Ole Klungsøyr

• Glastad, Stine Holmstul; Klungsøyr, Ole; Aminoff, Sofie Ragnhild; Hagen, Roger; Bjella, Thomas & Engen, Magnus Johan [Show all 11 contributors for this article] (2026). Frequency analysis of mood, sleep, and alcohol and nicotine use: investigating instability in bipolar I and II disorder. Frontiers in Psychiatry. 17, p. 1–12. doi: 10.3389/fpsyt.2026.1810743.
• Feng, Xin; Sigurdardottir, Fjola Dögg Hugberg; Arnardottir, Erna Sif; Dammen, Toril; Einvik, Gunnar & Korkalainen, Henri [Show all 15 contributors for this article] (2026). Association of major adverse cardiovascular events with the apnea-hypopnea index, desaturation severity parameters, and cardiac troponins in participants of the Akershus Sleep APnea cohort. Sleep. ISSN 0161-8105. 49(8). doi: 10.1093/sleep/zsag013. Full text in Research Archive Show summary

  Study Objectives: To examine the prognostic value of the apnea-hypopnea index (AHI), desaturation severity parameters, and cardiac troponins alone and combined for major cardiovascular events (MACEs). Methods: MACE data were retrieved in 2021 from the Norwegian Patient Registry for 518 participants in the Akershus Sleep APnea (ASAP) cohort. Baseline polysomnography and fasting blood samples were collected between June 2006 and January 2008. Desaturation duration (DesDur) and severity (DesSev) were calculated using Automatic Blood Oxygen Saturation Analysis software. Cox regression models estimated hazard ratios (HRs) for MACE. Predictive properties of combining troponins and obstructive sleep apnea severity were calculated by comparing established clinical thresholds for cardiac troponin I (cTnI) and T (cTnT) with AHI clinical thresholds of ≥15 and ≥30, respectively. Results: High AHI, DesDur, DesSev, cTnI, and cTnT were associated with increased MACE risk. However, only cTnI independently predicted MACE after adjustment (HR: 1.74, 95% CI: 1.32–2.29). The HR for MACE was 2.68 (95% CI: 1.03–6.97) in patients with both high cTnI and AHI ≥30 events/h. Conclusion: In this 15-year follow-up, cTnI was independently associated with risk of MACE, whereas the AHI, desaturation parameters, and cTnT were not independent predictors. cTnI, especially when combined with AHI, was a stronger MACE predictor than cTnT. Provided our findings are validated in clinical obstructive sleep apnea populations, the measurement of cTnI may be considered for cardiovascular risk stratification.

• Klungsøyr, Ole; Røssberg, Jan Ivar; Papageorgiou, Constantinos; Evensen, Julie Horgen; Løvgren, André & Malkomsen, Anders [Show all 10 contributors for this article] (2026). Personalized and optimal treatment estimated by a value search method in a randomized clinical trial with psychodynamic versus cognitive behavioral therapy for depression. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2026.2682995. Full text in Research Archive
• Mehlum, Lars; Dibaj, Iselin Solerød; Haga, Egil; Helle, Sofie Egidius; Morken, Katharina Teresa Enehaug & Klungsøyr, Ole [Show all 7 contributors for this article] (2026). Adult life outcomes for adolescents 12.4 years after dialectical behavior therapy - a randomized clinical trial. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-025-02856-w. Full text in Research Archive Show summary

  Adolescents with suicidal and self-harming behavior run significant risk for suicide. Outcomes in adult life after specialized treatment for this population are unknown. We examined adult life outcomes in adolescents with recurrent suicidal and self-harming behavior and borderline features having participated in a randomized trial of dialectical behavior therapy (DBT-A) or enhanced usual care (EUC). Of the original 77 study participants, 61 (79%) were followed-up at a mean age of 28 years, an average of 12.4 years post-baseline. Primary outcomes were frequency of self-harm episodes and levels of suicidal ideation and depressive symptoms over the follow-up intervals. Secondary outcomes were borderline symptoms, psychiatric morbidity, occupational and psychosocial functioning. Self-harm frequency was consistently lower throughout the 12.4 year follow-up period in participants who had received DBT-A, although differences were not statistically significant at the final follow-up. Whereas suicide attempts were infrequent in both groups, self-harm episodes were more than twice as common in the EUC group compared to the DBT-A group with a mean difference of 90 episodes per person from baseline to 12.4 years follow-up. DBT-A was associated with significantly stronger reductions in suicidal ideation, depressive and borderline symptoms at end of treatment but differences tapered off until not statistically significant at the final follow-up. There were no significant trend differences in current psychiatric morbidity, self-reported depressive symptoms and global functioning. This first study of adult life outcomes of specialized psychosocial interventions for adolescents with recurrent suicidal and self-harming behavior and borderline features suggests that adolescents may have a realistic hope of sustained recovery as adults.

• Torgersen, Kristin Stensland; Dammen, Toril; Klungsøyr, Ole; Wilberg, Theresa; Bringager, Christine Bull & Evensen, Julie Horgen [Show all 11 contributors for this article] (2026). Improvement and deterioration trajectories in psychotherapy for depression: results from an RCT with cognitive behavioural and psychodynamic therapy. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2026.2648291. Full text in Research Archive
• Sudmann, Thea Melsen; Jeber, Anne Kathinka; Brækhus, Anne; Klungsøyr, Ole; Rowe, Fiona J. & Jørstad, Øystein Kalsnes (2025). The impact of different spectacle designs on the European visual field requirements for driving. Journal of optometry. ISSN 1888-4296. 19(1). doi: 10.1016/j.optom.2025.100582. Full text in Research Archive Show summary

  Purpose Spectacles can obstruct the peripheral visual field (VF) and interfere with formal requirements for driving. The European VF standards can be assessed with perimetry using the European Driving Test (EDT). This study aimed to evaluate the impact of different spectacles on the EDT, and their compliance with the European VF standards for driving. Methods This cross-sectional study included 30 participants (15 males and 15 females) with normal VF. Participants underwent binocular EDT perimetry with three different spectacles. The number of missed test points were recorded and the vertex distance (VD), pupillary distance, and eye dominance were measured. Statistical comparisons were conducted using a generalized linear mixed model, with significance set at p < 0.05. Results Peripheral VF loss was observed in 11 (37 %) participants (10 males) with spectacle B and in six (20 %) participants (five males) with spectacle C, whereas only one participant had a single missed test point with spectacle A. Participants with spectacle-related VF loss had significantly greater VD than those without. Moreover, there were a higher number of missed test points on the side of the dominant eye. Conclusions Spectacles with thin frames and temples had a negligible impact on the peripheral VF, whereas thicker frames and temples could compromise compliance with the VF standards. VF loss was associated with greater VD, which can explain why male participants exhibited more artefacts. These findings emphasize the need to consider spectacle design in fitness-to-drive assessments with perimetry and raise awareness of potential VF restrictions associated with certain eyewear.

