Trond Heir

• Helander, Lars Robert; Silviken, Anne & Heir, Trond (2026). Mental health in the Sámi population and the importance of cultural affiliation: cross-sectional analyses at two time points in mid and Northern Norway. International Journal of Circumpolar Health. ISSN 1239-9736. 85(1). doi: 10.1080/22423982.2026.2688014. Full text in Research Archive Show summary

  Mental health disparities have been reported among Indigenous populations worldwide. It remains unclear how different dimensions of Sámi affiliation, such as heritage, identity, and language are related to mental health outcomes. We aimed to examine mental health in the Sámi population according to different forms of Sámi affiliation (heritage, identity, and language affiliation). Furthermore, we examined changes in mental health from 2004 to 2012. Data were derived from two cross-sectional population-based studies conducted in 2004 and 2012. Both surveys included information on Sámi heritage, Sámi identity, linguistic background, and mental health assessed by the Hopkins Symptom Checklist-10 (HSCL-10). Slightly higher levels of psychological distress were observed in most Sámi groups compared to the non-Sámi population, with the exception of Sámi-speaking women. Differences over time were generally small, although men with Sámi heritage showed a modest increase in distress. In adjusted analyses, Sámi affiliation remained associated with psychological distress after controlling for age, education, and household income. Psychological distress was slightly higher in the Sámi population compared to the non-Sámi population, although differences were modest. Sámi affiliation appears to be associated with psychological distress beyond socioeconomic factors, potentially reflecting a complex interplay of social, cultural, and historical influences.

• Skogstad, Laila; Schou-Bredal, Inger; Ekeberg, Øivind; Grimholt, Tine Kristin; Bonsaksen, Tore & Heir, Trond (2026). Lifetime exposure to bullying and its association with health status and quality of life in the general Norwegian population: a cross-sectional study. Frontiers in Public Health. 14. doi: 10.3389/fpubh.2026.1811310. Full text in Research Archive Show summary

  Background: Bullying may have a considerable negative impact on health and well-being. Nevertheless, there is a lack of studies investigating exposure to bullying in the general population. Thus, we aimed to assess the prevalence of lifetime exposure to bullying in the adult Norwegian population and to compare health-related quality of life (HRQoL), and physical and psychological health problems between bullied and non-bullied.Methods: We measured lifetime exposure to bullying in the general Norwegian population using a self-report questionnaire. The study was part of a cross-sectional national health survey (n = 1733) conducted in 2014–2015, to which a probability sample of people in the general population was recruited. Reports on socio-demographic data, HRQoL and a wide range of mental and somatic health problems provided the basis for a comparison of those who were bullied with those who were not. Chi square tests and logistic regression analyses were used to assess associations with lifetime exposure to bullying.Results: Across age groups, 28.2% reported exposure to bullying during their lifespan. Adjusted for other variables, the odds of bullying were higher in younger age groups, for those who lived as singles, and for those who were not working or in education. Respondents who had been bullied reported more mental problems such as depression, anxiety, insomnia, eating disorder, psychosis, self-harm, and suicide attempts, and they had lower HRQoL. They also reported more chronic pain, fibromyalgia, rheumatoid arthritis, diabetes mellitus, obesity, and musculoskeletal-, respiratory- and gastrointestinal diseases than people who had not been exposed to bullying.Conclusion: Bullying is common in the general Norwegian population, where more than a quarter of respondents had experienced exposure to bullying during their lifespan. Substantial more mental and somatic health problems among those exposed to bullying require a broad effort against bullying in central arenas in society.

• Grimholt, Tine Kristin; Gjesdal, Ola; Bonsaksen, Tore; Heir, Trond; Ekeberg, Øivind & Schou-Bredal, Inger [Show all 8 contributors for this article] (2025). Posttraumatic stress disorder symptoms in adults with congenital heart disease (ACHD) during the COVID-19 pandemic in Norway. International Journal of Cardiology Congenital Heart Disease. 20. doi: 10.1016/j.ijcchd.2025.100585. Full text in Research Archive Show summary

  The aims were to study symptom defined post-traumatic stress disorder, self-assessed anxiety and depression, and concerns about COVID19 in Norwegian adults with congenital heart disease compared to the general population during the COVID-19 pandemic. Further, the aim was to compare simple vs. complex CHD on these measures.

• Schmitz, Florentine; Elklit, Ask; Hansen, Marianne Bang; Heir, Trond; Hoskovcova, Simona & Boukalová, Hedvika [Show all 11 contributors for this article] (2025). Psychosocial crisis management: Assisting sensory-impaired individuals in case of disasters. Journal of Emergency Management. ISSN 1543-5865. 23(2), p. 147–159. doi: 10.5055/jem.0882. Full text in Research Archive
• Grimholt, Tine Kristin; Bonsaksen, Tore; Heir, Trond; Schou-Bredal, Inger; Skogstad, Laila & Ekeberg, Øivind (2024). Prevalence of suicide attempt and associations with deliberate self-harm, mental health problems, drug misuse and traumatic experiences - a cross sectional survey of the Norwegian population. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05610-9. Full text in Research Archive Show summary

  Background: Monitoring self-reported suicide attempts (SA) with nationally representative surveys is important to initiate suicide prevention strategies. The aim of the study was to assess the prevalence of SA and compare deliberate self-harm, (DSH), mental health, drug misuse and traumas between SA and non-suicide attempters (NSA). Methods: In this cross-sectional survey of a representative sample (N=1757) of the Norwegian population, we compared people with self-reported SA (n=54) to NSA (n=1703) regarding sociodemographic data, mental health problems, drug misuse and exposure to trauma. Results: The prevalence of SA was 3.1 %. There was a higher proportion of welfare recipients and more deliberate selfharm, mental health problems, drug misuse and traumas in the SA group compared to NSA. Conclusion: This national study confrms the association between suicide attempt and deliberate self-harm, mental health problems, drug misuse and traumas.

