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• Ghetti, Claire; Chen, Xi-Jing; Brenner, Annette; Hakvoort, Laurien G; Lien, Lars & Fachner, Jorg [Show all 7 contributors for this article] (2022). Music therapy for people with substance use disorders. Cochrane Database of Systematic Reviews. ISSN 1469-493X. 2022(5). doi: 10.1002/14651858.CD012576.pub3.
• Pandey, Susmita; Bolstad, Ingeborg; Lien, Lars; Walby, Fredrik A; Myhre, Martin Øverlien & Bramness, Jørgen Gustav (2022). Sex-specific factors associated with lifetime suicide attempt among patients with alcohol use disorders. BJPsych Open. ISSN 2056-4724. 8(4), p. 1–7. doi: 10.1192/bjo.2022.545. Full text in Research Archive Show summary

  Background: Patients with alcohol use disorder (AUD) are at high risk for suicide attempts. Mental health problems along with AUD-related factors may contribute to this increased risk. Studies have shown sex differences in rates and correlates of suicide attempts. Aims: The purpose of the study was to examine mental-health-related and AUD-related factors associated with suicide attempt separately in female and male AUD patients. Method: We collected information about lifetime suicide attempt and mental-health- and AUD-related factors for AUD in-patients (n = 114; 32 females) receiving rehabilitative treatment. Results: The prevalence of lifetime suicide attempt was 27%, and the rate was similar in both sexes. Among females, current depressive symptoms and current post-traumatic stress disorder diagnosis were associated with suicide attempt. In male AUD patients, among the mental-health-related factors, lifetime major depression, panic disorder, social phobia, childhood sexual abuse and antisocial personality disorder were associated with suicide attempt. In addition, AUD-related factors including longer duration of drinking, history of delirium tremens, greater severity of AUD and lower levels of prolactin were associated with suicide attempt in males. Conclusions: Our results indicate that suicide attempts in female AUD patients were more mental-health-related, whereas those in males were also related to the severity of AUD. This suggests that a suicide prevention programme for AUD patients would benefit from a sex-based understanding of the risk factors.

• Balieva, Flora Nicol; Schut, Christina; Kupfer, Jörg; Lien, Lars; Misery, Laurent & Sampogna, Francesca [Show all 8 contributors for this article] (2022). Perceived stress in patients with inflammatory and non‐ inflammatory skin conditions. An observational controlled study among 255 Norwegian dermatological outpatients. Skin Health and Disease. ISSN 2690-442X. doi: 10.1002/ski2.162.
• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2022). Association of daily hassles, daily uplifts, coping styles and stress-related symptoms among women exposed to sexual abuse—A cross-sectional study. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. p. 1–14. doi: 10.1111/scs.13107.
• Mthoko, Ndahambelela Frederika Nepando; Pazvakawambwa, Lilian; Leonhardt, Marja & Lien, Lars (2022). Physical comorbidity among patients attending mental health services at Windhoek Central Hospital, Namibia. Pan African Medical Journal. ISSN 1937-8688. 41. doi: 10.11604/pamj.2022.41.270.27134.
• Sørensen, Torgeir & Lien, Lars (2022). Significance of Self-Transcendence for Rehabilitation and Relapse Prevention among Patients with Substance Use Disorder: A Qualitative Study. Religions. ISSN 2077-1444. 13(6), p. 1–13. doi: 10.3390/rel13060491. Full text in Research Archive
• Sanhori, Zienat Balla Mohamed Ahmed; Lien, Lars; Hauff, Edvard; Ayazi, Touraj; Mdala, Ibrahimu & Eide, Arne Henning (2022). Change in Disability Associated with Psychological Distress among Internally Displaced Persons in Central Sudan. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(9). doi: 10.3390/ijerph19095347. Full text in Research Archive
• Toft, Helge; Bramness, Jørgen Gustav & Lien, Lars (2022). Levels of Peripheral Circulating IL-6 and IL-10 Decrease Over Time Despite High Depression Burden in PTSD Patients. Neuropsychiatric Disease and Treatment. ISSN 1176-6328. 18, p. 737–747. doi: 10.2147/NDT.S357797. Full text in Research Archive
• Mæland, Ragnhild; Lien, Lars & Leonhardt, Marja (2022). Association between cannabis use and physical health problems in Norwegian adolescents: a cross-sectional study from the youth survey Ungdata. BMC Public Health. ISSN 1471-2458. 22. doi: 10.1186/s12889-022-13136-6. Full text in Research Archive
• Kaldenbach, Siri; Leonhardt, Marja; Lien, Lars; Bjertnæs, Asborg Sine Aanstad; Strand, Tor Arne & Holten-Andersen, Mads Nikolaj (2022). Sleep and energy drink consumption among Norwegian adolescents – a cross-sectional study. BMC Public Health. ISSN 1471-2458. 22. doi: 10.1186/s12889-022-12972-w. Show summary

  Background Adolescents are recommended to get 8–10 h of sleep at night, yet more than 80% fail to obtain this goal. Energy drink (ED) consumption has been linked to later bedtime in adolescents. Therefore, we aimed to investigate the potential association between ED consumption and sleep duration, and shuteye latency among adolescents in Norway. Methods This study was based on data from 15- to 16-year-old adolescents living in Oppland County in 2017. In total, 1353 adolescents were included in the analysis. Multiple regression models were used to estimate the associations between the frequency of ED consumption with sleep duration, shuteye latency, and getting 8 h of sleep. Results Forty-six point five percent of the adolescents reported sleeping more than 8 h at night. Those who reported ED consumption at any frequency had significantly shorter sleep duration than those who did not. On average, high consumers of ED (consuming ED ≥ 4 times a week) had 0.95 (95% CI: 0.61, 1.28) hours (i.e., 57 min) less sleep than those who never consumed ED. In addition, high consumers had more than 25 min (95% CI: 13.95, 36.92) longer shuteye period than those who never consumed ED. Conclusion Most ED consumers fail to obtain the recommended 8 h of sleep at night, which could be a consequence of shorter sleep duration and longer shuteye latency. We found a dose-response relationship between frequency of ED consumption and reduced sleep. Yet, the potential long-term effects of both ED consumption and insufficient sleep among adolescents remain unclear.

• Olstad, Kjersti; Lien, Lars; Leonhardt, Marja; Sørensen, Torgeir & Danbolt, Lars Johan (2022). Therapists and the Topic of Meaning in Life in Their Encounters With Adolescents With Developmental Trauma: A Qualitative Study. Frontiers in Psychiatry. ISSN 1664-0640. doi: 10.3389/fpsyt.2022.835491. Full text in Research Archive
• Leonhardt, Marja; morten, brodahl; Cogan, Nicola & Lien, Lars (2022). How did the first COVID-19 lockdown affect persons with concurrent mental health and substance use disorders in Norway? A qualitative study. BMC Psychiatry. ISSN 1471-244X. doi: 10.1186/s12888-022-03812-7. Full text in Research Archive
• Schut, Christina; Dalgard, Florence; Bewley, Anthony; Evers, Andrea Walburga Maria; Gieler, Uwe & Lien, Lars [Show all 31 contributors for this article] (2022). Body dysmorphia in common skin diseases: results of an observational, cross-sectional multicentre study among dermatological outpatients in 17 European countries*. British Journal of Dermatology. ISSN 0007-0963. 187(1), p. 115–125. doi: 10.1111/bjd.21021. Full text in Research Archive Show summary

  Background: Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. Objectives: To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. Methods: This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. Results: The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. Conclusions: This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management

• Lien, Ingebjørg Aspeland; Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen Gustav (2021). Screening for depression in patients in treatment for alcohol use disorder using the Beck Depression Inventory-II and the Hopkins Symptom Checklist-10 . Psychiatry Research. ISSN 0165-1781. 308, p. 1–8. doi: 10.1016/j.psychres.2021.114363. Full text in Research Archive
• Aye, Win Thuzar; Lien, Lars; Stigum, Hein & Bjertness, Espen (2021). Childhood abuse and its association with adults’ mental health problems: A cross-sectional study among men and women in the Yangon Region of Myanmar. BMJ Open. ISSN 2044-6055. 11(11). doi: 10.1136/bmjopen-2020-045870. Full text in Research Archive
• Abebe, Dawit Shawel; Lien, Lars & Bramness, Jørgen Gustav (2021). Effects of age and gender on the relationship between alcohol use disorder and somatic diseases: a national register study in Norway. BMJ Open. ISSN 2044-6055. 11(11). doi: 10.1136/bmjopen-2021-050608. Full text in Research Archive Show summary

  Objective: This study aimed to examine how age and gender moderate the associations between alcohol use disorders (AUD) and several somatic diseases. Design and setting: We performed a retrospective, register-based cohort study with 6-years follow-up of AUD patients and the general population. Data were acquired from the Norwegian Patient Registry. Cox regressions were used to estimate hazard ratios (HRs) of somatic diseases. Participants: AUD patients (17,023; 0.4%) were compared to the population without AUD (4,271,559; 99.6%), with adults aged 18 years or older who were registered residents of Norway on January 1, 2008. Main outcomes: Dichotomous variables of 12 specific somatic diseases (cardiovascular diseases, endocrine, nutritional, and metabolic diseases, cancer, and infectious diseases) were assessed. Diagnoses were set in specialist health care services. Results: AUD patients, compared with a population without AUD, experienced a significantly greater burden of all studied somatic diseases. Middle-aged adults with AUD had increased risks (p0.05). Males with AUD had significantly higher risks for pulmonary heart diseases (HR= 3.9, 95% CI 3.3-4.6) and metabolic disorders (HR 4.7, 95% CI 4.5-5.0), while females with AUD had a significantly higher risk for viral hepatitis (HR = 4.4, 95% CI 3.8-5.1). Conclusions: Age moderated the associations between AUD and most somatic diseases, with middle-aged adults with AUD having a greater increased risk of somatic diseases compared to younger and older adults with AUD. Gender only moderated associations between AUD and pulmonary heart diseases, metabolic disorders, and viral hepatitis. This has implications for the prioritization of somatic resources among patients with AUD.