• Dibaj, Iselin Solerød; Tørmoen, Anita Johanna; Klungsøyr, Ole; Morken, Katharina Teresa Enehaug; Haga, Egil & Dymbe, Kine Johansen [Show all 7 contributors for this article] (2025). Early remission of deliberate self-harm predicts emotion regulation capacity in adulthood: 12.4 years follow-up of a randomized controlled trial of adolescents with repeated self-harm and borderline features. European Child and Adolescent Psychiatry. ISSN 1018-8827. p. 1–12. doi: 10.1007/s00787-024-02602-8. Full text in Research Archive Show summary

  Emotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: “Treatment for Adolescents with Deliberate Self-harm”; http://ClinicalTrials.gov/;NCT00675129

• Glastad, Stine Holmstul; Klungsøyr, Ole; Aminoff, Sofie Ragnhild; Hagen, Roger; Bjella, Thomas & Engen, Magnus Johan [Show all 14 contributors for this article] (2025). Exploring the temporal relationship between mood, alcohol- and nicotine use in bipolar disorder using time-series analyses. International journal of bipolar disorders. 13(1). doi: 10.1186/s40345-025-00388-5. Full text in Research Archive Show summary

  Background The prevalence of substance use disorders in bipolar disorder (BD) is high. Exploring potential interactions between mood and the use of common substances such as alcohol and nicotine may contribute to a better understanding of the mechanisms underlying such comorbidities. Digital tools now allow for continuous monitoring and data collection of both symptoms and behavior. This enables time-series analyses to explore such associations with greater precision. Methods Thirty-two individuals in the early phases of BD registered their mood daily and their use of substances weekly in the MinDag (MyDay) app for up to 6 months. We explored temporal relationships between the use of alcohol and nicotine and the levels of depressed, elevated, irritable, and anxious mood using Vector Autoregressive Models and Granger causality tests. Results We found indications that mood influenced alcohol- and nicotine use, and vice versa. Significant temporal relationships (Granger causality) were found in 55% (11 out of 20) of the participants for alcohol and 70% (7 out of 10) for nicotine use, and with high proportions of the variance explained by the one time-series on the other. The associations were consistent with causal effects in one or both directions, but with no adjustment for confounding. Conclusion Our findings indicate that mood influences alcohol- and nicotine use and vice versa in individuals with BD, although caution should be taken due to the exploratory approach. Larger samples are needed to further disentangle these relationships to provide insight for better prevention and treatment of BD and comorbid substance use disorders.

• Myhre, Martin Øverlien; Walby, Fredrik Andreas; Klungsøyr, Ole; Bramness, Jørgen Gustav & Mehlum, Lars (2025). Factors associated with self-harm in patients with substance use disorders who died by suicide: national hybrid questionnaire registry study. British Journal of Psychiatry. ISSN 0007-1250. p. 1–7. doi: 10.1192/bjp.2025.22. Full text in Research Archive Show summary

  Background - Self-harm, self-poisoning or self-injury, irrespective of the motivation, is a central risk factor for suicide. Still, there is limited knowledge of self-harm among patients with substance use disorders (SUDs) who die by suicide. <p> <p>Aims We aimed to describe the prevalence of a history of self-harm and identify the factors associated with self-harm, comparing individuals who died by suicide with and without SUDs. <p> <p>Method - We used data from the Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services, which is based on a national linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, to identify individuals who died by suicide within 1 year after last contact with mental health or substance use services (n=1140). A questionnaire was retrieved for 1041 (91.3%) of these individuals. We used least absolute shrinkage and selection operator (LASSO) regression to select variables and compared patients with and without SUDs. Conditional selective inference was used to improve 90% confidence intervals and p-values. <p> <p>Results - The prevalence of self-harm was 55% in patients with SUDs and 52.6% in patients without SUDs. Suicidal ideation (odds ratio 2.98 (95% CI 1.74–5.10)) emerged as a factor shared with patients without SUDs, while personality disorders (odds ratio 1.96 (1.12–3.40)) and a history of violence (odds ratio 1.86 (1.20–2.87)) were unique factors for patients with SUDs. <p> <p>Conclusions - Ahistory of self-harm is prevalent in patients with SUDs who die by suicide and is associated with suicidal ideation, a history of violence and personality disorders in patients with SUDs.

• Sudmann, Thea Melsen; Torblaa, Anna; Austeng, Dordi Kristine; Reshodko, Irina; Rehm, Johannes & Bro, Tomas [Show all 10 contributors for this article] (2024). Validation of the European visual field standards for driving: A driving simulator-based study. Acta Ophthalmologica. ISSN 1755-375X. doi: 10.1111/aos.16783. Full text in Research Archive Show summary

  Purpose To determine whether we could establish evidence-based pass/fail criteria for perimetry in the context of the European visual field standards for driving. Methods This two-centre, cross-sectional study included participants with binocular visual field loss that had led to revocation of a group-1 driving licence. The participants underwent cognitive and binocular visual testing, including the European Driving Test (EDT), a perimetry algorithm that adheres to the European visual field standards. We used a high-fidelity driving simulator to compare the driving ability of these participants with healthy controls. Two driving instructors classified each driving test as passed or failed. Receiver operating characteristic (ROC) analysis and area under the curve (AUC) determined the ability of perimetry to discriminate between passed and failed driving tests. Results The study included 70 participants with visual field loss and 37 controls. A non-significantly higher proportion of controls passed the driving test (75% vs. 63%; p = 0.22). In ROC analysis, contrast sensitivity performed best (AUC of 0.73), followed by NEI VFQ-25 (AUC of 0.64). Peripheral visual field (AUC of 0.56) and central visual field (AUC of 0.47) performed weaker. Combining the central and peripheral visual field, and their interaction, increased AUC to 0.63. Conclusion Perimetry was a poor predictor of simulator-based driving test result, and we could not establish appropriate pass/fail criteria for the European visual field standards. Because perimetry is not an accurate diagnostic tool for fitness to drive, a practical driving assessment should be performed in case of doubt.

• Dibaj, Iselin Solerød; Tørmoen, Anita Johanna; Klungsøyr, Ole; Haga, Egil & Mehlum, Lars (2023). Trajectories and Predictors of Change in Emotion Dysregulation and Deliberate Self-Harm Amongst Adolescents with Borderline Features. Clinical Child Psychology and Psychiatry. ISSN 1359-1045. 29(2), p. 407–423. doi: 10.1177/13591045231177374. Full text in Research Archive Show summary

  Background Deliberate self-harm (DSH) and emotion dysregulation (ED) peaks in adolescence, and is associated with an increased risk of psychopathology, suicide and lower functioning in adulthood. DBT-A has been established as an effective treatment for reducing DSH, however less is known about changes in emotion dysregulation. This study aimed to identify baseline predictors of treatment response in outcome trajectories of DSH and emotion dysregulation. Methods Response trajectories of DSH and ED were investigated using Latent Class Analysis on RCT data comparing DBT-A and EUC for 77 adolescents treated for deliberate self-harm and borderline traits. Logistic regression analysis was used to examine baseline predictors. Results Two-class solutions were selected for both indicators, distinguishing between early and late responders in DSH, and responders and non-responders in ED. Higher levels of depression, shorter DSH histories and not receiving DBT-A predicted less favourable response in DSH, while DBT-A was the only predictor of treatment response in ED. Conclusions DBT-A was associated with a significantly faster reduction of deliberate self-harm in the short-term and improved emotion regulation in the long-term.