• Bonsaksen, Tore; Brunes, Audun & Heir, Trond (2023). Quality of Life In People With Visual Impairment Compared With the General Population. Journal of Public Health (Berlin). ISSN 2198-1833. p. 1–9. doi: 10.1007/s10389-023-01995-1. Full text in Research Archive Show summary

  Aim The aim of the present study was to examine quality of life and its associated factors among adults with visual impairment in Norway. Subject and methods Of the 1216 adults contacted, 736 (61% response rate) participated in a cross-sectional survey. A general population probability sample served as reference (n=1792, 36% response rate). Differences between the populations were examined with independent t-tests for continuous variables and with Chi-square tests for categorical variables. Quality of life covariates were investigated with linear regression analysis. Results People with visual impairment had lower quality of life than the general Norwegian population, across all age groups (mean QOL: 6.8 versus 7.6, p<0.001) and within all age groups (all p<0.01). Compared with the general population, people with visual impairment were less likely to report the highest levels and more likely to report intermediate levels of quality of life. Higher quality of life was associated with lower onset-age of impaired vision (B=-0.11, p<0.001), having employment (B=0.36, p=0.02), lower levels of loneliness (B=-0.28, p<0.001) and higher levels of social support (B=0.40, p<0.001) and general self-efficacy (B=0.07, p<0.001). Conclusion Quality of life was lower among people with visual impairment and may be increased by promoting work participation, social inclusion, connectedness, and coping.

• Lerdal, Anners; Gay, Caryl; Bonsaksen, Tore; Ekeberg, Øivind; Grimholt, Tine Kristin & Heir, Trond [Show all 10 contributors for this article] (2023). Validation of a short version of the Lee fatigue scale in adults living in Norway: a cross-sectional population survey. BMC Public Health. 23(1). doi: 10.1186/s12889-023-17036-1. Full text in Research Archive Show summary

  Background Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. Methods This cross-sectional survey consists of a representative sample from the Norwegian population drawn by The National Population Register in Norway. The study is part of a larger study (NORPOP) aimed at collecting normative data from several questionnaires focused on health in adults living in Norway. Registered citizens between 18 and 94 years of age were randomly selected stratified by age, sex and geographic region. Of the 4971 respondents eligible for the study, 1792 (36%) responded to the survey. In addition to age and sex, we collected responses on a 5-item version of the LFS measuring current fatige severity. The psychometric properties focusing on internal structure and precision of the LFS items were analyzed by a Rasch rating scale model. Results Complete LFS scores for analyses were available for 1767 adults. Women had higher LFS-scores than men, and adults < 55 years old had higher scores than older respondents. Our analysis of the LFS showed that the average category on each item advanced monotonically. Two of the five items demonstrated misfit, while the three other items demonstrated goodness-of-fit to the model and uni-dimensionality. Items #1 and #4 (tired and fatigue respectively) showed differential item functioning (DIF) by sex, but no items showed DIFs in relation to age. The separation index of the LFS 3-item scale showed that the sample could be separated into three different groups according to the respondents’ fatigue levels. The LFS-3 raw scores correlated strongly with the Rasch measure from the three items. The core dimensions in these individual items were very similarly expressed in the Norwegian language version and this may be a threat to the cultural-related or language validity of a short version of the LFS using these particular items. Conclusions The study provides validation of a short LFS 3-item version for estimating fatigue in the general population.

• Heir, Trond; Bendiksen, Bothild; Minteh, Fabakary; Kuye, Rex A. & Lien, Inger-Lise (2023). Serious life events and associated PTSD in Gambian girls exposed to female genital cutting. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1242270. Full text in Research Archive Show summary

  Introduction Poor mental health, such as post-traumatic stress disorder (PTSD), has been reported after female genital cutting (FGC). However, data documenting adverse consequences of FGC have insufficiently considered confounding factors, such as other traumatising events. Here, we examined the extent to which FGC versus other serious life events disturbed Gambian girls subjected to FGC. We additionally assessed the prevalence of PTSD and the extent to which it was attributed to FGC versus other serious life events. Methods We conducted a cross-sectional study with a community-based sample of 12 years-old Gambian girls who had been subjected to FGC ( N  = 125). Using structured interviews, we assessed serious life events and probable PTSD related to the event that the girls cited as bothering them the most. Results Most of the girls reported several serious life events in addition to FGC, such as witnessing violence, experiencing violence or assaults, death of a close relative, and being exposed to natural disasters or serious accidents, for an average 4.5 events per girl. Around one-sixth of the girls (16.8%) stated that FGC was the event that currently bothered them the most, whereas the majority (75.2%) emphasised other experiences. The girls who said they were most troubled by other events reported more impaired daily functioning than those most bothered by FGC. Overall, we found a prevalence of probable PTSD of 19.2%. Of 24 PTSD cases, one was attributed to the experience of FGC, and the remaining 23 were attributed to other events. Conclusion Our findings indicate that FGC is less important than other serious life events in explaining high rates of PTSD in Gambian girls. Associations established in the field between FGC and adverse mental health must be interpreted with caution because girls who have undergone FGC may be severely exposed to other traumatising events.