• Pandey, Susmita; Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen Gustav (2021). Factors associated with the level of prolactin in patients under remission from Alcohol Use Disorder: A gender perspective. Neuropsychopharmacology Reports. ISSN 2574-173X. 41(3), p. 352–361. doi: 10.1002/npr2.12182. Full text in Research Archive
• Dybdahl, Ragnhild; Sørensen, Torgeir; Hauge, Hans A.; Røsvik, Kjersti; Lien, Lars & Eide, Ketil (2021). Same but different: meaning-making among refugee and non-refugee youths. International Journal of Migration, Health and Social Care. ISSN 1747-9894. 17(4), p. 433–448. doi: 10.1108/IJMHSC-02-2021-0019. Full text in Research Archive
• Roer, Grethe Emilie; Solbakken, Heidi Hurlen; Abebe, Dawit Shawel; Aaseth, Jan; Bolstad, Ingeborg & Lien, Lars (2021). Inpatients experiences about the impact of traumatic stress on eating behaviors: an exploratory focus group study. Journal of Eating Disorders. ISSN 2050-2974. 9, p. 1–12. doi: 10.1186/s40337-021-00480-y. Full text in Research Archive
• Pandey, Susmita; Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen Gustav (2021). Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (AUD): Characteristics and Predictors of Early Relapse or Drop-Out. Substance Abuse and Rehabilitation. ISSN 1179-8467. 12, p. 11–22. doi: 10.2147/SAR.S296526. Full text in Research Archive
• Kour, Prabhjot; Lien, Lars; Kumar, Bernadette N; Nordaunet, Ole Martin; Biong, Stian & Pettersen, Henning (2021). Health Professionals’ Experiences with Treatment Engagement Among Immigrants with Co-occurring Substance Use- and Mental Health Disorders in Norway. Substance Abuse: Research and Treatment. ISSN 1178-2218. 15, p. 1–11. doi: 10.1177/11782218211028667. Full text in Research Archive
• Lien, Lars; Bolstad, Ingeborg & Bramness, Jørgen G. (2021). Smoking among inpatients in treatment for substance use disorders: prevalence and effect on mental health and quality of life. BMC Psychiatry. ISSN 1471-244X. 21. doi: 10.1186/s12888-021-03252-9. Full text in Research Archive Show summary

  Background: Smoking is still prevalent among people with substance use disorders. The objective of this study was to investigate the prevalence of smoking among patients in treatment for substance use disorders and to analyze the effect of smoking both at baseline and follow-up on drop-out, mental health and quality of life. Methods: One hundred and twenty-eight inpatients (26% female), mainly with alcohol use disorder, staying at three different rehabilitation clinics in Eastern Norway, were interviewed at admission, and at 6 weeks and 6 months follow-up. The interview contained mental health-related problems, trauma, questions on alcohol and other substances and quality of life. Non-parametric tests were used to test group differences and unadjusted and adjusted linear regression to test the associations between smoking and the main outcome variables, while logistic regression was used to test the association between smoking and drop-out. Results: At admission, 75% were daily smokers. Compared to non-smokers at baseline, the smokers had higher drop-out rates (37% vs. 13%), more mental distress, and lower quality of life from baseline up to 6 months followup. Those quitting smoking while admitted improved in mental distress and quality of life at the same rate as nonsmokers. Alcohol-related factors did not differ between smokers and non-smokers. Conclusions: Smoking was associated with mental distress, quality of life and treatment drop-out among patients in primary alcohol use disorder treatment. The results indicate that smoking cessation should be recommended as an integral part of alcohol use treatment both before and during inpatient treatment to reduce drop-out. Keywords: Mental health problems, Alcohol use disorder, Smoking, Drop-out © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

• Toft, Helge; Bramness, Jørgen Gustav; Tilden, Terje; Bolstad, Ingeborg & Lien, Lars (2021). Persistent level of mental distress in PTSD patients is not reflected in cytokine levels 1 year after the treatment. Acta Neuropsychiatrica. ISSN 0924-2708. 33(5), p. 254–260. doi: 10.1017/neu.2021.11. Full text in Research Archive Show summary

  Objective: Cross-sectional data show that post-traumatic stress disorder (PTSD) patients often have increased levels of circulating inflammatory markers. There is, however, still a paucity of longitudinal studies with long follow-up times on levels of cytokines in such patients. The current study assesses patients with and without PTSD diagnosis 1 year after discharge from inpatient treatment. Methods: Patients in treatment for serious non-psychotic mental disorders were recruited at the beginning of their treatment stay at a psychiatric centre in Norway. Ninety patients submitted serum samples and filled out the Hopkins Symptom Checklist-90 Revised Global Severity Index (HSCL-90R GSI) questionnaire during their mainstay and at a follow-up stay 1 year after discharge. Of these patients, 33 were diagnosed with PTSD, 48 with anxiety, depression, or eating disorder, while 9 patients had missing data. The patients were diagnosed using the Mini-International Neuropsychiatric Interview (MINI). Results: At the follow-up stay (T3), PTSD patients had higher levels of GSI scores than non-PTSD patients (p = 0.048). These levels were unchanged from the year before (T2) in both groups. The levels of circulating cytokines/chemokine did not differ between the PTSD and non-PTSD patients at T3. At T2, however, the PTSD and non-PTSD groups exhibited different levels of interleukin 1β (IL-1β) (p = 0.053), IL-1RA (p = 0.042), and TNF-α (p = 0.037), with the PTSD patients having the higher levels. Conclusion: Despite exhibiting different mental distress scores, the PTSD and non-PTSD patients did not differ regarding levels of circulating inflammatory markers at 1-year follow-up. © The Author(s), 2021. Published by Cambridge University Press in association with Scandinavian College of Neuropsychopharmacology.

• Abraham, Ruth; Leonhardt, Marja; Lien, Lars; Hanssen, Ingrid; Hauff, Edvard & Thapa, Suraj Bahadur (2021). The relationship between religiosity/spirituality and quality of life among female Eritrean refugees living in Norwegian asylum centres. International Journal of Social Psychiatry. ISSN 0020-7640. doi: 10.1177/00207640211010207. Full text in Research Archive Show summary

  Background: Women are more vulnerable to mental health problems than men after migration, but little is known about the influence of religiosity/spirituality on their quality of life. The purpose of this study was to explore religiosity/spirituality, in relationships with various domains of quality of life, among female Eritrean refugees staying in Norwegian asylum centres. Method: A questionnaire assessing sociodemographic characteristics was used together with the World Health OrganizationQuality of Life – Spirituality, Religiosity and Personal Beliefs (WHOQOL-SRPB) questionnaire, which assesses religiosity/spirituality and domains of quality of life. A total of 63 adult female Eritrean refugees who had been granted asylum but were still living in asylum reception centres located in southern and central Norway participated. Results: Religiosity/spirituality was independently associated with psychological quality of life (B = 0.367, p < .001), level of independence (B = 0.184, p = .028), social quality of life (B = 0.500, p = .003), environmental quality of life (B = 0.323, p < .001) and overall quality of life (B = 0.213, p < .001), but not with physical quality of life (B = 0.056, p = .679). There were no significant differences between religious affiliations on religiosity/spirituality or quality of life measures. Conclusion: Consistent with previous research, this study highlights the correlation between religiosity/spirituality and overall quality of life. We recommend a longitudinal follow-up study of similar populations, after they are resettled and integrated into their host countries, to understand the associations between quality of life and religiosity/spirituality over time. Keywords Eritrea, refugees, religiosity, spirituality, quality of life, well-being

• Bolstad, Ingeborg; Lien, Lars & Bramness, Jørgen G. (2021). ADHD symptoms as risk factor for PTSD in inpatients treated for alcohol use disorder. Psychiatry Research. ISSN 0165-1781. 300, p. 1–6. doi: 10.1016/j.psychres.2021.113904. Full text in Research Archive
• Oerbeck, Beate; Overgaard, Kristin Romvig; Hjellvik, Vidar; Lien, Lars & Bramness, Jørgen G (2021). The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care. Journal of child and adolescent psychopharmacology. ISSN 1044-5463. 31(5), p. 350–357. doi: 10.1089/cap.2020.0123. Full text in Research Archive Show summary

  Objectives: To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Methods: Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age and gender adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age and gender. Results: 1856 children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥13 years. Among those, 423 or 23% used any of the three psychotropics, significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most. Polypharmacy was not frequent in RC, as only 26% used ≥ 2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and while the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6 to16 year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (CI: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (CI: 0.9-1.0). Conclusion: The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.