• Nyquist, Emil; Dalgaard, Jakob; Spetalen, Signe; Torkildsen, Synne; Frøen, Hege & Galteland, Eivind [Show all 17 contributors for this article] (2023). Pathogenic DDX41 variants, possible response predictors to low-dose melphalan in hypo- and normocellular MDS and AML. British Journal of Haematology. ISSN 0007-1048. 204(2), p. 724–729. doi: 10.1111/bjh.19226. Full text in Research Archive
• Jacobsen, Henrik Børsting; Lyby, Peter Solvoll; Johansen, Thomas; Reme, Silje Endresen & Klungsøyr, Ole (2023). Can cognitive inflexibility reduce symptoms of anxiety and depression? Promoting the structural nested mean model in psychotherapy research. Psychotherapy Research. ISSN 1050-3307. 33(8), p. 1096–1116. doi: 10.1080/10503307.2023.2221808. Full text in Research Archive Show summary

  Objective To estimate the causal effect of executive functioning on the remission of depression and anxiety symptoms in an observational dataset from a vocational rehabilitation program. It is also an aim to promote a method from the causal inference literature and to illustrate its value in this setting. Method With longitudinal (four-time points over 13 months) data from four independent sites, we compiled a dataset with 390 participants. At each time point, participants were tested on executive function and self-reported symptoms of anxiety and depression. We used g-estimation to evaluate whether objectively tested cognitive flexibility affected depressive/anxious symptoms and tested for moderation. Multiple imputations were used to handle missing data. Results The g-estimation showed a strong causal effect of cognitive inflexibility reducing depression and anxiety and modified by education level. In a counterfactual framework, a hypothetical intervention that could lower cognitive flexibility seemed to cause improvement in mental distress at the subsequent time-point (negative sign) for low education. The less flexibility, the larger improvement. For high education, the same but weaker effect was found, with a change in sign, negative during the intervention and positive during follow-up. Discussion An unexpected and strong effect was found from cognitive inflexibility on symptom improvement. This study demonstrates how to estimate causal psychological effects with standard software in an observational dataset with substantial missing and shows the value of such methods.

• Dong, Li; Nygård, Mari; Støer, Nathalie Charlotte; Klungsøyr, Ole & Hansen, Bo Lars Thorvald Terning (2023). Real-world effectiveness of HPV vaccination against cervical neoplasia among birth cohorts ineligible for routine vaccination. International Journal of Cancer. ISSN 0020-7136. 153(2), p. 399–406. doi: 10.1002/ijc.34489. Full text in Research Archive
• Dammen, Toril; Tunheim, Kristoffer; Munkhaugen, John; Klungsøyr, Ole & Papageorgiou, Constantinos (2023). Attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: study protocol for a waiting-list randomized controlled trial. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1226539. Full text in Research Archive
• Brager-Larsen, Anne Trana; Zeiner, Pål; Klungsøyr, Ole & Mehlum, Lars (2022). Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients? BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-03712-w. Full text in Research Archive Show summary

  Background Self-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm. Methods Data from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models. Results A lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt. Conclusion Initiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.

• Otterstad, Jan Erik; Norum, Ingvild Billehaug; Ruddox, Vidar; Le, An Chau Maria; Bendz, Bjørn & Munkhaugen, John [Show all 8 contributors for this article] (2021). Prognostic impact of non-improvement of global longitudinal strain in patients with revascularized acute myocardial infarction. The International Journal of Cardiovascular Imaging. ISSN 1569-5794. 37, p. 3477–3487. doi: 10.1007/s10554-021-02349-2. Full text in Research Archive Show summary

  Global longitudinal strain (GLS) is a more sensitive prognostic factor than left ventricular ejection fraction (LVEF) in various cardiac diseases. Little is known about the clinical impact of GLS changes after acute myocardial infarction (AMI). The present study aimed to explore if non-improvement of GLS after 3 months was associated with higher risk of subsequent composite cardiovascular events (CCVE). Patients with AMI were consecutively included at a secondary care center in Norway between April 2016 and July 2018 within 4 days following percutaneous coronary intervention. Echocardiography was performed at baseline and after 3 months. Patients were categorized with non-improvement (0 to − 100%) or improvement (0 to 100%) in GLS relative to the baseline value. Among 214 patients with mean age 65 (± 10) years and mean LVEF 50% (± 8) at baseline, 50 (23%) had non-improvement (GLS: − 16.0% (± 3.7) to − 14.2% (± 3.6)) and 164 (77%) had improvement (GLS: − 14.0% (± 3.0) to − 16.9% (± 3.0%)). During a mean follow-up of 3.3 years (95% CI 3.2 to 3.4) 77 CCVE occurred in 52 patients. In adjusted Cox regression analyses, baseline GLS was associated with all recurrent CCVE (HR 1.1, 95% CI 1.0 to 1.2, p < 0.001) whereas non-improvement versus improvement over 3 months follow-up was not. Baseline GLS was significantly associated with the number of CCVE in revascularized AMI patients whereas non-improvement of GLS after 3 months was not. Further large-scale studies are needed before repeated GLS measurements may be recommended in clinical practice.

• Kvarstein, Elfrida Hartveit; Antonsen, Bjørnar Torske; Klungsøyr, Ole; Pedersen, Geir Arild Feigum & Wilberg, Theresa (2021). A Longitudinal, Observational Study Investigating Predictors of Change in a Clinical Sample. Personality Disorders: Theory, Research, and Treatment. ISSN 1949-2715. doi: 10.1037/per0000471. Full text in Research Archive
• Øie, Merete Glenne; Sundet, Kjetil Søren; Haug, Elisabeth; Zeiner, Pål; Klungsøyr, Ole & Rund, Bjørn Rishovd (2021). Cognitive Performance in Early-Onset Schizophrenia and Attention-Deficit/Hyperactivity Disorder: A 25-Year Follow-up Study. Frontiers in Psychology. doi: 10.3389/fpsyg.2020.606365. Full text in Research Archive Show summary

  Early-Onset Schizophrenia (EOS) and Attention Deficit-Hyperactivity Disorder (ADHD) are early- onset neurodevelopmental disorders associated with cognitive deficits. The current study represents the first attempt to compare these groups on a comprehensive cognitive test battery in a longitudinal design over 25 years in order to enhance our knowledge of particular patterns resulting from the interaction between normal maturational processes and different illness processes of these disorders. In the baseline study, 19 adolescents with schizophrenia were compared to 20 adolescents with ADHD and 30 healthy controls (HC), all between 12 and 18 years of age. After 13 years (T2) and after 25 years (T3) they were re-evaluated with the cognitive test battery. A cognitive Composite Score was used in a linear mixed model. The EOS group had a significant cognitive stagnation or deterioration from T1 to T2 compared to HC. However, the EOS group had the most positive change from T2 to T3, supporting a stable level of cognitive performance over the 25 year span. The ADHD group improved or had similar development as the HC group from T1 to T2. They continued to improve significantly compared to the HC group from T2 to T3. Individuals in the EOS group performed more impaired on the cognitive composite score compared to the HC group and the ADHD group at all three time points. Results might indicate a neurodevelopmental pathway of EOS with subnormal cognitive development specific in adolescence. In comparison, the ADHD group had a more consistent cognitive maturation supporting a maturational delay hypothesis of ADHD.