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

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

• Ghiasvand, Reza; Berge, Leon Alexander Mclaren; Kulle, Bettina; Stenehjem, Jo Steinson; Heir, Trond & Karlstad, Øystein [Show all 11 contributors for this article] (2022). Use of antihypertensive drugs and risk of cutaneous melanoma: A nationwide nested case-control study. International Journal of Epidemiology. ISSN 0300-5771. 52(3), p. 887–898. doi: 10.1093/ije/dyac223. Full text in Research Archive Show summary

  Abstract Background Most antihypertensives can induce dermal photosensitivity, which may increase melanoma risk. However, corroborating evidence is limited. We examined the associations between use of antihypertensives and melanoma risk. Methods A nationwide nested case-control study was conducted using data from the Cancer Registry of Norway, the National Registry and the Norwegian Prescription Database in 2004–15. Ten controls were randomly selected for each melanoma case, matched on sex and birth year. The study included 12 048 cases and 117 895 controls. We estimated rate ratios (RRs) with 95% confidence intervals (CIs). All analyses were adjusted for ambient ultraviolet radiation (UVR). We additionally performed active comparator analyses, and sensitivity analyses by only including new users, distinguishing between exclusive and mixed users, allowing for different latency periods, and subgroup analyses by melanoma subtype and clinical stage. Results Compared with non-use, we observed a slightly increased melanoma risk in users of diuretics (RR 1.08, CI 1.01–1.15), calcium-channel blockers (RR 1.10, CI 1.04–1.18) and drugs affecting the renin-angiotensin system (RR 1.10, CI 1.04–1.16), but not for beta blockers (RR 0.97, CI 0.92–1.03). We found no heterogeneity of associations by melanoma subtype or clinical stage and no dose-response relationship between the cumulative defined daily doses (DDDs) and melanoma. No interaction was found between cumulative DDDs and ambient UVR. Conclusions Weak associations, with lack of a dose-response relationship and lack of interactions with ambient UVR, in the DDD analysis in this nationwide study do not support a causal relationship between antihypertensives and melanoma risk.

• Bredal, Inger Schou; Bonsaksen, Tore; Ekeberg, Øivind; Skogstad, Laila; Grimholt, Tine Kristin & Heir, Trond (2022). A comparison between healthcare workers and non-healthcare workers’ anxiety, depression and PTSD during the initial COVID -19 lockdown. Public Health in Practice. 3. doi: 10.1016/j.puhip.2022.100267. Full text in Research Archive Show summary

  Objective: Several studies have found that Healthcare workers are vulnerable to mental health problems during the COVID-19 pandemic. However, few studies have made comparisons of healthcare workers (HCWs) and nonHCWs. The current study aimed to compare mental health problems among HCWs with non-HCWs during the initial lockdown of COVID 19.<p> <p>Study design: A population-based cross-sectional survey. Methods: The survey was conducted by means of an open web link between April and May 2020. Data were collected by self-report. The PTSD Checklist for DSM-5 (PCL-5) was used to assess posttraumatic stress.<p> <p>Results: A total of 4527 citizens answered the questionnaire and 32.1% were HCWs. The majority were female, under 60 years of age, and lived in urban areas. Among the HCWs, the majority were registered nurses working in hospitals. The prevalence were 12.8% vs 19.1% for anxiety, 8.5% vs 14.5% for depression and 13.6% vs 20.9% for PTSD among HCWs and non-HCWs respectively. The highest prevalence’s for anxiety and PTSD among HCWs were found for those under 40 years of age and having low education level (<12 years).<p> <p>Conclusion: Mental health problems was significantly lower among HCWs compared to non-HCWs. However, the COVID-19 poses a challenge for HCWs, especially young HCWs and those with low level of education. Providing support, appropriate education, training, and authoritative information to the different members of the HCWs could be effective ways to minimize the psychological effect.

• Bonsaksen, Tore; Brunes, Audun & Heir, Trond (2022). Post-traumatic stress disorder in people with visual impairment compared with the general population. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(2), p. 619–619. doi: 10.3390/ijerph19020619. Full text in Research Archive Show summary

  Background: People with a visual impairment appear to have an increased risk of experiencing potentially traumatizing life events and possibly also subsequently developing post-traumatic stress disorder (PTSD). This study investigated the point prevalence of PTSD in people with a visual impairment compared with the general population of Norway and examined factors associated with PTSD among people with a visual impairment. Methods: A telephone-based survey was administered to a probability sample of 1216 adults with a visual impairment. Of these, 736 (61% response rate) participated. A probability sample from the general population served as a reference (n = 1792, 36% response rate). PTSD was measured with the PTSD Checklist for the DSM-5 (PCL-5), based on the currently most bothersome event reported from the Life Events Checklist for DSM-5 (LEC-5). We used the DSM-5 diagnostic guidelines to categorize participants as fulfilling the PTSD symptom criteria or not. Results: The prevalence of PTSD was higher among people with a visual impairment than in the general population, both for men (9.0% vs. 3.8%) and women (13.9% vs. 8.5%). The prevalence rates of PTSD from the illness or injury that had caused the vision loss (men 3.9%, women 2.2%) accounted for a considerable part of the difference between the populations. For women, PTSD related to sexual assaults also contributed significantly to a higher PTSD prevalence in the visually impaired versus the general population (5.2% vs. 2.2%), while for men there were no other event categories which resulted in significant differences. Among people with a visual impairment, the higher risk of PTSD was associated with lower age, female gender, having acquired the vision loss, and having other impairments in addition to the vision loss. Conclusion: The higher prevalence of PTSD in people with a visual impairment suggests that vulnerability to mental health problems is associated with serious life events. The higher incidence than in the general population is partly due to the illness or injury that had led to the vision loss and partly due to people with vision loss appearing to be more vulnerable through exposure to other types of potentially traumatizing events, such as sexual abuse.