• Silwal, Sanju; Chudal, Roshan; Dybdahl, Ragnhild; Sillanmaki, Lauri; Lien, Lars & Sourander, A (2021). Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study. Child Psychiatry and Human Development. ISSN 0009-398X. doi: 10.1007/s10578-021-01136-3. Full text in Research Archive
• Sanhori, Zienat Balla Mohamed Ahmed; Hauff, Edvard; Eide, Arne Henning; Mdala, Ibrahimu; Abdelrahman, Abdullah & Brunborg, Cathrine [Show all 7 contributors for this article] (2020). Changes in prevalence of mental disorders among internally displaced persons in central Sudan: a 1-year follow-up study. Global Mental Health (GMH). ISSN 2054-4251. 7. doi: 10.1017/gmh.2020.16. Full text in Research Archive
• Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Win, Hla Hla; Oo, Tin & Bjertness, Espen (2020). The prevalence of mental distress and the association with education: a cross-sectional study of 18-49-year-old citizens of Yangon Region, Myanmar. BMC Public Health. ISSN 1471-2458. 20(1). doi: 10.1186/s12889-020-8209-8. Full text in Research Archive Show summary

  Background: Poor mental health is an important contributor to the global burden of disease. Mental health problems are often neglected in communities, and are scarcely studied in developing countries, including Myanmar. This study estimates the prevalence of mental distress by socio-demographic and health related factors, and the association between education and mental distress. As far as the authors are aware, this is the first population-based study in Myanmar estimating the prevalence of mental distress. Methods: Between October and November 2016, a cross sectional study was conducted using a multi-stage sampling design with face-to-face interviews using the Hopkins Symptom Checklist (HSCL-10) for mental distress (symptoms of depression and anxiety). The multivariable analysis strategy was based on Directed Acyclic Graphs (DAGs), to identify confounders, mediators and colliders. Pearson's chi-square was used for testing differences between proportions and multiple linear regression analysis was applied to explore the association between education (years at school) and mental distress (HSCL score). Results: A random sample of 2391 (99.6% response) men and women aged 18-49 years participated in the study. The prevalence of mental distress was 18.0% (95% confidence interval (CI): 14.7-21.9), being higher among women (21.2%; 95% (CI): 16.6-26.6) than men (14.9%; 95% (CI): 11.4-19.2). Older-age, being separated or divorced and having a higher number of children were associated with increased mental distress. In linear regression analyses, adjusted for confounders (age, marital status and income), there was a significant negative association between years at school and mental distress among women and older men (> 30 years), but not among the youngest men. Conclusions: The prevalence of mental distress is high, and there is an association between HSCL-10 score and education. Due to the scarcity of mental health services in Myanmar, the findings indicate a need for a mental health policy to handle the burden of mental health problems in Yangon, a burden which is probably high within the country.

• Johnson, Sverre Urnes; Hoffart, Asle; Tilden, Terje; Toft, Helge Prytz; Neupane, Sudan & Lien, Lars [Show all 7 contributors for this article] (2020). Circulating cytokine levels in the treatment of comorbid anxiety disorders. Acta Neuropsychiatrica. ISSN 0924-2708. p. 1–7. doi: 10.1017/neu.2020.38. Full text in Research Archive
• Altunay, Ilknur K; Özkur, Ezgi; Dalgard, Florence; Gieler, Uwe; Aragones, Lucia Tomas & Lien, Lars [Show all 21 contributors for this article] (2020). Psychosocial Aspects of Adult Acne: Data from 13 European Countries. Acta Dermato-Venereologica. ISSN 0001-5555. 100(4). doi: 10.2340/00015555-3409. Full text in Research Archive
• Sampogna, Francesca; Abeni, Damiano; Gieler, Uwe; Tomas-Aragones, Lucia ; Lien, Lars & Poot, Françoise [Show all 21 contributors for this article] (2020). Exploring the EQ-5D Dimension of Pain/Discomfort in Dermatology Outpatients from a Multicentre Study in 13 European Countries. Acta Dermato-Venereologica. ISSN 0001-5555. 100(8). doi: 10.2340/00015555-3477. Full text in Research Archive
• Kour, Prabhjot; Lien, Lars; Kumar, Bernadette N.; Biong, Stian & Pettersen, Henning (2020). Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders. Substance Abuse: Research and Treatment. ISSN 1178-2218. 14, p. 1–10. doi: 10.1177/1178221820970929. Full text in Research Archive Show summary

  Immigrants are considered at risk of psychological distress and therefore involvement in substance abuse, due to a variety of pre- and post-migration factors. Further, there is lower treatment engagement, a higher dropout rate, and less frequent hospitalizations among this group compared to the general population. There are few studies on the subjective understanding of co-occurring substance use disorder (SUD) and mental health disorder (MHD) among immigrants in Norway. This qualitative study aims to explore the treatment experiences of immigrant men living with co-occurring SUD and MHD. Within a collaborative approach, individual interviews were conducted with 10 men of immigrant background, living with co-occurring SUD and MHD, who had treatment experiences from the Norwegian mental health and addiction services. Data were analyzed using a systematic text condensation. The analysis yielded 6 categories where participants described their treatment experiences in mental health and addiction services in Norway as: lack of connection, lack of individually tailored treatment, stigma and discrimination preventing access to treatment, health professionals with multi-cultural competence, care during and after treatment, and raising awareness and reducing stigma. A significant finding was the mention by participants of the value of being seen and treated as a “person” rather than their diagnosis, which may increase treatment engagement. They further mentioned aftercare as an important factor to prevent relapse. This study provides an enhanced understanding of how immigrant men living with co-occurring SUD and MHD experienced being treated in Norwegian healthcare settings. These experiences may add to the knowledge required to improve treatment engagement.

• Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Schei, Berit; Sundby, Johanne & Bjertness, Espen (2020). Domestic violence victimisation and its association with mental distress: A cross-sectional study of the Yangon Region, Myanmar. BMJ Open. ISSN 2044-6055. 10:e037936(9), p. 1–13. doi: 10.1136/bmjopen-2020-037936. Full text in Research Archive
• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2020). Interrelationship of Posttraumatic Stress, Hassles, Uplifts, and Coping in Women With a History of Severe Sexual Abuse: A Cross-Sectional Study. Journal of Interpersonal Violence. ISSN 0886-2605. doi: 10.1177/0886260520935479. Full text in Research Archive
• Vattø, Ingvild E.; Haug, Sigrid H. K.; deMarinis, Valerie; Lien, Lars & Danbolt, Lars Johan (2020). The significance ascribed to contacting a diaconal suicide-prevention crisis line in Norway: a qualitative study. Mental Health, Religion & Culture. ISSN 1367-4676. 23(2), p. 113–126. doi: 10.1080/13674676.2020.1763281.
• Vattø, Ingvild Engh; DeMarinis, Valerie; Haug, Sigrid H. K.; Lien, Lars & Danbolt, Lars Johan (2020). Emotional stressors among volunteers operating a diaconal suicide-prevention crisis line in Norway: a qualitative study. British Journal of Guidance and Counselling. ISSN 0306-9885. 48(4), p. 563–575. doi: 10.1080/03069885.2019.1646409.
• Kour, Prabhjot; Lien, Lars; Kumar, Bernadette N.; Biong, Stian & Pettersen, Henning (2020). Coping and Negotiating a Sense of Self: Immigrant Men's Experiences of Living with Co-Occurring Substance Use and Mental Health Disorders in Norway. American Journal of Psychiatric Rehabilitation (AJPR). ISSN 1548-7768. 22(1-2), p. 43–63. Show summary

  Recent years have seen an increase in the immigrant population in Norway, and within this population, a considerable rise in substance use disorders (SUDs) and elevated odds of developing mental health disorders (MHDs). Immigrants are thus regarded as an at-risk group for both situations. No studies have been conducted on the subjective understanding of co-occurring SUDs and MHDs among this immigrant population; thus, there is limited knowledge of the field. This qualitative study aims to explore the lived experiences of being an immigrant and living with co-occurring SUDs and MHDs. Individual interviews with 10 persons of immigrant background with co-occurring SUDs and MHDs, and treatment experience in Norway, were conducted. Data were analyzed using a phenomenological approach and systematic text condensation. Analysis yielded three categories, each with two subcategories, of the immigrants’ experiences of living with cooccurring SUDs and MHDs. The overarching theme was how they coped and negotiated a sense of self within the self, within the surrounding culture, and within the structures of society. Subcategories revealed their experiences that necessitated coping and negotiating sense of self within each level. Participants experienced “living a double life” and a “culture clash” along with a sense of belonging to a marginalized group, thus, lacking a sense of belonging in mainstream society. This study provides enhanced understanding of how immigrants with co-occurring SUDs and MHDs experience being an immigrant and having the concurrent disorders.