• Klungsøyr, Ole; Lystad, June Ullevoldsæter; Bull, Helen; Evensen, Stig; Ueland, Torill & Falkum, Erik (2021). G-estimation of causal pathways in vocational rehabilitation for adults with psychotic disorders – a secondary analysis of a randomized trial. BMC Psychiatry. 21(1), p. 1–13. doi: 10.1186/s12888-021-03349-1. Full text in Research Archive Show summary

  Background: Vocational rehabilitation (VR) has increasingly become an important intervention targeting poor occupational functioning in schizophrenia. The Norwegian Job Management Program (JUMP), sought to enhance occupational outcomes by augmenting VR with either cognitive behavioral therapy (CBT) techniques aiming to improve psychotic symptoms or cognitive remediation (CR) aiming to improve cognition. CBT is standard treatment in schizophrenia, but recent meta-analyses question the effect of CBT on negative psychotic symptoms. It is of interest to study the causal role of psychotic symptoms and cognitive functioning on occupational functioning. Methods: Data from the JUMP VR – program, was reanalyzed with a causal inference method to assess the causal effects of reduced symptoms / improved neurocognitive functioning on occupational functioning measured by number of working hours per week. Participants (N = 131) had been randomized to either VR + CBT (N = 68) or VR + CR (N = 63). Large improvements in number of working hours were demonstrated in both intervention groups (nonsignificant group difference). G-estimation was used to assess the strength and nature of the causal effects, adjusted for time-varying confounding and selection – bias from loss to follow-up. Results: Significant causal effects of reduction in each of four dimensions of symptoms and improved neurocognition respectively, on number of working hours were found (separate models). The effect of negative symptoms was the strongest and increased in magnitude during the whole observation period, while the effect of two other symptoms and neurocognition was constant. Adjusted for confounding (including potential feedback), the causal effect of a hypothetical change in negative symptoms equal to the average improvement in the CBT group corresponded to an increase in working hours of 3.2 h per week (95% CI: 1.11, 5.35). Conclusion: High performance of g-estimation in a small psychiatric data set with few repeated measures and time-varying confounding and effects, was demonstrated. Augmented vocational rehabilitation showed causal effects of intervention targets with the strongest and increasing effect from negative symptoms on number of working hours. Combination of therapy and activation (indirect and direct approach) might explain improvement in both cognition and negative symptoms, and shed some light on effective ingredients for improved treatment of negative symptoms.

• Røssberg, Jan Ivar; Evensen, Julie Horgen; Dammen, Toril; Wilberg, Theresa; Klungsøyr, Ole & Jones, Maria-Helene [Show all 11 contributors for this article] (2021). Mechanisms of change and heterogeneous treatment effects in psychodynamic and cognitive behavioural therapy for patients with depressive disorder: a randomized controlled trial. BMC Psychology. 9, p. 1–14. doi: 10.1186/s40359-021-00517-6. Full text in Research Archive Show summary

  Background Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. Methods One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. Discussion The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. Trial registration ClinicalTrials.gov Identifier: NCT03022071.

• Jacobsen, Henrik Børsting; Klungsøyr, Ole; Landrø, Nils Inge; Stiles, Tore C & Roche, Bryan T (2020). MINDFLEX Training for Cognitive Flexibility in Chronic Pain: A Randomized, Controlled Cross-Over Trial. Frontiers in Psychology. 11. doi: 10.3389/fpsyg.2020.604832. Full text in Research Archive Show summary

  Impairments in executive functioning are prevalent in chronic pain conditions, with cognitive inflexibility being the most frequently reported. The current randomized, cross-over trial, piloted a computerized cognitive training (CCT) program based on Relational Frame Theory, targeting improvement in cognitive flexibility. At baseline, 73 chronic pain patients completed testing on pre-selected outcomes of executive functioning, alongside IQ measures. When tested three times over the course of 5 months, there was a drop-out rate of 40% at the third time point, leaving 44 patients who had data at all time points. The results showed that there was a substantial learning effect from the MINDFLEX training and a substantial time-dependent improvement on the primary outcomes of increased flexibility, but that this could not be tied to active training. In conclusion, this small study indicated a learning effect as well as improvement on primary outcomes. Based on the current results, a larger trial with improved feasibility of training is warranted.

• Chahal-Kummen, Monica; Høgestøl, Ingvild Kristine; Eribe, Inger; Klungsøyr, Ole; Kristinsson, Jon Adalsteinn & Mala, Tom (2019). Abdominal pain and symptoms before and after Roux-en-Y gastric bypass. BJS Open. 3(3), p. 317–326. doi: 10.1002/bjs5.50148. Full text in Research Archive Show summary

  Background Despite increased emphasis on patient‐reported outcomes, few studies have focused on abdominal pain symptoms before and after Roux‐en‐Y gastric bypass (RYGB). The aim of this study was to quantify chronic abdominal pain (CAP) in relation to RYGB. Methods Patients with morbid obesity planned for RYGB were invited to participate at a tertiary referral centre from February 2014 to June 2015. Participants completed a series of seven questionnaires before and 2 years after RYGB. CAP was defined as patient‐reported presence of long‐term or recurrent abdominal pain lasting for more than 3 months. Results A total of 236 patients were included, of whom 209 (88·6 per cent) attended follow‐up. CAP was reported by 28 patients (11·9 per cent) at baseline and 60 (28·7 per cent) at follow‐up (P  < 0·001). Gastrointestinal Symptom Rating Scale (GSRS) scores (except reflux scores) and symptoms of anxiety increased from baseline to follow‐up. Most quality of life (QoL) scores (except role emotional, mental health and mental component scores) also increased. At follow‐up, patients with CAP had higher GSRS scores than those without CAP, with large effect sizes for abdominal pain and indigestion syndrome scores. Patients with CAP had more symptoms of anxiety, higher levels of catastrophizing and lower QoL scores. Baseline CAP seemed to predict CAP at follow‐up. Conclusion The prevalence of CAP is higher 2 years after RYGB compared with baseline values.

• Hanvold, Susanna; Vinknes, Kathrine; Løken, Elin Bjørge; Hjartåker, Anette; Klungsøyr, Ole & Birkeland, Eline [Show all 10 contributors for this article] (2019). Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial. Obesity Surgery. ISSN 0960-8923. 29(11), p. 3419–3431. doi: 10.1007/s11695-019-04109-7. Full text in Research Archive
• Jansen, Aina; Berg, Jens Petter; Klungsøyr, Ole; Müller, Mette Helen Bjørge; Lyche, Jan Ludvig & Aaseth, Jan (2019). The Influence of Persistent Organic Pollutants on Thyroidal, Reproductive and Adrenal Hormones After Bariatric Surgery. Obesity Surgery. ISSN 0960-8923. doi: 10.1007/s11695-019-04273-w. Full text in Research Archive Show summary

  Persistent organic pollutants (POPs) including organochlorine pesticides, polychlorinated biphenyls (PCBs), and per- and polyfluoroalkylated substances (PFASs) are suspected endocrine disruptors. AIM: To evaluate the associations between POPs and thyroidal, reproductive, and adrenal hormones in a study population treated with bariatric surgery. METHODS: Blood samples from a cohort of 63 participants before and 1 year after bariatric surgery were analyzed for 16 lipophilic POPs, 17 PFASs, and thyroidal, reproductive, and adrenal hormones. Participants reporting relevant medical conditions or interfering medication were excluded, and plausible confounders were corrected for in multiple regression analyses. RESULTS: Free thyroxine (fT4) showed a significant decrease from preoperative to postoperative follow-up, and regression analyses demonstrated that p,p'-dichlorodiphenyldichloroethylene (p,p-DDE) was inversely associated with the ratio free triiodothyronine/free thyroxine (fT3/fT4). Testosterone concentrations in male participants increased significantly in the study period, and sex hormone-binding globulin (SHBG) increased in both gender. Regression analyses showed positive associations between increased levels of lipophilic POPs and the raised postoperative testosterone and SHBG concentrations in males. For females, an inverse association between the sum perfluoroalkyl carboxylic acids (ΣPFCA) and SHBG was seen. Regression analyses of postoperative serum cortisol concentrations on changes in hexachlorobenzene (HCB) showed a non-significant inverse association. CONCLUSION: The results suggest that POPs may have an influence on the hypothalamic-pituitary-thyroid (HPT) and the hypothalamic-pituitary-gonadal (HPG) axes after bariatric surgery. Because of small sample sizes and discrepancy in the sampling time points pre- and postoperatively, the observed hormonal impacts of POPs must be interpreted as associative and not causative. Further studies are needed to confirm the findings.