• Brunes, Audun; Falkenberg, Helle Kristine; Berndtsson, Inger & Heir, Trond (2022). Use and underuse of mobility aids in individuals with visual impairment: a cross-sectional study of a Norwegian sample. Disability and Rehabilitation: Assistive Technology. ISSN 1748-3107. p. 1–8. doi: 10.1080/17483107.2022.2081735. Full text in Research Archive Show summary

  Purpose: To examine the use and underuse of mobility aids in individuals with visual impairment. Methods: A telephone survey including a probability sample of 736 adults who were members of the Norwegian Association of the Blind and Sighted (response rate: 61%). The interviews took place between January and May 2017, collecting information about access, use, underuse and training in five types of mobility aids (white cane, guide dog, GPS, door-to-door transport and sighted guide). For each mobility aid, we obtained data for underuse defined as non-use despite expecting benefits of use in terms of increased mobility or safety. Participants also answered questions about loneliness (Three-Item Loneliness Scale) and life satisfaction (Cantril’s Ladder of Life Satisfaction). Results: Of the participants, 69% reported using at least one type of mobility aid. Use of specific aids ranged from 12% for the GPS to 52% for door-to-door transport. Estimates of underuse ranged between 14% for door-to-door transport and 28% for GPS. Underuse was not related to lack of resources, as many non-users expecting benefits had access to mobility aids and had undergone training in its use. For example, 81% of non-users of the white cane had access to a cane. In post hoc analyses, non-users who expected benefits from use had lower life satisfaction compared with users. Conclusions: Many individuals with visual impairment do not use mobility aids. Strategies that help visually impaired individuals overcome barriers to the use of mobility aids may improve their sense of safety, mobility and quality of life.

• Stavem, Knut; Heir, Trond; Dammen, Toril; Brønstad, Eivind; Lerum, Tøri Vigeland & Durheim, Michael Thomas [Show all 9 contributors for this article] (2022). The course and determinants of post-traumatic stress over 12 months after hospitalization for COVID-19. Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.931349. Full text in Research Archive Show summary

  Objective: To assess the trajectory of symptoms and symptom-defined post-traumatic stress disorder (PTSD) from 1.5 to 12 months after hospitalization for COVID-19 and determine risk factors for persistent symptoms and PTSD. Methods: This was a prospective cohort study of consecutive patients discharged after hospitalization for COVID-19 before 1 June 2020 in six hospitals in Southern Norway. Symptom-defined PTSD was assessed by the post-traumatic stress disorder (PTSD) checklist for DSM-5 (PCL-5) at 1.5, 3 and/or 12 months after hospitalization, using DSM-5 criteria. Changes in PCL-5 symptom score and the prevalence of PTSD were analyzed with multivariable mixed models. Results: In total, 388 patients were discharged alive, and 251 (65%) participated. Respondents had a mean (SD) age of 58.4 (14.2) years, and 142 (57%) were males. The prevalence of symptom-defined PTSD was 14, 8, and 9% at 1.5, 3, and 12 months, respectively. WHO disease severity for COVID-19 was not associated with PCL-5 scores. Female sex, lower age and non-Norwegian origin were associated with higher PCL-5 scores. The odds ratio (OR) (95%CI) for PTSD was 0.32 (0.12 to 0.83, p = 0.019) at 3 months and 0.38 (0.15 to 0.95, p = 0.039) at 12 months compared to 1.5 months. There was no association between PTSD and WHO severity rating. Conclusions: The level of PTSD symptoms decreased from 1.5 to 3 months after hospitalization, but did not decrease further to 12 months, and there was no association between PTSD symptoms and COVID-19 disease severity.

• Brunes, Audun & Heir, Trond (2022). Visual impairment and employment in Norway. BMC Public Health. 22(1), p. 1–9. doi: 10.1186/s12889-022-13077-0. Full text in Research Archive Show summary

  Background Past studies have suggested lower employment of people with visual impairment. Reasons for this are less known. This study aimed to examine the employment rates among people with visual impairment, and its association with sociodemographic characteristics, vision-related factors, depression, and life satisfaction. Methods This cross-sectional study included a stratified random sample of 574 working-age adults (18–67 years) who were members of the Norwegian Association of the Blind and Partially Sighted. Data were collected by telephone interviews between January and May 2017, and included information on work status, sociodemographic factors, vision-related characteristics, depression (Patient Health Questionnaire-9), and life satisfaction (Cantril’s Ladder of Life Satisfaction). Associations with employment (full-time, part-time, or self-employment) were examined using regression analyses. Results Of the participants, 51.2% of males and 38.1% of females reported to be employed. Employment was associated with being of middle age, male gender, higher education, residing in high-income municipalities, having a moderate degree of vision loss, lower onset-age of vision loss, and having no additional impairments. Employed participants had lower levels of depression compared to others (adjusted exponentiated beta: 0.80, 95% confidence interval (CI): 0.67, 0.96). They also had a higher odds of scoring higher on life satisfaction (adjusted exponentiated beta (odds ratio): 1.85, 95% CI: 1.32, 2.59). Conclusions Employment was lower in people with visual impairment than in the general population. Inclusion of the blind and partially sighted into the workforce could promote health and thus have socio-economic benefits.