• Brekke, Eva; Ness, Ottar & Lien, Lars (2020). Relational recovery in co-occurring conditions: a qualitative study of first-person experiences. Advances in Dual Diagnosis: Policy, practice and research in mental health and substance use. ISSN 1757-0972. 13(2), p. 89–100. doi: 10.1108/ADD-12-2019-0017. Show summary

  Purpose: The purpose of this study was to explore and describe first-person experiences of relational recovery in co-occurring mental health and substance use conditions. Design/methodology/approach: Within a phenomenological and collaborative approach, indepth individual interviews with eight persons with co-occurring conditions were analysed using systematic text condensation. Findings: Participants described interpersonal relationships as both supporting and hindering recovery in fundamental ways. Four categories of experiences of relational recovery were described: (1) Choosing one’s child; (2) Living with loneliness and a painful past; (3) Sacrificing everything for one’s partner; and (4) Regaining trust and support. Originality/value: This article provides an enhanced understanding of how interpersonal relationships may be experienced by persons who live with co-occurring conditions. The results generally support an understanding of recovery as a relational process.

• Ørbeck, Beate; Øvergaard, Kristin Romvig; Hjellvik, Vidar; Bramness, Jørgen Gustav; Hansen, Berit M Hjelde & Lien, Lars (2020). The Use of Sleep Medication in Youth Residential Care. Journal of child and adolescent psychopharmacology. ISSN 1044-5463. 30(5), p. 335–341. doi: 10.1089/cap.2019.0172. Full text in Research Archive Show summary

  Objectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0–20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ‡ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5–2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3–1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylumseekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; Girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.

• Toft, Helge Prytz; Lien, Lars; Neupane, Sudan Prasad; Abebe, Dawit Shawel; Tilden, Terje & Wampold, Bruce E. [Show all 7 contributors for this article] (2020). Cytokine concentrations are related to level of mental distress in inpatients not using anti-inflammatory drugs. Acta Neuropsychiatrica. ISSN 0924-2708. 32(1). doi: 10.1017/neu.2019.36. Full text in Research Archive Show summary

  Objective: Cross-sectional data show elevated levels of circulating cytokines in psychiatric patients. The literature is divided concerning anti-inflammatory drugs' ability to relieve symptoms, questioning a causal link between inflammatory pathways and psychiatric conditions. We hypothesised that the development of circulating cytokine levels is related to mental distress, and that this relationship is affected by the use of anti-inflammatory drugs. Methods: The study was a longitudinal assessment of 12-week inpatient treatment at Modum Bad Psychiatric Center, Norway. Sera and self-reported Global Severity Index (GSI) scores, which measure psychological distress, were collected at admission (T0), halfway (T1) and before discharge (T2). Other variables known to distort the neuroimmune interplay were included. These were age, gender, diagnosis of PTSD, antidepressants and anti-inflammatory drugs. A total of 128 patients (92 women and 36 men) were included, and 28 were using anti-inflammatory medication. Multilevel modelling was used for data analysis. Results: Patients with higher levels of IL-1RA and MCP-1 had higher GSI scores (p = 0.005 and p = 0.020). PTSD patients scored higher on GSI than non-PTSD patients (p = 0.002). These relationships were mostly present among those not using anti-inflammatory drugs (n = 99), with higher levels of IL-1RA and MCP-1 being related to higher GSI score (p = 0.023 and 0.018, respectively). Again, PTSD patients showed higher GSI levels than non-PTSD patients (p = 0.014). Conclusions: Cytokine levels were associated with level of mental distress as measured by the GSI scores, but this relationship was not present among those using anti-inflammatory drugs. We found no association between cytokine levels and development of GSI score over time. Keywords: PTSD; anti-inflammatory agents; cytokines; depression; inflammation.

• Dalgard, Florence; Svensson, Åke; Halvorsen, Jon Anders; Gieler, Uwe; Schut, Christina & Tomas-Aragones, Lucia [Show all 22 contributors for this article] (2019). Itch and mental health in dermatological patients across Europe: A cross-sectional study in 13 countries. Journal of Investigative Dermatology. ISSN 0022-202X. p. 1–6. doi: 10.1016/j.jid.2019.05.034.
• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2019). First-line managers' experience of the use of audit and feedback cycle in specialist mental health care: A qualitative case study. Archives of Psychiatric Nursing. ISSN 0883-9417. 33(6), p. 103–109. doi: 10.1016/j.apnu.2019.10.009. Full text in Research Archive
• Titeca, Géraldine; Goudetsidis, Laetitia; Francq, Bernard G.; Sampogna, Francesca; Gieler, Uwe & Tómas-Aragonés, Lucía [Show all 23 contributors for this article] (2019). 'The psychosocial burden of alopecia areata and androgenetica': a cross-sectional multicentre study among dermatological out-patients in 13 European countries. Journal of the European Academy of Dermatology and Venereology. ISSN 0926-9959. p. 1–6. doi: 10.1111/jdv.15927. Full text in Research Archive
• Leonhardt, Marja & Lien, Lars (2019). Fargerikt og grønt - innvandrere og friluftsliv. In Tellnes, Gunnar (Eds.), NaKuHel og folkehelse som bærekraft: Samspillet Natur-Kultur-Helse sett i lys av FNs bærekraftmål. Det norske medicinske Selskab. ISSN 978-82-92871-81-2. p. 64–69.
• Aaseth, Jan; Roer, Grethe Emilie; Lien, Lars & Bjørklund, Geir (2019). Is there a relationship between PTSD and complicated obesity? A review of the literature. Biomedicine and Pharmacotherapy. ISSN 0753-3322. 117. doi: 10.1016/j.biopha.2019.108834. Full text in Research Archive
• Silwal, Sanju; Lehti, Venla; Chudal, Roshan; Suominen, Auli; Lien, Lars & Sourander, Andre (2019). Parental immigration and offspring post-traumatic stress disorder: A nationwide population-based register study. Journal of Affective Disorders. ISSN 0165-0327. 249, p. 294–300. doi: 10.1016/j.jad.2019.02.002.
• Vattø, Ingvild Engh; Lien, Lars; deMarinis, Valerie; Haug, Sigrid Helene Kjørven & Danbolt, Lars Johan (2019). Caught between Expectations and the Practice Field: Experiences of This Dilemma among Volunteers Operating a Diaconal Crisis Line in Norway. Crisis. ISSN 0227-5910. doi: 10.1027/0227-5910/a000573.
• Sanhori, Zienat Balla Mohamed Ahmed; Eide, Arne Henning; Ayazi, Touraj; Mdala, Ibrahimu & Lien, Lars (2019). Change in Mental Health Stigma After a Brief Intervention Among Internally Displaced Persons in Central Sudan. Community mental health journal. ISSN 0010-3853. 55(3), p. 534–541. doi: 10.1007/s10597-019-00375-y. Full text in Research Archive
• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2019). How women experience and cope with daily hassles after sexual abuse – a retrospective qualitative study. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. doi: 10.1111/scs.12649. Show summary

  The impact of stress on health can depend on factors such as frequency, heightening of stress during a given period or the presence of one or a few repeated hassles of psychological importance. The aim of this study was to gain a deeper understanding of how adult women experience and cope with daily hassles after sexual abuse. Ten interviews were analysed using the grounded theory method. The theoretical model of ‘protecting armor in daily life’ emerged. The aftermath of sexual abuse related coping with daily stress can be understood as a three-phase process: (1) avoiding and Introduction Violence against women is a common public health con- cern and one in three women worldwide, experiences physical or sexual violence in their lifetime (1). The World Health Organization (2) defines sexual violence as: Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed against a person’s sexu- ality using coercion, by any person regardless of their relationship to the victim, in any setting including but not limited to home and work. (p. 11) Sexual abuse may include everything from sexualised language/behaviour to more severe abuse like intimate touching and rape (3). According to the World Health Organization (4), one in five women reports having been sexually abused as a child and one in three women has been a victim of physical or sexual violence by an Correspondence to: Marianne Torp Stensvehagen, Inland Norway University of Applied Sciences, Postboks 400, 2418 Elverum, Norway. E-mail: marianne.stensvehagen@inn.no escaping—coping after experiencing sexual abuse; (2) accepting and disclosing—starting a process of recovery; and (3) reconciling and repossessing—living with the experience in the present. The model contributes to a deeper understanding of the everyday life of women who have experienced sexual abuse. Increased knowl- edge of coping behaviours that can be used to deal with daily hassles may also serve as a tool for health professionals, other helpers and family to help these women rebuild a good life. Keywords: sexual abuse, women, daily hassles, daily uplifts, coping strategies, stress reactions.