• Jansen, Aina; Müller, Mette Helen Bjørge; Grønnestad, Randi; Klungsøyr, Ole; Polder, Anuschka & Skjerve, Eystein [Show all 8 contributors for this article] (2018). Decreased plasma levels of perfluoroalkylated substances one year after bariatric surgery. Science of the Total Environment. ISSN 0048-9697. 657, p. 863–870. doi: 10.1016/j.scitotenv.2018.11.453. Full text in Research Archive Show summary

  Per- and polyfluoroalkylated substances (PFASs) are classified as persistent organic pollutants (POPs), and known to be protein bound. The aim of the present study was to determine the levels of 17 different PFASs before and one year after bariatric surgery, and to assess whether weight loss and changed serum protein concentrations could be influencing factors. Plasma samples from 63 patients were analyzed for nine perfluoroalkyl carboxylic acids (PFCAs), three perfluoroalkane sulfonic acids (PFSAs), and five perfluoroalkyl sulfonamide based substances (PASF) before and after surgery. Protein determination was performed in the corresponding serum samples. Mean weight loss one year after surgery was 32.1 kg. The plasma levels of all PFASs decreased with 4–34% compared to preoperative values, and included perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), and perfluorobutane sulfonate (PFBS), which have been identified with increasing levels in the general population during recent years. Serum protein concentrations also decreased with 7–8%. Although protein levels were positively correlated with PFOA, PFBS, PFHxS and PFOS, regression analysis revealed that neither weight loss nor reductions in concentrations of serum protein could explain the decreased PFAS levels. The type of surgical procedure did not influence the changes of PFAS levels between the two sample points. A reduced food intake and alterations in absorptions of nutrients after bariatric surgery may have influenced the observed decreasing plasma levels of PFASs.

• Klungsøyr, Ole; Antonsen, Bjørnar Torske & Wilberg, Theresa (2017). Contours of a causal feedback mechanism between adaptive personality and psychosocial function in patients with personality disorders: A secondary analysis from a randomized clinical trial. BMC Psychiatry. 17:210, p. 1–13. doi: 10.1186/s12888-017-1365-4. Full text in Research Archive Show summary

  Background Patients with personality disorders commonly exhibit impairment in psychosocial function that persists over time even with diagnostic remission. Further causal knowledge may help to identify and assess factors with a potential to alleviate this impairment. Psychosocial function is associated with personality functioning which describes personality disorder severity in DSM-5 (section III) and which can reportedly be improved by therapy. Methods The reciprocal association between personality functioning and psychosocial function was assessed, in 113 patients with different personality disorders, in a secondary longitudinal analysis of data from a randomized clinical trial, over six years. Personality functioning was represented by three domains of the Severity Indices of Personality Problems: Relational Capacity, Identity Integration, and Self-control. Psychosocial function was measured by Global Assessment of Functioning. The marginal structural model was used for estimation of causal effects of the three personality functioning domains on psychosocial function, and vice versa. The attractiveness of this model lies in the ability to assess an effect of a time – varying exposure on an outcome, while adjusting for time – varying confounding. Results Strong causal effects were found. A hypothetical intervention to increase Relational Capacity by one standard deviation, both at one and two time-points prior to assessment of psychosocial function, would increase psychosocial function by 3.5 standard deviations (95% CI: 2.0, 4.96). Significant effects of Identity Integration and Self-control on psychosocial function, and from psychosocial function on all three domains of personality functioning, although weaker, were also found. Conclusion This study indicates that persistent impairment in psychosocial function can be addressed through a causal pathway of personality functioning, with interventions of at least 18 months duration.

• Falkum, Erik; Klungsøyr, Ole; Lystad, June Ullevoldsæter; Bull, Helen Christine; Evensen, Stig & Martinsen, Egil Wilhelm [Show all 8 contributors for this article] (2017). Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society. BMC Psychiatry. 17:24, p. 1–11. doi: 10.1186/s12888-016-1183-0. Full text in Research Archive Show summary

  Background: This study examined the outcomes of a vocational rehabilitation program (The Job Management Program, JUMP) for persons with psychotic disorders based on close collaboration between health and welfare services. Methods: Participants (N = 148) with broad schizophrenia spectrum disorders (age 18–65) were recruited from six counties in Norway. Three counties were randomized to vocational rehabilitation augmented with cognitive behaviour therapy (CBT), while the remaining three counties were randomized to vocational rehabilitation augmented with cognitive remediation (CR). This paper compares the vocational activity of the total group of JUMP participants with a treatment as usual group (N = 341), and further examines differences between the two JUMP interventions. Employment status (working/not working) was registered at the time of inclusion and at the end of the intervention period. Results: The total number of JUMP participants in any kind of vocational activity increased from 17 to 77% during the intervention. Of these, 8% had competitive employment, 36% had work placements in ordinary workplaces with social security benefits as their income, and 33% had sheltered work. The total number of working participants in the TAU group increased from 15.5 to 18.2%. The JUMP group showed significant improvements of positive (t = −2. 33, p = 0.02) and general (t = −2.75, p = 0.007) symptoms of psychosis. Significant differences between the CBT and CR interventions were not demonstrated. Conclusions: The study supports existing evidence that the majority of persons with broad schizophrenia spectrum disorders can cope with some kind of work, given that internal and external barriers are reduced. Those who wish to work should be offered vocational rehabilitation.

• Klungsøyr, Ole & Fredriksen, Mats (2017). Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder (ADHD) in a Longitudinal Observational Study: Estimated Treatment Effect Strengthened by Improved Covariate Balance. Open Journal of Statistics. ISSN 2161-718X. 7, p. 988–1012. doi: 10.4236/ojs.2017.76070. Full text in Research Archive
• Evensen, Stig; Ueland, Torill; Lystad, June Ullevoldsæter; Bull, Helen Christine; Klungsøyr, Ole & Martinsen, Egil Wilhelm [Show all 7 contributors for this article] (2017). Employment outcome and predictors of competitive employment at 2-year follow-up of a vocational rehabilitation programme for individuals with schizophrenia in a high-income welfare society. Nordic Journal of Psychiatry. ISSN 0803-9488. 71(3), p. 180–187. doi: 10.1080/08039488.2016.1247195. Full text in Research Archive Show summary

  Background: Employment is an important part of recovery for individuals with schizophrenia. The employment rate for this group is as low as 10% in Norway, and major system related barriers to employment are evident. Aims: This study reports the competitive employment outcome at 2-year follow-up of a vocational rehabilitation study augmented with cognitive remediation (CR) or elements from cognitive behaviour therapy (CBT) for individuals with schizophrenia spectrum disorders. It also investigates if global functioning, self-esteem, and depression at baseline predicts employment outcome, and if change in these variables during the intervention period is associated with employment outcome. Method: One hundred and forty-eight participants with schizophrenia spectrum disorders in six Norwegian counties received 10 months vocational rehabilitation augmented with either CBT (n = 84) or CR (n = 64). Both competitive and sheltered workplaces were used. Participants were assessed at baseline, at the end of the intervention period, and at 2-year follow-up. Results: At 2-year follow-up, 21.2% had obtained competitive employment. A further 25.3% had work placements in competitive workplaces. Significant improvements were found in global functioning, self-esteem, and depression during the intervention period, but no significant differences between the two intervention groups. High baseline global functioning and self-esteem, as well as positive change in these variables during the intervention period, were significantly associated with higher competitive employment outcome at 2-year follow-up. Conclusion: The results add to existing evidence that competitive employment is attainable for individuals with schizophrenia. High global functioning and self-esteem were strongly associated with competitive employment outcome. “This is an Accepted Manuscript of an article published by Taylor & Francis in Nordic Journal of Psychiatry on 24 Oct 2016, available online: http://www.tandfonline.com/10.1080/08039488.2016.1247195