• Anker, Espen; Ginsberg, Ylva & Heir, Trond (2021). Prevalence of criminal convictions in Norwegian adult ADHD outpatients and associations with ADHD symptom severity and emotional dysregulation. BMC Psychiatry. 21, p. 226–226. doi: 10.1186/s12888-021-03223-0. Full text in Research Archive Show summary

  Abstract Objectives Attention deficit hyperactivity disorder (ADHD) often co-occurs with antisocial behaviour. Several studies have shown high rates of ADHD among prisoners. However, the prevalence of crime among individuals with ADHD is less known. The aim of the present study was to estimate the prevalence of lifetime criminal conviction (CC) in a clinical sample of adults with ADHD, and the associations with the severity of ADHD and emotional dysregulation (ED). Methods Patients were admitted to a private psychiatric outpatient clinic in Oslo between 2014 and 2018. Of the 656 patients diagnosed with ADHD, 629 (95.9%) agreed to participate in the study. CC was determined based on self-reporting of the lifetime history of criminal behaviour. ADHD was diagnosed according to the DSM-5 criteria, and ADHD severity was measured using the Adult ADHD Self-Report Scale (ASRS). ED was assessed by the eight-item version of Barkley’s Current Behaviour Scale - Self-Report (CBS-SR). Results The prevalence of self-reported CC in this clinical sample was 11.7% among women and 24.5% among men. CC was associated with hyperactive-impulsive severity ( p  &lt; 0.001) and ED ( p  = 0.006). Conclusions The prevalence of self-reported lifetime criminal conviction was high for both genders. CC was associated with symptom severity of hyperactivity-impulsivity and emotional dysregulation. The findings suggest the need for greater research efforts on the avoidance of criminal activity in people with ADHD and targeted intervention for ADHD treatment and CC prevention.

• Falk, Ragnhild Sørum; Robsahm, Trude Eid; Paulsen, Jan Erik; Stocks, Tanja; Drake, Isabel & Heir, Trond (2021). Fasting serum potassium and long-term mortality in healthy men. BMC Public Health. 21. doi: 10.1186/s12889-021-10738-4. Full text in Research Archive Show summary

  Background Serum potassium levels have been positively associated with cardiovascular mortality, but little is known about the association with cancer mortality and death due to other causes. We examined whether serum levels of potassium were associated with long-term mortality in a healthy cohort. Methods Oslo Ischemia Study invited 2341 initially healthy men aged 40–59 years with no use of medication to a comprehensive health survey in 1972. Fasting serum level of potassium (mmol/L) was ascertained at baseline for 1989 men. We have complete follow-up for death throughout 2017. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) and adjusted for multiple confounders. Results After a median follow-up of 30 years (interquartile range 21.2–38.7), 1736 deaths were observed, of which 494 were cancer deaths, 688 cardiovascular deaths, and 536 deaths related to other causes. Restricted cubic spline analysis showed that potassium level was linearly and positively associated with long-term cancer mortality; HR per mmol/L 1.8, 95% CI 1.4–2.4. Compared with low levels of potassium (≤ 4.0 mmol/L), men with high levels (≥4.6 mmol/L) showed a significantly 78% higher risk of cancer death. A positive linear association was found for all-cause mortality (HR per mmol/L 1.6, 95% CI 1.4–1.8), and for cardiovascular (HR per mmol/L 1.4, 95% CI 1.1–1.7) and other cause mortality (HR per mmol/L 1.7, 95% CI 1.3–2.2). Conclusions These findings suggest that serum potassium level appears to predict long-term mortality in healthy middle-aged men, and it might imply future surveillance strategies for individuals with high serum potassium levels.

• Berthelsen, Mona; Hansen, Marianne Bang; Nissen, Alexander; Nielsen, Morten Birkeland; Knardahl, Stein & Heir, Trond (2021). The Impact of a Workplace Terrorist Attack on the Psychosocial Work Environment: A Longitudinal Study From Pre- to Post-disaster. Frontiers in Public Health. 9. doi: 10.3389/fpubh.2021.708260. Full text in Research Archive Show summary

  The psychosocial work environment is of great importance for regaining health and productivity after a workplace disaster. Still, there is a lack of knowledge about the impact of a disaster on the psychosocial work environment. The purpose of this study was to examine whether employees' perceptions of role clarity, role conflicts, and predictability in their work situation changed from before to after a workplace terrorist attack. We combined data from two prospective work environment surveys of employees in three governmental ministries that were the target of the 2011 Oslo terrorist attack. A first two-wave survey was conducted 4–5 years and 2–3 years before the attack, and a second three-wave survey took place 10 months, 2 years, and 3 years after the attack. Of 504 individuals who were employed at the time of the bombing, 220 were employed in both pre- and post-disaster periods, participated in both the first and the second survey, and consented to the linking of data from the two surveys. We found no significant changes in levels of role clarity, role conflict, and predictability from before to after the terrorist attack. Adjusting for sex, age and education had no effect on the results. The findings suggest that perceptions of the psychosocial working environment are likely to be maintained at previous levels in the aftermath of a workplace disaster. Considering the importance of the psychosocial work environment for regaining health and productivity, the findings are important for the preparation for, and management of, future crises.