• Schut, Christina; Dalgard, Florence; Halvorsen, Jon Anders; Gieler, Uwe; Lien, Lars & Aragones, Lucia Tomas [Show all 21 contributors for this article] (2018). Occurrence, chronicity and intensity of itch in a clinical consecutive sample of patients with skin diseases: A multi-centre study in 13 european countries. Acta Dermato-Venereologica. ISSN 0001-5555. 99(2), p. 146–151. doi: 10.2340/00015555-3040. Full text in Research Archive
• Brénaut, Émilie; Halvorsen, Jon Anders; Dalgard, Florence; Lien, Lars; Balieva, Flora Nicol & Sampogna, Francesca [Show all 21 contributors for this article] (2018). The self-assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries. Journal of the European Academy of Dermatology and Venereology. ISSN 0926-9959. 33(1), p. 157–162. doi: 10.1111/jdv.15145.
• Dalgard, Florence; Bewley, Anthony; Evers, Andrea W.; Gieler, Uwe; Lien, Lars & Sampogna, Francesca [Show all 10 contributors for this article] (2018). Stigmatisation and body image impairment in dermatological patients: Protocol for an observational multicentre study in 16 European countries. BMJ Open. ISSN 2044-6055. 8:e024877(12), p. 1–5. doi: 10.1136/bmjopen-2018-024877.
• Sørensen, Torgeir; la Cour, Peter; Danbolt, Lars Johan; Stifoss-Hanssen, Hans; Lien, Lars & deMarinis, Valerie [Show all 8 contributors for this article] (2018). The Sources of Meaning and Meaning in Life Questionnaire in the Norwegian Context: Relations to Mental Health, Quality of Life, and Self-Efficacy. The international journal for the psychology of religion. ISSN 1050-8619. p. 32–45. doi: 10.1080/10508619.2018.1547614.
• Søberg, Ane Inger Bondahl; Haug, Sigrid Helene Kjørven; Danbolt, Lars Johan; Lien, Lars & Sørensen, Torgeir (2018). Existential themes in the treatment of people at suicide risk. Understandings and practices of specialist healthcare professionals. Mental Health, Religion & Culture. ISSN 1367-4676. 21(6), p. 588–600. doi: 10.1080/13674676.2018.1524860. Show summary

  This qualitative study focuses on the ways in which existential themes were understood and addressed in therapeutic relationships with patients who had attempted suicide. Health care professionals (HCP) from Norway specialist healthcare participated in focus groups. The interviews were transcribed and analysed by systematic text-condensation through a four-step procedure. We found that the HCPs emphasised the context-specific functions of their departments. They considered these conversations essential but demanding. They indicated existential themes of hope/hopelessness, loneliness, meaning, life/death, shame, religion and suicide. The HCPs’ understandings of themes deemed to be existential and how they should be addressed were primarily based on clinical experience. This appeared to exacerbate the pressure on their personal involvement, leading to the question of whether patients’ existential needs are tackled or instead disappear into a conversational vacuum. The study suggests that HCPs' professional competence of existential themes pertaining to patients at suicide risk needs to be strengthened.

• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2018). Audit and feedback in mental healthcare: staff experiences. International Journal of Health Care Quality Assurance. ISSN 0952-6862. 31(7), p. 822–833. doi: 10.1108/IJHCQA-08-2017-0142. Full text in Research Archive
• Abebe, Dawit Shawel; Elstad, Jon Ivar & Lien, Lars (2018). Utilization of somatic specialist services among psychiatric immigrant patients: the Norwegian patient registry study. BMC Health Services Research. ISSN 1472-6963. 18:852, p. 1–7. doi: 10.1186/s12913-018-3672-y. Full text in Research Archive
• Dalgard, Florence; Svensson, Åke; Gieler, Uwe; Tómas-Aragonés, Lucía; Lien, Lars & Poot, Françoise [Show all 21 contributors for this article] (2018). Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations. British Journal of Dermatology. ISSN 0007-0963. 179(2), p. 464–470. doi: 10.1111/bjd.16250. Full text in Research Archive
• Toft, Helge Prytz; Bramness, Jørgen Gustav; Lien, Lars; Abebe, Dawit Shawel; Wampold, Bruce E. & Tilden, Terje [Show all 8 contributors for this article] (2018). PTSD patients show increasing cytokine levels during treatment despite reduced psychological distress. Neuropsychiatric Disease and Treatment. ISSN 1176-6328. 14, p. 2367–2378. doi: 10.2147/NDT.S173659. Full text in Research Archive Show summary

  Background: A reciprocal relationship between activated innate immune system and changes in mood and behavior has been established. There is still a paucity of knowledge on how the immune system responds during psychiatric treatment. We aimed to explore circulating cytokines and assess psychiatric symptom severity scores during 12 weeks of inpatient psychiatric treatment. Methods: The study was a longitudinal assessment of 124 patients (88 women and 36 men) in treatment at Modum Psychiatric Center, Norway. The patient sample comprised a mixed psychiatric population of whom 39 were diagnosed with posttraumatic stress disorder (PTSD). Serum blood samples for cytokine analysis and measures of mental distress using Global Severity Index were collected at admission (T0), halfway (T1), and before discharge (T2). Other factors assessed were age, gender, and the use of antidepressants and anti-inflammatory drugs. Multilevel modeling was used for longitudinal analyses to assess the repeated cytokine samples within each patient. Results: Overall level of IL-1RA was higher in PTSD patients when compared to those without PTSD (P=0.021). The level of IL-1β, MCP-1, and TNF-α increased over time in PTSD compared to non-PTSD patients (P=0.025, P=0.011 and P=0.008, respectively). All patients experienced reduced mental distress as measured by self-reported Global Severity Index scores. Stratified analysis showed that PTSD patients who used anti-inflammatory drugs had higher levels of IL-1β (P=0.007) and TNF-α (P=0.049) than PTSD patients who did not use such drugs. Conclusion: The study indicates that traumatized patients may have a distinct neuroimmune development during recovery. Their activated immune system shows even further activation during their rehabilitation despite symptom reduction.

• Khalifa, Dina Mohammed Sami; Glavin, Kari; Bjertness, Espen & Lien, Lars (2018). Course of depression symptoms between 3 and 8 months after delivery using two screening tools (EPDS and HSCL-10) on a sample of Sudanese women in Khartoum state. BMC Pregnancy and Childbirth. ISSN 1471-2393. 18(324). doi: 10.1186/s12884-018-1948-1. Full text in Research Archive Show summary

  Background Effects of depression on parenting and on cognitive development of newborns are augmented when symptoms continue throughout the first postnatal year. Current classification systems recognize maternal depression as postnatal if symptoms commence within four to six weeks. Traditional cultural rituals in Sudan offer new mothers adequate family support in the first 6–8 weeks postpartum. The course of postnatal depression symptoms beyond that period is not explored in such settings. We therefore aim to investigate the change in screening status and in severity of depression and distress symptoms between three and eight months postpartum among a sample of Sudanese women using the Edinburgh Postnatal Depression Scale (EPDS) and a locally used tool: the 10-items Hopkins Symptoms Checklist (HSCL-10). Methods Three hundred pregnant women in their 2nd or 3rd trimester were recruited from two clinics in Khartoum state. They were followed up and screened for depression symptoms eight months after delivery by EPDS at ≥12, and by HSCL-10 at ≥1.85. The same sample was previously screened for depression at three months after birth. Results Prevalence of postnatal depression symptoms by EPDS was lower at eight months compared to three months after birth (3.6% at eight months (8/223) compared to 9.2% at three months (22/238), p <  0.001). Eight Mothers exhibited depression symptoms eight months after birth. Depressed mothers at three months had a 56% reduction in EPDS mean scores by eight months and 96.4% of participants either remained in the same EPDS category, or improved eight months after birth. Four participants with major depression symptoms at eight months were also depressed three months after birth and four participants had new onset depression symptoms. The HSCL-10 measured higher distress than EPDS across the two screening points (19.3% at three months, 9.1% at eight months postpartum, p <  0.001). Nonetheless, the two tests correlated positively at both points. Conclusions Repeated screenings by EPDS (depression surveillance) is recommended during the first postnatal year because a subset of mothers can have symptoms beyond the early postnatal period. Existing depression screening instruments can be assessed for their validity to detect PND.