• Leinonen, Maarit; Campbell, Suzanne; Klungsøyr, Ole; Lönnberg, Stefan; Hansen, Bo Terning & Nygård, Mari (2017). Personal and provider level factors influence participation to cervical cancer screening: A retrospective register-based study of 1.3 million women in Norway. Preventive Medicine. ISSN 0091-7435. 94, p. 31–39. doi: 10.1016/j.ypmed.2016.11.018. Full text in Research Archive
• Johansen, Merete Selsbakk; Normann, Eivind; Normann-Eide, Tone; Klungsøyr, Ole; Kvarstein, Elfrida Hartveit & Wilberg, Theresa (2016). Relationship Between Affect Consciousness and Personality Functioning in Patients With Personality Disorders: A Prospective Study. Journal of Personality Disorders. ISSN 0885-579X. 30(5), p. 633–652. doi: 10.1521/pedi_2015_29_220. Full text in Research Archive
• Lorentzen, Steinar; Fjeldstad, Anette; Ruud, Torleif; Marble, Alice Ruth; Klungsøyr, Ole & ULBERG, RANDI [Show all 7 contributors for this article] (2015). The Effectiveness of Short- and Long-Term Psychodynamic Group Psychotherapy on Self-Concept: Three Years Follow-Up of a Randomized Clinical Trial. International journal of group psychotherapy. ISSN 0020-7284. 65(3), p. 362–85. doi: 10.1521/ijgp.2015.65.3.362. Full text in Research Archive
• Fredriksen, Mats; Dahl, Alv A; Martinsen, Egil Wilhelm; Klungsøyr, Ole; Faraone, Stephen V. & Peleikis, Dawn Elisabeth (2014). Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD. ADHD Attention Deficit and Hyperactivity Disorders. ISSN 1866-6116. 6(2), p. 87–99. doi: 10.1007/s12402-014-0126-1. Full text in Research Archive
• Jordbru, Anika Aakerøy; Smedstad, Liv Marit; Klungsøyr, Ole & Martinsen, Egil Wilhelm (2014). Psychogenic gait disorder:A randomized controlled trial of physical rehabilitation with one-year follow-up. Journal of Rehabilitation Medicine. ISSN 1650-1977. 46(2), p. 181–187. doi: 10.2340/16501977-1246. Full text in Research Archive
• Antonsen, Bjørnar Torske; Klungsøyr, Ole; Kamps, Anne; Hummelen, Benjamin; Johansen, Merete Selsbakk & Pedersen, Geir Feigum [Show all 10 contributors for this article] (2014). Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project. BMC Psychiatry. 14(119). doi: 10.1186/1471-244X-14-119. Full text in Research Archive Show summary

  Background Although psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy. Methods The UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses. Results At the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant. Conclusions The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment. Trial registration NCT00378248 .

• Fredriksen, Mats; Dahl, Alv A; Martinsen, Egil Wilhelm; Klungsøyr, Ole; Haavik, Jan & Peleikis, Dawn Elisabeth (2014). Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD): An open-label prospective study of time in treatment, dose, side-effects and comorbidity. European Neuropsychopharmacology. ISSN 0924-977X. 24(12), p. 1873–1884. doi: 10.1016/j.euroneuro.2014.09.013. Full text in Research Archive
• Larsson, Sara; Aas, Monica; Klungsøyr, Ole; Agartz, Ingrid; Mork, Erlend & Steen, Nils Eiel [Show all 12 contributors for this article] (2013). Patterns of childhood adverse events are associated with clinical characteristics of bipolar disorder. BMC Psychiatry. 13. doi: 10.1186/1471-244X-13-97. Full text in Research Archive Show summary

  Background Previous studies in bipolar disorder investigating childhood trauma and clinical presentations of the illness have mainly focused on physical and sexual abuse. Our aim was to explore further the relationship between childhood trauma and disease characteristics in bipolar disorder to determine which clinical characteristics were most strongly associated with childhood trauma total score, as well as subtypes of adverse childhood events, including physical, sexual, emotional abuse and neglect. Methods 141 Patients with bipolar disorder were consecutively recruited, and disease history and clinical characteristics were assessed. History of childhood abuse was obtained using the Childhood Trauma Questionnaire (CTQ). Statistical methods used were factor analysis, Poisson and linear regression, and generalized additive modeling (GAM). Results The factor analysis of CTQ identified three factors: emotional abuse/neglect, sexual abuse and physical abuse. There were significant associations between CTQ total score and earlier onset of illness, reduced level of psychosocial functioning (GAF; Global Assessment of Functioning) and decreased number of hospitalization, which mainly were due to the factor emotional abuse/neglect. Physical abuse was significantly associated with lower GAF scores, and increased number of mood episodes, as well as self-harm. Sexual abuse was significantly associated with increased number of mood episodes. For mood episodes and self-harm the associations were characterized by great variance and fluctuations. Conclusions Our results suggest that childhood trauma is associated with a more severe course of bipolar illness. Further, childhood abuse (physical and sexual), as well as emotional abuse and neglect were significantly associated with accelerating staging process of bipolar disorder. By using specific trauma factors (physical abuse, sexual abuse and emotional abuse/neglect) the associations become both more precise, and diverse.

• Klungsøyr, Ole; Sexton, Joseph; Sandanger, Inger & Nygård, Jan Franz (2013). A time-varying measurement error model for age of onset of a psychiatric diagnosis: applied to first depressive episode diagnosed by the Composite International Diagnostic Interview (CIDI). Journal of Applied Statistics. ISSN 0266-4763. 40(4), p. 843–861. doi: 10.1080/02664763.2012.756859. Full text in Research Archive
• Bakali, Jan Vegard; Wilberg, Theresa; Klungsøyr, Ole & Lorentzen, Steinar (2013). Development of Group Climate in Short- and Long-Term Psychodynamic Group Psychotherapy. International journal of group psychotherapy. ISSN 0020-7284. 63(3), p. 366–393. doi: 10.1521/ijgp.2013.63.3.366. Full text in Research Archive
• Gullestad, Frida Slagstad; Wilberg, Theresa; Klungsøyr, Ole; Johansen, Merete Selsbakk; Urnes, Øyvind & Karterud, Sigmund (2012). Is treatment in a day hospital step-down program superior to outpatient individual psychotherapy for patients with personality disorders? 36 months follow-up of a randomized clinical trial comparing different treatment modalities. Psychotherapy Research. ISSN 1050-3307. 22(4), p. 426–441. doi: 10.1080/10503307.2012.662608. Full text in Research Archive
• Sørensen, Tom; Klungsøyr, Ole; Kleiner, Robert & Klepp, Olav Martin (2011). Social support and sense of coherence: Independent, shared and interaction relationships with life stress and mental health. International Journal of Mental Health Promotion. ISSN 1462-3730. 13(1), p. 27–44. doi: 10.1080/14623730.2011.9715648. Full text in Research Archive
• Turnip, Sherly Saragih; Klungsøyr, Ole & Hauff, Edvard (2010). The mental Health of populations directly and indirectly exposed to violent conflict in Indonesia. Conflict and Health. 4(14). doi: 10.1186/1752-1505-4-14. Full text in Research Archive Show summary