• Bonsaksen, Tore; Skogstad, Laila; Heir, Trond; Ekeberg, Øivind; Bredal, Inger Schou & Grimholt, Tine Kristin (2021). Suicide Thoughts and Attempts in the Norwegian General Population during the Early Stage of the COVID-19 Outbreak. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(8), p. 1–9. doi: 10.3390/ijerph18084102. Full text in Research Archive Show summary

  The aim of the study was to examine the prevalence of suicide thoughts and attempts during the early stage of the COVID-19 outbreak and examine pandemic-related factors associated with suicide thoughts in the general Norwegian population. A sample of 4527 adults living in Norway were recruited via social media. Data related to suicide thoughts and attempts, alcohol use, pandemic-related concerns, and sociodemographic variables were collected. Associations with suicide thoughts were analyzed with logistic regression analysis. In the sample, 3.6% reported suicide thoughts during the last month, while 0.2% had attempted suicide during the same period. Previous suicide attempts (OR: 11.93, p < 0.001), lower age (OR: 0.69, p < 0.001), daily alcohol use (OR: 3.31, p < 0.001), being in the risk group for COVID-19 complications (OR: 2.15, p < 0.001), and having economic concerns related to the pandemic (OR: 2.28, p < 0.001) were associated with having current suicide thoughts. In addition to known risk factors, the study suggests that aspects specific to COVID-19 may be important for suicidal behaviors during the pandemic.

• Heir, Trond; Hussain, Ajmal; Kristensen, Pål & Weisæth, Lars (2021). Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study. BJPsych Open. 7(4), p. 1–7. doi: 10.1192/bjo.2021.955. Full text in Research Archive Show summary

  Background The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned. Aims We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster. Method Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events. Results When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events. Conclusions Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event.

• Schou-Bredal, Inger; Grimholt, Tine; Bonsaksen, Tore; Skogstad, Laila; Heir, Trond & Ekeberg, Øivind (2021). Optimists' and pessimists' self-reported mental and global health during the COVID-19 pandemic in Norway. Health Psychology Report. ISSN 2353-4184. 9(2), p. 1–9. doi: 10.5114/hpr.2021.102394. Full text in Research Archive Show summary

  background The COVID-19 pandemic represents a global health crisis. How well people cope with this situation depends on many factors, including one’s personality, such as dispositional optimism. The aim of the study was to investigate: 1) optimists’ and pessimists’ concerns during lockdown, and mental and global health; 2) whether pessimists without known risk factors more often than optimists report being at risk for COVID-19. participants and procedure A snowball sampling strategy was used; 4,527 people, 18 years or older, participated in a survey on a variety of mental health conditions and COVID-19 worries. In addition, they completed the Life Orientation Test-Revised (LOT-R). Optimism was defined by LOT-R f ≥ 17. results Fewer optimists than pessimists reported that they were worried about COVID-19, respectively 51.2% vs. 66.8%, p < .001. Among those reporting none of the known somatic risk factors, more pessimists than optimists (14.3% vs. 9.1%, p < .001) considered themselves at risk of a fatal outcome from COVID-19. Significantly fewer optimists reported that they had anxiety (5.1%), depression (3.4%), suicidal ideation (0.7%) and insomnia (19.3%) during the COVID-19 outbreak than pessimists (24.7% anxiety, 18.4% depression, 5.4% suicidal ideation, 39.8% insomnia, all p < .001). Optimists reported better global health than pessimists (87.2 vs. 84.6, p < .001). conclusions Optimists were generally less worried about the COVID-19 pandemic than pessimists and reported better mental and global health during lockdown. Pessimists more often than optimists reported being at risk for COVID-19 without reporting known risk factors. key words anxiety; COVID-19; depression; dispositional optimism; insomnia

• Bendiksen, Bothild; Heir, Trond; Minteh, Fabakary; Ziyada, Mai Mahgoub; Kuye, Rex A. & Lien, Inger-Lise (2021). The association between physical complications following female genital cutting and the mental health of 12-year-old Gambian girls: A community-based crosssectional study. PLOS ONE. 16, p. 1–15. doi: 10.1371/journal.pone.0245723. Full text in Research Archive Show summary

  Background Female genital cutting (FGC) involve an acute physical trauma that hold a potential risk for immediate and long-term complications and mental health problems. The aim of this study was to examine the prediction of depressive symptoms and psychological distress by the immediate and current physical complications following FGC. Further, to examine whether the age at which 12-year-old Gambian girls had undergone the procedure affected mental health outcomes. Method This cross-sectional study recruited 134 12-year-old girls from 23 public primary schools in The Gambia. We used a structured clinical interview to assess mental health and life satisfaction, including the Short Mood and Feeling Questionnaire (SMFQ), the Symptom check list (SCL-5) and Cantril’s Ladder of Life Satisfaction. Each interview included questions about the cutting procedure, immediate- and current physical complications and the kind of help and care girls received following FGC. Results Depressive symptoms were associated with immediate physical health complications in a multivariate regression model [RR = 1.08 (1.03, 1.12), p = .001], and with present urogenital problems [RR = 1.19 (1.09, 1.31), p < .001]. The girls that received medical help following immediate complications had a lower risk for depressive symptoms [RR = .73 (.55, .98), p = .04]. Psychological distress was only associated with immediate complications [RR = 1.04 (1.01, 1.07), p = .004]. No significant differences in mental health outcomes were found between girls who underwent FGC before the age of four in comparison to girls who underwent FGC after the age of four. Conclusion Our findings indicate that the immediate and long-term complications following FGC have implications for psychological health. Only a minimal number of girls received medical care when needed, and the dissemination of health education seems crucial in order to prevent adverse long-term physical and psychological health consequences.