• Marrón, Servando E.; Tómas-Aragonés, Lucía; Navarro-Lopez, Jorge; Gieler, Uwe; Kupfer, Jörg & Dalgard, Florence [Show all 22 contributors for this article] (2018). The psychosocial burden of hand eczema: Data from a European dermatological multicentre study. Contact Dermatitis. ISSN 0105-1873. 78(6), p. 406–412. doi: 10.1111/cod.12973. Full text in Research Archive
• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2018). Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway. BMC Health Services Research. ISSN 1472-6963. 18(71). doi: 10.1186/s12913-018-2862-y. Full text in Research Archive Show summary

  Background The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014. Methods This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings. Results The discussions provided health professionals with insight into their own and their colleagues’ practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working. Conclusion Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups

• Brekke, Eva; Lien, Lars; Nysveen, Kari & Biong, Stian (2018). Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: A qualitative study of staff experiences in Norway. International Journal of Mental Health Systems. ISSN 1752-4458. 12(30). doi: 10.1186/s13033-018-0211-5. Full text in Research Archive Show summary

  Background Recovery-oriented practice is recommended in services for people with co-occurring mental health and substance use disorders. Understanding practitioners’ perceptions of recovery-oriented services may be a key component of implementing recovery principles in day-to-day practice. This study explores and describes staff experiences with dilemmas in recovery-oriented practice to support people with co-occurring disorders. Methods Three focus group interviews were carried out over the course of 2 years with practitioners in a Norwegian community mental health and addictions team that was committed to developing recovery-oriented services. Thematic analysis was applied to yield descriptions of staff experiences with dilemmas in recovery-oriented practice. Results Three dilemmas were described: (1) balancing mastery and helplessness, (2) balancing directiveness and a non-judgmental attitude, and (3) balancing total abstinence and the acceptance of substance use. Conclusions Innovative approaches to practice development that address the inherent dilemmas in recovery-oriented practice to support people with co-occurring disorders are called for

• Belfrage, Anna; Grotmol, Kjersti Støen; Tyssen, Reidar; Moum, Torbjørn Åge & Lien, Lars (2018). Factors associated with low vs increased perceived mastery of clinical work over ten years of practice: a prospective study of Norwegian doctors. BMC Medical Education. ISSN 1472-6920. 18:116(116). doi: 10.1186/s12909-018-1236-9. Full text in Research Archive Show summary

  Background A higher sense of mastery of doctors’ clinical work could benefit not only their own mental health but also their work performance and patient care. However, we know little about factors associated with perceived mastery of clinical work among physicians. Our aim was therefore to study characteristics of those with stable low levels and of those with increased levels of mastery over a period of ten years of medical practice. Methods N = 631 doctors were surveyed in their final year of medical school in 1993/94 (T1) and 10 (T2), 15 (T3) and 20 (T4) years later. Low and increased perceived mastery of clinical work were measured between T2, T3 and T4. Response rates for all items measuring low and increased mastery were 238/522 (46%) and 256/522 (49%) respectively. The following explanatory variables were included: demographics, medical school factors, personality and contextual work-related and non-work-related factors. Results N = 73 (31%) of the doctors reported stable low mastery from T2 to T4. The following variables were significantly associated with low mastery in the adjusted analyses: vulnerability (OR: 1.30, P < .000, CI: 1.12 to 1.50), drinking alcohol to cope with stress during medical school (OR: 2.66, P = .04, CI: 1.03 to 6.85) and social support (OR: 0.78, P = .002, CI: 0.66 to 0.91). N = 39 (15%) reported increased mastery during the ten-year period from T2 to T4. Perceived job demands (OR: 0.66, P = .02, CI: 0.45 to 0.98) and taking up a leading position (OR: 3.04, P = .01, CI: 1.31 to 7.07) were associated with increased mastery after adjustment. Conclusions Stable low sense of mastery over time is associated with having a vulnerable personality, a history of having used alcohol to cope with stress during medical school and lack of contemporary social support. Conversely, increased sense of mastery is associated with taking up a leading position and having the perception that job demands are decreasing over time. These findings indicate that perceived mastery of clinical work may not be a trait, but a state modifiable over time

• Toft, Helge Prytz; Neupane, Sudan Prasad; Bramness, Jørgen Gustav; Tilden, Terje; Wampold, Bruce E. & Lien, Lars (2018). The effect of trauma and alcohol on the relationship between level of cytokines and depression among patients entering psychiatric treatment. BMC Psychiatry. ISSN 1471-244X. 18(95). doi: 10.1186/s12888-018-1677-z. Full text in Research Archive Show summary

  Background Depression is associated with immunological responses as reflected by altered levels of circulating cytokines. Alcohol use and trauma may modulate immune activity, and few studies have investigated these factors in depressed patients. We aimed to explore the association between circulating peripheral cytokine levels and degree of depressive symptoms, taking trauma and alcohol into account. Methods The study was a cross-sectional assessment of patients at admission to a specialized psychiatric center in Norway. A total of 128 patients were included. Information was gathered using the self-administered questionnaires Beck Depression Inventory-II (BDI-II) and the Alcohol Use Disorders Identification Test (AUDIT), in addition to clinical interviews recording childhood or adult life trauma. Serum levels of the cytokines Interleukin-1β (IL-1β), Interleukin-1 Receptor Antagonist (IL-1RA), Tumor Necrosis Factor-α (TNF-α) and the chemokine Monocyte Chemoattractant Protein-1 (MCP-1) were assessed. A Luminex bead-based multiplex assay was used for cytokine measurements. Patient cytokine levels were compared to those of healthy volunteers by the Mann-Whitney U test. Results Levels of cytokines did not differ across patients with mild, moderate and severe depression. AUDIT score was not related to cytokine levels, but to level of depression. A history of trauma was related to higher levels of IL-1RA and TNF-α (p = 0.048 and p = 0.033, respectively), especially among the severely depressed. Serum levels of MCP-1 and TNF-α were significantly higher among psychiatric patients than in healthy volunteers. Conclusions Findings indicate that depression was not related to levels of circulating cytokines among patients in treatment, but that traumatized patients had higher levels of IL-1RA and TNF-α than patients without trauma experience. The lack of relationship between cytokine level and depression was evident both in those without and with trauma.

• Balieva, Flora Nicol; Finlay, Andrew Y.; Kupfer, Jörg; Aragones, Lucia Tomas; Lien, Lars & Gieler, Uwe [Show all 20 contributors for this article] (2018). The role of therapy in impairing quality of life in dermatological patients: A multinational study. Acta Dermato-Venereologica. ISSN 0001-5555. 98(6), p. 563–569. doi: 10.2340/00015555-2918. Full text in Research Archive Show summary

  Skin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%). The largest reduction in HRQoL attributable to therapy, as a percentage of total DLQI, adjusted for confounders, was seen in blistering conditions (10.7%), allergic/drug reactions (10.2%), psoriasis (9.9%), vasculitis/immunological ulcers (8.8%), atopic dermatitis (8.7%), and venous leg ulcers (8.5%). In skin cancer, although it had less impact on HRQoL, the reduction due to therapy was 6.8%. Treatment for skin disease contributes considerably to reducing HRQoL: the burden of dermatological treatment should be considered when planning therapy and designing new dermatological therapies.

• Abraham, Ruth; Lien, Lars & Hanssen, Ingrid (2018). Coping, resilience and posttraumatic growth among Eritrean female refugees living in Norwegian asylum reception centres: A qualitative study. International Journal of Social Psychiatry. ISSN 0020-7640. 64(4), p. 359–366. doi: 10.1177/0020764018765237. Show summary

  Background: The links between migration and health are well documented. Being a refugee exacerbates migrants’ vulnerability through trauma and loss. The aim of this study is to identify sources of resilience, coping and posttraumatic growth in female Eritrean refugees living in Norwegian asylum reception centres. Method: The study had a qualitative, descriptive and explorative design with two focus group interviews and 10 individual in-depth interviews. Participants included 18 female Eritrean refugees aged 18–60, who had obtained refugee status and were still living in an asylum reception centre. A content-focused hermeneutic analytic approach was used. Results: Interviewees described the challenges of pre-flight and flight trauma, conditions at the refugee centre, communication difficulties and the ‘endless’ waiting for transfer to a municipality. To cope, they found it helpful to focus on the future and to think positively. Fellowship with and support from fellow Eritrean refugees were essential as they became a proxy family and provided a strong ethnic identity. Their religious belief also helped them cope and gave them hope for the future. Discussion: The interviewees in this study perceived their psychological problems as a normal reaction to what they had been through. Religious belief was an important resilience factor, as was social support, especially from peers. Conclusion: The interviewees’ coping was based on the realization of their psychological reactions being normal while doing their utmost to focus on their aims and hopes for the future. Keywords Refugees, resilience, coping, posttraumatic growth, religiosity, positive psychiatry

