated HoNOSCA, indicating that the HoNOSCA ratings reflect unique perspectives from multiple informants.

• Bjørngaard, Johan Håkon; Andersson, Helle Wessel; Ose, Solveig Osborg & Hanssen-Bauer, Ketil (2008). User satisfaction with child and adolescent mental health services: impact of the service unit level. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 43(8), p. 635–641. doi: 10.1007/s00127-008-0347-8. Full text in Research Archive Show summary

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

• Bjertnæs, Øyvind Andresen; Garratt, Andrew Malcolm; Helgeland, Jon; Holmboe, Olaf; Dahle, Kari Aanjesen & Hanssen-Bauer, Ketil [Show all 7 contributors for this article] (2008). Foresattes vurdering av barne- og ungdomspsykiatriske poliklinikker. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 118(9), p. 1041–1045. Full text in Research Archive Show summary

  Bakgrunn: De foresattes vurderinger av poliklinikkene innen barne- og ungdomspsykiatrien (BUP) er blitt en del av det nasjonale kvalitetsindikatorsystemet. Vi presenterer resultater fra en nasjonal undersøkelse der foresatte vurderte alle BUP-poliklinikker i Norge. Materiale og metode: Vi samlet inn data blant et utvalg foresatte til barn/ungdom som hadde et tilbud ved poliklinikkene i perioden 1.9. – 31.12. 2006. Vi sendte spørreskjema i posten til barnas hjemmeadresse, purret inntil to ganger og mottok 7 906 besvarte skjemaer (46 %). I tillegg ble et utvalg ikke-svarere telefonintervjuet. Det ble identifisert tre dimensjoner for foresattes erfaringer – behandlere, medbestemmelse/informasjon og utbytte. Resultater: De foresatte var mest fornøyd med behandlerne. Det nasjonale gjennomsnittet var 75 på behandlerdimensjonen (på en skala fra 0 til 100, der 100 er best), 72 på utbyttedimensjonen og 59 på dimensjonen informasjon og medbestemmelse. På alle dimensjoner var det stor spredning i poliklinikkenes gjennomsnitt, størst for informasjon og medbestemmelse, der beste gjennomsnitt var 68 og dårligste 48. Det var imidlertid få signifikante forskjeller mellom poliklinikkene og landsgjennomsnittet på alle tre dimensjonene. Fortolkning: De foresatte rapporterer gode erfaringer med poliklinikkene. Det var størst forbedringspotensial på området informasjon og medbestemmelse. Flere poliklinikker hadde gjennomgående høye resultater og kan ha nyttige erfaringer å formidle til andre poliklinikker.

• Hanssen-Bauer, Ketil; Aalen, Odd O.; Ruud, Torleif & Heyerdahl, Sonja (2007). Inter-rater reliability of clinician-rated outcome measures in child and adolescent mental health services. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 34(6), p. 504–512. doi: 10.1007/s10488-007-0134-y. Full text in Research Archive Show summary

  This study investigated the inter-rater reliability when 169 out of 171 clinicians working in 10 Norwegian child and adolescent mental health services rated 20 written vignettes using the following outcome measures: Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), Children’s Global Assessment Scale (CGAS) and Global Assessment of Psychosocial Disability (GAPD). Three clinicians rated both patients and vignettes. On vignettes the intraclass correlation coefficient (ICC) for the HoNOSCA total score was 0.81 (single scales 0.47–0.96), for the CGAS 0.61 and for the GAPD 0.60. The reliability was not lower on patients. The rater’s profession, experience or clinic did not have effect on the scores

• Hanssen-Bauer, K; Gowers, S; Aalen, Odd O.; Bilenber, N; Brann, P & Garralda, E [Show all 8 contributors for this article] (2007). Cross-national reliability of clinician-rated outcome measures in child and adolescent mental health services. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 34, p. 513–518. doi: 10.1007/s10488-007-0135-x. Full text in Research Archive Show summary

  Clinician-rated measures are in extensive use as routine outcome measures in child and adolescent mental health services. We investigated cross-national differences and inter-rater reliability of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), the Children’s Global Assessment Scale (CGAS) and the Global Assessment of Psychosocial Disability (GAPD). Thirty clinicians from 5 nations independently rated 20 written vignettes. The national groups afterwards established national consensus ratings. There were no cross-national differences in independent scores, but there were differences in national consensus scores, which were also more severe than independent scores. The ICC for the HoNOSCA total score was 0.84, for the CGAS 0.61 and for the GAPD 0.54. These measures may usefully contribute to cross-national comparison studies.