• Moss, Sigrun Marie; Hauge, Mona-Iren; Blix, Ines & Heir, Trond (2021). “I Could Have Been Dead”: Counterfactual Thinking and Posttraumatic Stress Disorder in Individuals Directly Exposed to the 2011 Oslo Bombing. Traumatology. ISSN 1534-7656. doi: 10.1037/trm0000356. Full text in Research Archive
• Bredal, Inger Schou; Skogstad, Laila; Grimholt, Tine K.; Bonsaksen, Tore; Ekeberg, Øivind & Heir, Trond (2021). Concerns in the norwegian population during the initial lockdown due to the covid-19 pandemic. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(11). doi: 10.3390/ijerph18116119. Full text in Research Archive Show summary

  Abstract: Although concern affects one’s welfare or happiness, few studies to date have focused on peoples’ concerns during the initial COVID-19 lockdown. The aim of the study was to explore concerns in the Norwegian populations according to gender and age, and identify which concerns were most prominent during the lockdown. A population-based cross-sectional online survey using snowball-sampling strategies was conducted, to which 4527 adults (≥18 years) responded. Questions related to concerns had response alternatives yes or no. In addition, they were asked which concern was most prominent. Nearly all the 4527 respondents (92%) reported that they were concerned: 60.9% were generally concerned about the pandemic, 83.9% were concerned about family and friends, 21.8% had financial concerns, and 25.3% expected financial loss. More women were concerned about family and friends than males, (85.2% vs. 76.2%, p < 0.001), whereas more men expected financial loss (30.4% vs. 24.4%y, p = 0.001). Younger adults (<50 years) had more financial concerns than older adults (25.9% vs. 10.5%, p < 0.001). Being concerned about family and friends was the most prominent concern and was associated with; lower age (OR 0.79), female gender (OR 1.59), and being next of kin (2.42). The most prominent concern for adults 70 years or older was being infected by COVID-19. In conclusion, women and younger individuals were most concerned. While adults under 70 years of age were most concerned about family and friends and adults 70 years or older were most concerned about being infected by COVID-19.

• Einvik, Gunnar; Dammen, Toril; Ghanima, Waleed Khalid; Heir, Trond & Stavem, Knut (2021). Prevalence and risk factors for post-traumatic stress in hospitalized and non-hospitalized COVID-19 patients. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(4), p. 1–12. doi: 10.3390/ijerph18042079. Full text in Research Archive Show summary

  This population-based study assessed the prevalence and determinants of symptom-defined post-traumatic stress disorder (PTSD) in a cohort of hospitalized and non-hospitalized patients about 1.5–6 months after their COVID-19 onset. The data were acquired from two mixed postal/web surveys in June–September 2020 from patients all aged ≥18 years with a positive polymerase chain reaction for severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) until 1 June 2020, comprising both hospitalized and non-hospitalized subjects. The catchment areas of the two included hospitals covers about 17% of the population of Norway. In total, 211 hospitalized and 938 non-hospitalized subjects received invitation. The prevalence of symptom-defined PTSD was assessed using the PTSD checklist for DSM-5 (PCL-5). Determinants of symptom-defined PTSD and PTSD symptoms were analyzed using multivariable logistic and linear regression analysis. In total, 583 (51%) subjects responded at median 116 (range 41–200) days after COVID-19 onset. The prevalence of symptom-defined PTSD was 9.5% in hospitalized and 7.0% in non-hospitalized subjects (p = 0.80). Female sex, born outside of Norway, and dyspnea during COVID-19 were risk factors for persistent PTSD symptoms. In non-hospitalized subjects, previous depression and COVID-19 symptom load were also associated with persistent PTSD symptoms. In conclusion, COVID-19 symptom load, but not hospitalization, was associated with symptom-defined PTSD and PTSD symptom severity.

• Heir, Trond; Stokke, Elise Hansen & Tvenge, Karina Pauline (2021). The Role of Workplace on Work Participation and Sick Leave after a Terrorist Attack: A Qualitative Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(4). doi: 10.3390/ijerph18041920. Full text in Research Archive Show summary

  Returning to work after large-scale traumatic events is desirable for employees, their organization, and society. The aim of the present study was to identify work-related factors that are perceived as important for work participation versus sick leave after a terrorist attack. We conducted in-depth interviews of 98 employees in the Norwegian governmental ministries that were the target of the 2011 Oslo bombing. Participants were randomly selected from 2519 employees who had responded to a web-based survey. We used a stratified sampling procedure to ensure inclusion of a wide range of experiences in terms of exposure and stress reactions. Participants were asked what, if any, factors contributed to work participation or sick leave, and which factors made a difference in how quickly people on sick leave returned to work. Thematic analyses provided three themes that stimulate work participation and prevent sick leave: supportive management, the ability of a leader to accept individual needs and help people cope with stress; sense of cohesion, feelings of being close, caring for each other, and working well together; and working as a coping strategy, basic assumptions that it is best to stick to work and familiar routines, or a strong belief in one’s ability to master. A fourth theme, high demands and lack of acceptance, included experiences that promoted an absence from work, such as too much business as usual, management’s lack of priorities for which tasks could be left out, or a lack of recognition of individual needs. The findings point to key factors that workers perceive as important for work participation in the aftermath of a disaster. We suggest that health and productivity benefits can be achieved by organizing work and the work environment in line with these experiences.