  Background Large disasters affect people who live both near and far from the areas in which they occur. The mental health impact is expected to be similar to a ripple effect, where the risk of mental health consequences generally decreases with increasing distance from the disaster center. However, we have not been able to identify studies of the ripple effect of man-made disaster on mental health in low-income countries. Objectives The objective was to examine the hypothesis of a ripple effect on the mental health consequences in populations exposed to man-made disasters in a developing country context, through a comparison of two different populations living in different proximities from the center of disaster in Mollucas. Methods Cross-sectional longitudinal data were collected from 510 Internally Displaced Persons (IDPs) living in Ambon, who were directly exposed to the violence, and non-IDPs living in remote villages in Mollucas, Indonesia, who had never been directly exposed to violence in Mollucas. Data were collected during home visits and statistical comparisons were conducted by using chi square tests, t-test and logistic regression. Results There was significantly more psychological distress "caseness" in IDPs than non-IDPs. The mental health consequences of the violent conflict in Ambon supported the ripple effect hypothesis as displacement status appears to be a strong risk factor for distress, both as a main effect and interaction effect. Significantly higher percentages of IDPs experienced traumatic events than non-IDPs in all six event types reported. Conclusions This study indicates that the conflict had an impact on mental health and economic conditions far beyond the area where the actual violent events took place, in a diminishing pattern in line with the hypothesis of a ripple effect.

• Turnip, Sherly Saragih; Klungsøyr, Ole & Hauff, Edvard (2010). The Mental Health Impact of Disaster of Populations Directly and Indirectly Exposed to violent Conflict in Indonesia. Conflict and Health. 4, p. 14–14. doi: 10.1186/1752-1505-4-14. Full text in Research Archive
• Engh, John; Friis, Svein; Birkenæs, Astrid Brate; Jónsdóttir, Halldóra; Klungsøyr, Ole & Ringen, Petter Andreas [Show all 10 contributors for this article] (2010). Delusions Are Associated With Poor Cognitive Insight in Schizophrenia. Schizophrenia Bulletin. ISSN 0586-7614. 36(4), p. 830–835. doi: 10.1093/schbul/sbn193. Full text in Research Archive
• Røssberg, Jan Ivar; Johannessen, Jan Olav; Klungsøyr, Ole; Ilner, Stein E. Opjordsmoen; Evensen, Julie Horgen & Fjell, Anders Martin [Show all 17 contributors for this article] (2010). Are multi family groups appropriate for patients with first episode psychosis? A 5-year naturalistic follow-up study. Acta Psychiatrica Scandinavica. ISSN 0001-690X. 122(5), p. 384–394. doi: 10.1111/j.1600-0447.2010.01571.x. Full text in Research Archive
• Klungsøyr, Ole; Nygård, Mari; Skare, Gry; Eriksen, Tormod & Nygård, Jan Franz (2009). Validity of self-reported Pap smear history in Norwegian women. Journal of Medical Screening. ISSN 0969-1413. 16(2), p. 91–97. doi: 10.1258/jms.2009.008087. Full text in Research Archive
• Engh, John; Friis, Svein; Birkenæs, Astrid Brate; Jónsdóttir, Halldóra; Klungsøyr, Ole & Ringen, Petter Andreas [Show all 10 contributors for this article] (2009). Delusions are associated with low cognitive insight in schizophrenia. Cognitive insight, delusions and hallucinations. Schizophrenia Bulletin. ISSN 0586-7614. doi: 10.1093/schbul/sbn193. Full text in Research Archive
• Klungsøyr, Ole; Sexton, Joseph; Sandanger, Inger & Nygård, Jan Franz (2009). Sensitivity analysis for unmeasured confounding in a marginal structural Cox proportional hazards model. Lifetime Data Analysis. ISSN 1380-7870. 15(2), p. 278–294. doi: 10.1007/s10985-008-9109-x. Full text in Research Archive
• Nygård, Jan F; Klungsøyr, Ole; Sandanger, Inger & Svensson, Elisabeth (2009). Selection effects in psychiatric epidemiology. A 14-year prospective study of the Hopkins Symptom Check List-25 as a predictor of mortality in the Norwegian general population. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 44(10), p. 881–886. doi: 10.1007/s00127-009-0010-z. Full text in Research Archive
• Klungsøyr, Ole; Sexton, Joseph; Sandanger, Inger & Nygård, Jan Franz (2008). Sensitivity analysis for unmeasured confounding in a marginal structural Cox proportional hazards model. Lifetime Data Analysis. ISSN 1380-7870. doi: 10.1007/s10985-008-9109-x. Full text in Research Archive
• Klungsøyr, Ole; Nygård, Jan Franz; Sørensen, Tom & Sandanger, Inger (2006). Cigarette smoking and incidence of first depressive episode: An 11-year, population-based follow-up study. American Journal of Epidemiology. ISSN 0002-9262. 163, p. 421–432. Full text in Research Archive

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• Dibaj, Iselin Solerød; Tørmoen, Anita Johanna; Klungsøyr, Ole; Haga, Egil; Morken, Katharina Teresa Enehaug & Dymbe, Kine Johansen [Show all 7 contributors for this article] (2025). Remisjon av selvskading hos ungdommer predikerte bedre emosjonsregulering i voksen alder. Suicidologi. ISSN 1501-6994. 30(1). doi: 10.5617/suicidologi.12350. Full text in Research Archive Show summary

  Emotion regulation capacity, which is critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals, whereas deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH], which peaks in adolescence. Dialectical behaviour therapy for adolescents [DBT-A] has previously been shown to effectively induce DSH remission in adolescents. The present study aimed to investigate whether such remission was associated with reduced ED in adulthood, and whether this effect was mediated by reductions in dysfunctional coping. The design was a prospective longterm follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents with borderline personality features and repeated self-harm. The original sample consisted of 77 adolescents, of which 61 were assessed in adulthood, 12.4 years later. The results showed that there was a direct effect of DSH remission one year after treatment on adult ED, although this effect was not mediated by changes in coping. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood, and highlights the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED.

• Hrubos-Strøm, Harald; Hansen, Diana Dobran; Feng, Xin; Mäkinen, Hanna; Tinbod, Unn & Köster, Andres [Show all 12 contributors for this article] (2025). Effect of Orofacial Myofunctional Therapy with Auto-Monitoring on the Apnea–Hypopnea Index and Secondary Outcomes in Treatment-Naïve Patients with Mild to Moderate Obstructive Sleep Apnea (OMTaOSA): A Multicenter Randomized Controlled Trial Protocol. doi: 10.3390/ijom51020008. Full text in Research Archive Show summary

  Background: The aim of this article is to describe the protocol of a large, multicenter randomized controlled trial evaluating the effects of orofacial myofunctional therapy with auto-monitoring (OMTa) versus auto-monitoring alone on obstructive sleep apnea (OSA) assessed by the apnea–hypopnea index and other pre-specified outcomes. Method: The OMTaOSA study protocol was registered at ClinicalTrials.gov (NCT06079073) in August 2023, and data collection ended in January 2025. One hundred and four participants with mild and moderate OSA were included. Randomization was conducted in a 1:1 ratio, using sex-stratified blocks. The intervention was a standardized protocol of OMT exercises previously shown to be effective, auto-monitoring with a Withings scan watch, and feedback from self-reports. Controls received watches and access to the same application without the exercise module. Sleep was measured over three nights at baseline and after three months. The sleep scorer and researchers evaluating other outcomes were blinded to the treatment allocation. Change in the apnea–hypopnea index was defined as the primary outcome. Secondary outcomes are published on Clinicaltrials.gov. Results: The results of the trial are still in preparation. Conclusions: By addressing the limitations of previous OMT studies, this trial may clarify the effectiveness of digitally delivered OMT for patients with mild to moderate OSA.