• Hanssen-Bauer, Ketil; Heyerdahl, Sonja & Eriksson, Ann-Sofie (2007). Mental health problems in children and adolescents referred to a national epilepsy center. Epilepsy & Behavior. ISSN 1525-5050. 10(2), p. 255–262. doi: 10.1016/j.yebeh.2006.11.011. Full text in Research Archive Show summary

  This study aimed to investigate the occurrence of psychiatric morbidity in children and adolescents referred to a tertiary national epilepsy center (inpatient unit) and the extent of the unmet need for psychiatric services in this group. Participants were 74 children and adolescents aged 9–15 referred from February 2001 to October 2002 (67% response rate). The multi-informant (parent, teacher, self-report) Strengths and Difficulties Questionnaires (SDQs) were answered before or at admission. Patients with severe mental retardation or pervasive developmental disorder were excluded. We found a large proportion (77%) with a possible or probable psychiatric disorder. The parents, teachers, and adolescents themselves had higher mean SDQ scores than a British community sample on total difficulties, emotional symptoms, conduct problems, hyperactivity–inattention, peer problems, and impairment, but not self-reported conduct problems. Nearly 80% of the children who probably had a psychiatric disorder had no contact with the psychiatric service.

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• Ellingsen-Dalskau, Lina Harvold; Bjertnæs, Øyvind Andresen; Hanssen-Bauer, Ketil & Iversen, Hilde Karin Hestad (2026). Development and validation of a follow-up questionnaire for patients discharged from inpatient mental health care. Full text in Research Archive
• Nyland, Camilla Skau; Siqveland, Johan; Hanssen-Bauer, Ketil; Ellingsen-Dalskau, Lina Harvold & Iversen, Hilde Karin Hestad (2025). Pasientrapporterte erfaringer etter utskrivelse fra spesialisert døgnbehandling i psykisk helsevern: En nasjonal studie av variasjon mellom pasientgrupper. Full text in Research Archive
• Jelin, Elma; Ellingsen-Dalskau, Lina Harvold; Hanssen-Bauer, Ketil; Siqveland, Johan; Isham, Aleksandra Eriksen & Nyland, Camilla Skau [Show all 7 contributors for this article] (2025). Patient Experience Measurement in Mental Health and Substance Dependence inpatient care: Development of Short Versions of Validated Questionnaires Through Importance Ranking and Psychometric testing. Full text in Research Archive
• Iversen, Hilde Karin Hestad; Kjøllesdal, Marte Karoline Råberg; Nyland, Camilla Skau; Skudal, Kjersti Eeg; Hanssen-Bauer, Ketil & Isham, Aleksandra Eriksen [Show all 8 contributors for this article] (2025). Towards more inclusive patient experience surveys: Applying a standardised TRAPD-based approach for translating and adapting measures for Polish-speaking inpatients in psychiatric and substance dependence care in Norway (PRQMs-MAS*). Full text in Research Archive
• Iversen, Hilde Karin Hestad; Ellingsen-Dalskau, Lina Harvold; Paulsrud, Inger Opedal; Haugum, Mona; Jelin, Elma & Bjertnæs, Øyvind Andresen [Show all 11 contributors for this article] (2024). Patient-Reported Quality of Mental Health and Addiction Services: A longitudinal Study on Specialist and Primary Care in Norway. Full text in Research Archive
• Jelin, Elma; Ellingsen-Dalskau, Lina Harvold; Hanssen-Bauer, Ketil; Siqveland, Johan; Isham, Aleksandra Eriksen & Nyland, Camilla Skau [Show all 7 contributors for this article] (2024). Patient and Health Care Workers' Perspectives in Mental Health and Substance Dependence Care: The Short-Form Development of the PIPEQ-CEM* and the PEQ-ITSD – CEM** (PRQMs-MAS***). Full text in Research Archive
• Sannes, Annika; Rognli, Erling W.; Hanssen-Bauer, Ketil; Torp, Nor Christian & Aalberg, Marianne (2024). Barriers and facilitators to implementation of internet-delivered therapist-guided therapy in child and adolescent mental health services: A systematic review. Full text in Research Archive
• Iversen, Hilde Karin Hestad; Ellingsen-Dalskau, Lina Harvold; Skudal, Kjersti Eeg; Aasgaard, Karoline; Linnemørken, Lene Therese Bergerud & Kjøllesdal, Marte Karoline Råberg [Show all 9 contributors for this article] (2023). A new generation of Patient-Reported Quality Measurements in Mental health and Addiction Services (PRQMs-MAS). Full text in Research Archive
• Vatne, Karin; Kristensen, Hanne; Bengtson, Mette; Harstad, Stine; Hanssen-Bauer, Ketil & Villabø, Marianne Aalberg (2014). Erfaringer med å implementere evidensbaserte metoder for utredning og behandling av barn med angstlidelser. Full text in Research Archive
• Vatne, Karin; Kristensen, Hanne; Bengtson, Mette; Harstad, Stine; Hanssen-Bauer, Ketil & Villabø, Marianne Aalberg (2014). Effektivitet av standardisert evidensbasert utredning for angstlidelser i BUP. Full text in Research Archive
• Vatne, Karin; Hanne, Kristensen; Bengtson, Mette; Harstad, Stine; Hanssen-Bauer, Ketil & Villabø, Marianne (2014). Effektivitet av standardisert evidensbasert utredning for angstlidelser i BUP. Full text in Research Archive
• Mathiassen, Børge Idar; Brøndbo, Per Håkan; Waterloo, Knut; Martinussen, Monica; Eriksen, Mads & Hanssen-Bauer, Ketil [Show all 7 contributors for this article] (2012). IQ as a moderator of outcome in severity of children's mental health status after treatment in outpatient clinics. Full text in Research Archive
• Mathiassen, Børge; Brøndbo, P H; Eriksen, M; Hanssen-Bauer, Ketil; Martinussen, Monica & Waterloo, Knut [Show all 7 contributors for this article] (2009). IQ som prediktor for funksjonssvikt og psykisk helsetilstand hos barn og ungdom henvist til BUP. Full text in Research Archive
• MØRDRE, MARIANNE & Hanssen-Bauer, Ketil (2006). Bokanmeldelse av: Da barnepsykiatrien kom til Norge : beretninger ved noen som var med. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 126(7), p. 947–947. Full text in Research Archive
• Vittersø, Axel; Isham, Aleksandra Eriksen; Siqveland, Johan & Hanssen-Bauer, Ketil (2023). Hvorfor er det økt belegg på Akuttpsykiatrisk avdeling på Ahus? Evalueringsrapport. Ahus. Full text in Research Archive
• Nyttingnes, Olav; Hanssen-Bauer, Ketil; Ruud, Torleif & Rugkåsa, Jorun (2018). Patients’ Experience of Coercion in Mental Health Care. Universitetet i Oslo. Full text in Research Archive Show summary