• Martinez, Priscilla; Lien, Lars; Zemore, Sarah E.; Bramness, Jørgen Gustav & Neupane, Sudan Prasad (2018). Circulating cytokine levels are associated with symptoms of depression and anxiety among people with alcohol and drug use disorders. Journal of Neuroimmunology. ISSN 0165-5728. 318, p. 80–86. doi: 10.1016/j.jneuroim.2018.02.011.
• Silwal, Sanju; Dybdahl, Ragnhild; Chudal, Roshan; Sourander, Andre & Lien, Lars (2018). Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquakes. Journal of Affective Disorders. ISSN 0165-0327. 234, p. 239–246. doi: 10.1016/j.jad.2018.03.002. Show summary

  Background In 2015, Nepal was hit by two major earthquakes, which caused 8900 deaths and displaced more than 450,000 people. We assessed the prevalence of post-traumatic stress symptoms (PTSS) and depressive symptoms and explored potential risk factors among adolescents. Methods This cross-sectional study comprised 893 students aged 11–17 in school grades 7–10. They lived in two districts affected by the earthquakes: Sindhupalchok and Kathmandu. Psychiatric symptoms were assessed using Child PTSD symptom scale and Depression Self-Rating Scale. Multiple logistic regression analysis examined the associations between demographic, earthquake-related factors and psychiatric symptoms. Results The prevalence of PTSS in the Sindhupalchok and Kathmandu districts were 39.5% and 10.7%, and depression symptoms were 40.4% and 23.2% respectively. The moderating effect of gender on the relationship between age and PTSS was significant. In the multivariate logistic analyses, the factors associated with PTSS and depression were: being female, prior exposure to trauma and being directly affected by the earthquakes. Limitations Due to the lack of pre-earthquake prevalence rates, our estimates may have been due to chronic long-lasting problems of poverty and lack of access to physical and mental health services. The use of self-reported questionnaires might have overestimated the prevalence rates compared to psychiatric interviews. Conclusions One year after the earthquakes, adolescents living in Sindhupalchok had a higher prevalence of PTSS and depressive symptoms than those living in Kathmandu. Socio-economic and earthquake-related factors were associated with psychiatric outcomes. The findings indicate the need for early psychosocial interventions, prevention and future research after emergency relief

• Lesner, Karolina; Reich, Adam; Szepietowski, Jacek C.; Dalgard, Florence; Gieler, Uwe & Tomasaragones, Lucia [Show all 22 contributors for this article] (2017). Determinants of psychosocial health in psoriatic patients: A multinational study. Acta Dermato-Venereologica. ISSN 0001-5555. 97(10), p. 1182–1188. doi: 10.2340/00015555-2760. Full text in Research Archive Show summary

  There are limited data on the differences in the impact of psoriasis between various countries with respect to quality of life (QoL). The aim of this study was to explore the psychosocial health of patients with psoriasis in different European countries. A total of 682 patients were recruited in 13 European countries. All patients completed a questionnaire regarding sociodemographic information, negative life events, suicidal ideation and satisfaction with their dermatologist. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS), and QoL with the Dermatology Life Quality Index (DLQI) and EuroQoL (EQ-5D). The lowest anxiety and depression scoring was noted in patients from Denmark, the lowest level of impairment in QoL in subjects from Spain, and the highest level of impairment in QoL in patients from Italy. The most relevant parameters influencing patients’ well-being were severity of pruritus and satisfaction with their dermatologist. The level of anxiety and depression symptoms correlated significantly with suicidal ideation.

• Szabo, Csanad; Altmayer, Anita; Lien, Lars; Poot, Francoise; Gieler, Uwe & Tómas-Aragonés, Lucía [Show all 21 contributors for this article] (2017). Attachment styles of dermatological patients in europe: A multicentre study in 13 countries. Acta Dermato-Venereologica. ISSN 0001-5555. 97(7), p. 813–818. doi: 10.2340/00015555-2619. Full text in Research Archive
• Brekke, Eva; Lien, Lars & Biong, Stian (2017). Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders. International Journal of Mental Health and Addiction. ISSN 1557-1874. 16(1), p. 53–65. doi: 10.1007/s11469-017-9780-9. Full text in Research Archive Show summary

  Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.

• Neupane, Sudan Prasad; Bramness, Jørgen Gustav & Lien, Lars (2017). Comorbid post-traumatic stress disorder in alcohol use disorder: relationships to demography, drinking and neuroimmune profile. BMC Psychiatry. ISSN 1471-244X. 17(312), p. 1–10. doi: 10.1186/s12888-017-1479-8. Full text in Research Archive Show summary

  BACKGROUND: This study examined how alcohol use disorder (AUD) patients with post-traumatic stress disorder (PTSD) differed from those without PTSD in terms of demography, drinking patterns and C-reactive protein, inflammatory cytokines, tryptophan metabolism parameters, and brain-derived neurotrophic factor (BDNF). METHODS: A consecutive sample (N = 187) of treatment-receiving AUD individuals were recruited from Nepalese facilities. They underwent fully structured psychiatric interviews. Serum levels of inflammatory cytokines [interleukin (IL)-6, IL-1 Receptor antagonist (IL-1Ra), IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ)] were determined by a multiplex assay, kynurenine and tryptophan levels by high-performance liquid chromatography, and BDNF by enzyme-linked immunosorbent assay (ELISA). RESULTS: The prevalence of exposure to severe trauma and PTSD was 74% and 17%, respectively. PTSD comorbidity was not associated with age, gender, or socioeconomic status, but with co-occurring major depression, history of attempted suicide, earlier peak of drinking problems, higher drinking quantity and withdrawal symptoms, experiencing alcoholic blackouts, and drinking problems among parents. None of the assessed neuroimmune parameters was related to comorbid PTSD. CONCLUSIONS: The findings support routine trauma screening in AUD treatment samples and screening for risky drinking in trauma populations to help guide interventions. The expected aberrations in neuroimmune functioning may not be found when examined in a sample with multiple psychiatric morbidities

• Hanevik, Hilde; Hestad, Knut; Lien, Lars; Joa, Inge; Larsen, Tor Ketil & Danbolt, Lars Johan (2017). Religiousness in First-Episode Psychosis. Archive for the Psychology of Religion/ Archiv für Religionspsychologie. ISSN 0084-6724. 39(2), p. 139–164. doi: 10.1163/15736121-12341336. Show summary

  The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, their religiousness often contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy.

• Abebe, Dawit Shawel; Lien, Lars & Elstad, Jon Ivar (2017). Immigrants’ utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. p. 1–9. doi: 10.1007/s00127-017-1381-1. Full text in Research Archive Show summary

  Purpose As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Methods Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0–59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008–2011 according to country of origin, age group, reason for immigration, and length of stay. Results Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Conclusion Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population

• Sampogna, Francesca; Abeni, Damiano; Gieler, Uwe; Tomas-Aragones, Lucia; Lien, Lars & Titeca, Geraldine [Show all 21 contributors for this article] (2017). Impairment of Sexual Life in 3,485 Dermatological Outpatients From a Multicentre Study in 13 European Countries. Acta Dermato-Venereologica. ISSN 0001-5555. 97(4), p. 478–482. doi: 10.2340/00015555-2561. Full text in Research Archive Show summary

  Skin conditions may have a strong impact on patients’ sexual life, and thus influence personal relationships. Sexual issues are difficult to discuss directly in clinical practice, and a mediated instrument may be useful to capture such information. In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation.

• Brekke, Eva; Lien, Lars; Davidson, Larry & Biong, Stian (2017). First-person experiences of recovery in co-occurring mental health and substance use conditions. Advances in Dual Diagnosis: Policy, practice and research in mental health and substance use. ISSN 1757-0972. 10(1), p. 13–24. doi: 10.1108/ADD-07-2016-0015. Full text in Research Archive Show summary

  Purpose The purpose of this paper is to explore and describe experiences of recovery among people with co-occurring mental health and substance use conditions (co-occurring conditions) in a rural community in Norway. Design/methodology/approach In-depth individual interviews with eight persons with co-occurring conditions were conducted, audiotaped, transcribed and analysed using a phenomenological approach. This study is part of a research project investigating recovery orientation of services in a Norwegian district. Findings The analysis yielded four dimensions of recovery: feeling useful and accepted; coming to love oneself; mastering life; and emerging as a person. Insecure and inadequate housing and limited solutions to financial problems were described as major obstacles to recovery. Research limitations/implications Further research into the facilitation of recovery as defined by persons with concurrent disorders is needed, particularly regarding the facilitation of community participation. Practical implications This study supports an increased focus on societal and community factors in promoting recovery for persons with co-occurring conditions, as well as service designs that allow for an integration of social services and health care, and for collaboration among services. Social implications The results suggest that the community can aid recovery by accepting persons with co-occurring conditions as fellow citizens and welcoming their contributions. Originality/value The paper provides an enhanced understanding of how persons with co-occurring conditions may experience recovery.