• Klungsøyr, Ole & Sexton, Joseph (2025). Kan vi bli SMARTere? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(12). doi: 10.4045/tidsskr.25.0326. Full text in Research Archive
• Hansen, Bo Lars Thorvald Terning; Klungsøyr, Ole; Labberton, Angela Susan; Sääksvuori, Lauri; Rydland, Kjersti Margrethe & Ødeskaug, Liz Ertzeid [Show all 8 contributors for this article] (2025). Effectiveness of Text Messaging Nudging to Increase Coverage of Influenza Vaccination Among Older Adults in Norway (InfluSMS Study): Protocol for a Randomized Controlled Trial. doi: 10.2196/63938. Full text in Research Archive
• Dibaj, Iselin Solerød; Tørmoen, Anita; Klungsøyr, Ole; Haga, Egil; Morken, Katharina Teresa Enehaug & Dymbe, Kine Johansen [Show all 7 contributors for this article] (2024). Behaviour Matters: The Significance of Early Remission of Deliberate Self-Harm in adolescents. Results from a follow-up study of a Randomized Controlled Trial comparing Dialectical Behaviour Therapy for Adolescents with Enhanced Usual Care. Full text in Research Archive
• Dibaj, Iselin Solerød; Mehlum, Lars; Tørmoen, Anita Johanna; Klungsøyr, Ole & Haga, Egil (2024). Behaviour matters: The significance of early remission of deliberate self-harm in adolescents. Full text in Research Archive
• Pacheco, André Pekkola; Munkhaugen, John; Hrubos-Strøm, Harald; Klungsøyr, Ole; Kværner, Kari Jorunn & Støme, Linn Nathalie [Show all 8 contributors for this article] (2024). Cognitive behavioural therapy for insomnia (CBT-I) in patients with coronary heart disease: a protocol for a randomized controlled trial with six months follow-up. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 31(Supplement_1). doi: 10.1093/eurjpc/zwae175.434. Full text in Research Archive
• Landrø, Nils Inge; Harmer, Catherine; Blackwell, Simon E.; Bø, Ragnhild; Dawson, Gerry & Goodwin, Guy [Show all 16 contributors for this article] (2023). Combining antidepressants and attention bias modification in primary health care (DEPTREAT): Protocol for a pragmatic randomized controlled trial. Contemporary Clinical Trials. ISSN 1551-7144. 133. doi: 10.1016/j.cct.2023.107326. Full text in Research Archive Show summary

  Background Major depressive disorder (MDD) is a highly prevalent psychiatric condition associated with significant disability, mortality and economic burden. A large proportion of MDD patients are treated in primary health care in the local community. Attentional Bias Modification (ABM) training in combination with antidepressants could be an effective treatment. Here we test the hypothesis that adding an ABM procedure to regular treatment with antidepressants in primary health care will result in further improvement of symptoms compared to treatment with antidepressants alone (treatment as usual, TAU) and as compared to an active comparison condition. Methods A total of 246 patients with a diagnosis of MDD will be included in this study. The study is a three-armed pragmatic randomized controlled trial comparing the efficacy of ABM as add-on to treatment with antidepressants in primary care (ABM condition) compared to standard antidepressant treatment (TAU condition). In a third group participants will complete the same schedule of intermediate assessments as the ABM condition in addition to TAU, but no ABM, thus controlling for the non-training-specific aspects of the ABM condition (Antidepressant active comparison group). Discussion The clinical outcome of this study may help develop easily accessible, low-cost treatment of depression in primary health care. Moreover, the study aims to broaden our knowledge of optimal treatment for patients with a MDD by providing adjunct treatment to facilitate recovery and long-term gain.

• Klepp, OM; Sørensen, Tom; Klungsøyr, Ole; Kleiner, Robert & Sørensen, Andreas (2013). Psychological coping concepts and quality of life - a gender perspective. Full text in Research Archive
• Klungsøyr, Ole; Sørensen, Tom; Dalgard, Odd Steffen & Nygård, J (2009). Psychological distress as a precursor of depression. Full text in Research Archive
• Nygård, Jan Franz; Sandanger, Inger; Sørensen, Tom & Klungsøyr, Ole (2004). HSCL-25 as a predictor of mortality. A 13 years follow-up study of a random population sample in Norway. Full text in Research Archive
• Klungsøyr, Ole; Sandanger, Inger & Nygård, Jan Franz (2004). Does smoking cause depression? Full text in Research Archive
• Nygård, Jan Franz; Sandanger, Inger & Klungsøyr, Ole (2003). Problems with prediction in mental health follow-up studies. Full text in Research Archive
• Sandanger, Inger; Nygård, Jan Franz; Sørensen, Tom; Dalgard, Odd Steffen; Platou, Waldemar S & Klungsøyr, Ole [Show all 7 contributors for this article] (2003). Endringer i psykiatrisk sykelighet 1990 - 2001. Full text in Research Archive
• Klungsøyr, Ole; Sandanger, Inger & Nygård, Jan Franz (2003). Is smoking a riskfactor for depression? Full text in Research Archive
• Sudmann, Thea Melsen; Jørstad, Øystein Kalsnes; Klungsøyr, Ole & Brækhus, Anne (2026). A Study of the European Visual Field Standards for Driving: Cross-Country Practices, Spectacle Frame Effects, and Correlation with Driving Ability. Universitetet i Oslo. ISSN 9788234808326. Full text in Research Archive Show summary

  Visual field measurements with perimetry may cause unnecessary withdrawal of driving privileges Across Europe, drivers who may not meet the visual requirements for driving should undergo assessment by an ophthalmic specialist. Accurate assessment of the visual field requires standardized perimetry. However, the European Commission Directive 2009/113/EC does not specify which perimetry algorithm should be used or how results should be interpreted in terms of pass–fail criteria for driving eligibility. This lack of guidance risks inconsistent standards and unequal assessment practices between countries. In Norway, legislation advises on the use of the Esterman test. This perimetry test has been criticised for not having a sufficient correlation to actual driving skills. This thesis A Study of the European Visual Field Standards for Driving: Cross-Country Practices, Spectacle Frame Effects, and Correlation with Driving Ability aimed to investigate how the European Commission directive 2009/113/EC is enforced in member states, to investigate how a new perimetry program called European Driving Test (EDT) would be affected if participants performed the test wearing different spectacle designs and finally, how well visual field loss measured with the EDT corresponded to actual driving skills, to establish evidence based passed-failed-criteria. Findings from the studies show that the same visual field loss may cause loss of driving privileges in one country but not another, that certain spectacle frames cause visual field obstructions that alone might conflict with driving privileges, and that even with the new EDT test, perimetry is unfit for predicting driving eligibility and should not be used alone in determinations on fitness to drive in individuals with visual field loss. Instead, the thesis advocates for individual assessments, including practical driving assessments.

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