  Tvangsinnleggelse, tvangsbehandling og tvangsmidler er inngripende tiltak som kan brukes ved alvorlig psykisk lidelse. Likevel samsvarer ikke alltid bruk av tvang med pasientenes opplevelse av å være tvunget. I studien Patients’ Experience of Coercion in Mental Health Care, undersøker Nyttingnes og kolleger opplevelsen av tvang i psykisk helsevern, og utvikler et standardisert spørreskjema for å måle dette. De undersøker også opplevd tvang hos ungdommer i døgnbehandling, og de foreslår en modell for å forstå forholdet mellom bruk av tvang og opplevelse av tvang. Analyse av referater fra åpne dialogmøter viste at de som var misfornøyde med tvang beskrev tvang med svært negative ord som krenkelse og mishandling. De vurderte at medisiner mot psykose hadde virket dårlig for dem, og at denne behandlingen likevel fortsatte under press og tvang. Denne kunnskapen var med når Nyttingnes og kolleger utviklet måleskalaen Experienced Coercion Scale (ECS). En lang rekke utsagn om opplevelse av tvang ble testet på pasienter i ulike deler av psykisk helsevern, slik at man kunne finne de beste utsagnene. Skalaen er et enkelt og følsomt mål på om man opplever omsorg og behandling som tvang eller ikke. Hos voksne er tvangsbehandling med medikamenter den tvangsformen som er tettest knyttet til høy opplevd tvang. Men selv blant disse pasientene rapporterer over 30 % lav opplevd tvang. Ungdommer i døgnavdelinger rapporterte omtrent samme nivå av opplevd tvang som voksne i samme type avdelinger. Hos ungdom var det behandling og tiltak for spiseforstyrrelser som bidro mest til høy opplevd tvang, mens ungdommer med psykose rapporterte lav opplevd tvang og var stort sett i frivillig behandling. Sentrale faktorer i modellen om opplevd tvang er pasientens vurdering av om bruken av tvang er rimelig, og om den er rettferdig besluttet og gjennomført. Modellen kan forklare funn i denne og flere andre studier om opplevd tvang. Den kan også klargjøre hvordan man kan redusere opplevd tvang, og den kan bidra til å identifisere viktige problemstillinger for framtidige studier.

• Hanssen-Bauer, Ketil & Heyerdahl, Sonja (2010). Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) as a routine measure in child and adolescent mental health services : reliability, validity and use of a clinician-rated measure. Universitetet i Oslo. ISSN 9788282640053. Full text in Research Archive

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