• Balieva, Flora Nicolaeva; Kupfer, Jörg; Lien, Lars; Gieler, U; Finlay, AY & Tomas-Aragones, Lucia [Show all 16 contributors for this article] (2016). The burden of common skin diseases assessed with the EQ5D™: a European multicentre study in 13 countries. British Journal of Dermatology. ISSN 0007-0963. 176(5), p. 1170–1178. doi: 10.1111/bjd.15280. Show summary

  Background Generic instruments measuring health related quality of life (HRQoL), like EQ5D, enable comparison of skin diseases with healthy populations and non-dermatological medical conditions, as well as calculation of utility data. Objectives The aims were to measure HRQoL in patients with common skin diseases and healthy controls across Europe using the EQ5D. Methods This multi-center observational cross-sectional study was conducted in 13 European countries. Each dermatology clinic recruited at least 250 consecutive adult outpatients to complete questionnaires, including the EQ5D. Results There were 5369 participants, 4010 patients and 1359 controls. Mean self-rated health state reported by patients was 69.9 (SD 19.7), controls 82.2 (SD 15.5). When adjusted for confounding factors, including comorbidity, mean patient EQ-VAS scores were 10.5 points lower than for controls (standardized β = −0.23). Odds ratio with 95% confidence interval for impairment in all 5 dimensions of EQ5D adjusted for confounders was doubled for patients compared with controls. Patients with hidradenitis suppurativa (HS), blistering conditions, leg ulcers, psoriasis and eczemas had the highest risk for reduction in HRQoL in most dimensions (two-tenfold). Data on differences of impairment by dimensions offer new insights. Conclusions This study confirms the large impact skin conditions have on patients’ wellbeing, differentiating between aspects of HRQoL. Patients with HS, blistering diseases, leg ulcers, infections and most chronic skin diseases reported reduced HRQoL comparable to patients with chronic obstructive lung disease, diabetes mellitus, cardio-vascular disease and cancers. These findings are important in the prioritization of resource allocation between medical fields and within dermatological sub-specialities.

• Hagen, Christina; Lien, Lars; Hauff, Edvard & Heir, Trond (2016). Mindfulness, Sustained Attention and Post-traumatic Stress in Tsunami Survivors. PSYCHOLOGY AND COGNITIVE SCIENCES. ISSN 2380-727X. 2 (2 ), p. 54–63. doi: 10.17140/PCSOJ-2-115.
• Lien, Lars (2016). Smoking, Mental Health and Addiction: A Review of the Literature. Journal of addiction and preventive medicine. ISSN 2474-5049. 1(1)(105).

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• Dybdahl, Ragnhild; Lien, Lars; Siem, Harald; Bakke, Hege Helene & Julardzija, Irma (2019). Asylsøkere og flyktninger. Psykisk helse og livsmestring. Universitetsforlaget. ISBN 9788215031514. 328 p.

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• Dybdahl, Ragnhild; Lien, Lars; Engebretsen, Ingunn Marie Stadskleiv & Skar, Ane-Marthe Solheim (2022). Matsikkerhet og psykisk helse henger sammen. Bistandsaktuelt. ISSN 1501-0201.
• Lien, Lars & Bergem, Anne Kristine (2021). Psykiatrien trenger et løft – ikke tomme løfter. Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.21.0532.
• Lien, Lars & Stensrud, Bjørn (2020). Samtidig rusmisbruk og psykisk lidelse - "ROP-lidelser". In Gonzalez, Marianne Thorsen (Eds.), Psykiske lidelser - Faglig forståelse og terapeutisk tilnærming. Sykepleiefaglige og flerfaglige perspektiver. Gyldendal Akademisk. ISSN 9788205516700. p. 177–186.
• Lien, Lars & Lund, Johan (2019). To 70th Jubilee og professor Gunnar Tellnes. Herald of the International Academy of Science. Russian Section. ISSN 1819-5733. p. 74–74.
• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2019). Hvordan håndterer kvinner som har opplevd seksuelle overgrep hverdagsstress - en retrospektiv kvalitativ studie.
• Stensvehagen, Marianne Torp; Bronken, Berit Arnesveen; Lien, Lars & Larsson, Ulf Gerry (2019). How women experience and cope with daily hassles after sexual abuse– a retrospective qualitative study.
• Toft, Helge; Lien, Lars; Neupane, Sudan Prasad; Abebe, Dawit Shawel; Tilden, Terje & Bramness, Jørgen Gustav (2019). Anti-inflammatory drugs obscure the relationship between mental distress and inflammatory cytokines.
• Dybdahl, Ragnhild & Lien, Lars (2018). Mental helse er nøkkel til utvikling. Avisa Vårt land.
• Abebe, Dawit Shawel & Lien, Lars (2018). Immigrant psychiatric patients and the utilisation of specialist services for circulatory system diseases – a nation-wide register study in Norway . European Journal of Public Health. ISSN 1101-1262. doi: 10.1093/eurpub/cky048.231. Show summary

  Background: Circulatory system diseases, particularly cardiovascular diseases, are the leading cause of impaired quality of life and excess premature death among psychiatric patients. Nevertheless, psychiatric patients are subject to unacceptably high levels of disparity in somatic healthcare. Little research has been conducted among immigrant psychiatric patients. This study aims to examine the use of specialist somatic services for circulatory system diseases among psychiatric patients with different countries of origin. Methods: Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (ages 0-90+) consisted of 317,260 ethnic Norwegians (native-born) and 14,938 immigrants from 11 countries that had contacts with specialist mental healthcare during 2008-2011. Countries of origin included Sweden, Poland, Bosnia-Herzegovina, Russia, Somalia, Turkey, Sir Lanka, Iraq, Iran, Pakistan and Vietnam. Statistical analyses were applied using logistic regression models. A p-value ≤ 0.05 was regarded as statistically significant. Results: There were no overall significant differences in rates of outpatient consultations for circulatory system diseases between immigrant (7%) and Norwegian (7.2%) psychiatric patients. A distinct exception was the high outpatient rate among people from Bosnia-Herzegovina, and the low outpatient rate among those from Somalia, Pakistan and Vietnam. Immigrant psychiatric patients had a lower overall admission rate (3.1%) compared to Norwegian psychiatric patients (4.7%). The majority of immigrant psychiatric patients had statistically significant lower admission rates than Norwegian psychiatric patients, except those from Sweden, Bosnia-Herzegovina and Sir Lanka. Conclusions: The findings suggest that the majority of immigrant psychiatric patients have lower hospitalisation rates for circulatory system diseases than Norwegian psychiatric patients. This suggests that limited access to hospitalisation could be the main possible explanation.

• Dybdahl, Ragnhild & Lien, Lars (2018). Mental health is an integral part of the sustainable development goals. Preventive Medicine and Community Health. doi: 10.15761/PMCH.1000104.
• Toft, Helge Prytz; Lien, Lars; Neupane, Sudan Prasad; Tilden, Terje; Wampold, Bruce E. & Bramness, Jørgen Gustav (2017). PTSD Patients in treatment show increasing cytokine levels despite symptom relief.
• Haug, Sigrid Helene Kjørven & Lien, Lars (2017). Implementation of the Cultural Formulation Interview in Norway-aim and scope with an emphasis on its recovery-oriented properties.
• Brekke, Eva; Lien, Lars; Davidson, Larry & Biong, Stian (2017). Recovery in Co-occurring Mental Health and Substance Use Disorders: First-person Perspectives.
• Silwal, Sanju; Dybdahl, Ragnhild; Chudal, Roshan; Sourander, Andre & Lien, Lars (2017). Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquake.
• Dybdahl, Ragnhild & Lien, Lars (2017). The role of trauma interventions in the sustainable global Development agenda.
• Ness, Ewa; Antonsen, Bjørg; Grøvli, Morten; Hymer, Knut-Erik; Lindkvist, Kari-Venke & Lien, Lars [Show all 11 contributors for this article] (2016). Færre tvangsinnleggelser – dilemmaer og utfordringer :. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 136(7), p. 598–599. doi: 10.4045/tidsskr.15.1031.
• Brekke, Eva; Lien, Lars; Biong, Stian & Davidson, Larry (2016). From double trouble to dual recovery: Patient perspectives on recovery in dual disorders.
• Bjørkhaug, Steinar Traae; Valeur, Jørgen; Bramness, Jørgen Gustav & Lien, Lars (2020). Alcohol-related alterations of the gut microbial flora. Universitetet i Oslo.
• Bramnes, Jørgen; Westby, Lena Catherine Lossius; Hjellvik, Vidar; Fauske, Halvor & Lien, Lars (2018). Legemidler og deres håndtering i barnverninstitusjoner. Nasjonal kompetansetjeneste for samtidig rusmisbruk og psykisk lidelse.

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