• Ham, Alida J. van der; Aa, Hilde P.A. van der; Brunes, Audun; Heir, Trond; Vries, Ralph de & Rens, Ger H.M.B. van [Show all 7 contributors for this article] (2021). The development of posttraumatic stress disorder in individuals with visual impairment: a systematic search and review. Ophthalmic & physiological optics. ISSN 0275-5408. 41(2), p. 331–341. doi: 10.1111/opo.12784. Full text in Research Archive Show summary

  Purpose Posttraumatic stress disorder (PTSD) is a mental health problem with a negative impact on quality of life. Little is known about the relationship between PTSD and visual impairment. According to diagnostic criteria for PTSD, vision loss in itself is generally not considered as a traumatic event. PTSD in people with visual impairment is more likely to be the result of traumatic events, which are not directly related, or are only indirectly related to, visual impairment. The purpose of this systematic review was to describe and discuss the literature on the development of PTSD in people with visual impairment. Methods A literature search in PubMed, Embase, PsycINFO and Web of Science was performed up to 15 November 2019 in collaboration with a medical information specialist. Additional search strategies included hand searches of references of retrieved papers and free-text hand searches in Google Scholar. Thematic content analysis of the extracted data was carried out in order to identify main themes and subthemes. Results Findings from 13 articles are presented in a narrative manner along three main themes: (1) posttraumatic stress disorder; (2) traumatic events and (3) impact of traumatic events. People with visual impairments may be at higher risk of being exposed to certain potentially traumatic events. Limited/restricted access to situational information during events may contribute to the stressfulness of the experience. Furthermore, visual impairment may shape the impact of traumatic events. Conclusions The current evidence suggests some unique experiences and challenges for people who are visually impaired. PTSD was prevalent in this population, and prevalence rates ranged from 4% to 50%. Future research may focus on gaining insight into the extent and burden of PTSD, and exploring help-seeking behaviour and treatment needs among those with visual impairment and PTSD.

• Brunes, Audun & Heir, Trond (2021). Serious life events in people with visual impairment versus the general population. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(21). doi: 10.3390/ijerph182111536. Full text in Research Archive Show summary

  The present study aimed to examine the lifetime exposure to serious life events in people with visual impairment compared with the general population. Data were derived from a telephone survey including a probability sample of 736 adults with visual impairment (response rate: 61%). The lifetime prevalence of direct experiences with seventeen different categories of serious life events (Life Events Checklist for DSM-5 (LEC-5)) were compared to that obtained from the general Norwegian population (N = 1792, 36% response rate). Altogether, 68% of people with visual impairment had been directly exposed to at least one serious life event, with equal rates among males and females (p = 0.59). The prevalence of serious life events was higher than for the general population (60%, p &lt; 0.001), especially for fire or explosions, serious accidents, sexual assaults, life-threatening illness or injury, and severe human suffering. In conclusion, our results indicate that people with visual impairment are more prone to experiencing serious life events. This highlights the need for preventive strategies that reduce the risk of serious life events in this population.

• Schou-Bredal, Inger; Grimholt, Tine K.; Bonsaksen, Tore; Skogstad, Laila; Heir, Trond & Ekeberg, Øivind (2021). Psychological responses and associated factors during the initial lockdown due to the corona disease epidemic (COVID-19) among Norwegian citizens. Journal of Mental Health. ISSN 0963-8237. p. 1–9. doi: 10.1080/09638237.2021.1952949. Full text in Research Archive Show summary

  BACKGROUND Ongoing COVID-19 studies pay little attention to the risk or protective factors related to psychological stress. AIMS This study aims to estimate the prevalence of anxiety, depression and insomnia during the initial phase of the COVID-19 outbreak, and explore factors that might be associated with these outcomes. METHODS A population-based cross-sectional survey was conducted using snowball-sampling strategy. Participants from 18 years or older filled out an anonymous online questionnaire. RESULTS A total of 4527 citizens filled out the questionnaire. Prevalence rates were; insomnia 31.8%, anxiety 17.1% and depression 12.5%. Risk factors associated with anxiety, depression and insomnia were being single (OR = 0.75, OR = 0.57, OR = 0.59), unemployed (OR = 0.47, OR = 0.53, OR = 0.73), financial concerns (OR = 1.66, OR = 2.09, OR = 1.80) at risk for complication from COVID-19 (OR = 1.63, OR = 1.68, OR = 1.60), and being generally worried due to the COVID-19 (OR 0 3.06, OR = 1.41, OR = 1.74). CONCLUSION Being single, unemployed, at risk of health complications, or having concerns because of financial or other consequences of the pandemic are associated with mental health adversities such as anxiety, depression and insomnia during a pandemic lockdown.

• Dale, Maria Teresa Grønning; Nissen, Alexander; Berthelsen, Mona; Gjessing, Håkon K. & Heir, Trond (2021). Psychosocial work factors and sick leave risk after a terrorist bomb attack: a survey and registry-based longitudinal study of governmental employees in Norway. BMJ Open. 11(10). doi: 10.1136/bmjopen-2021-052628. Full text in Research Archive Show summary

  Objectives Studies show that social support may reduce the negative psychological effects of terror. The aim was to explore the effects of the psychosocial work environment on sick leave risk among governmental employees after a workplace bomb attack. Design We linked longitudinal survey data collected at 10 and 22 months after the bombing with registry data on doctor-certified sick leave collected from 42 months before the attack to 33 months after the attack. ORs and rate ratios were estimated with mixed effects hurdle models. Setting The bombing of the government ministries in Oslo, Norway, 22 July 2011. Participants We identified 1625 participants from a cohort of 3520 employees working in the ministries during the bombing in 2011. Results After adjustment for confounders, social support from coworkers reduced the odds of sick leave (OR 0.80, 95% CI 0.68 to 0.93), and there was marginal evidence for reduced odds with support from superior (OR 0.87, 95% CI 0.87 to 1.03). A social work climate, an innovative climate and a human resource primacy climate (HRP) reduced the sick leave risk (eg, HRP OR 0.77, 95% CI 0.66 to 0.90). The hurdle model found no associations between psychosocial support at work and the duration of sick leave. Conclusions Psychosocial support at work can enhance employees’ work ability after terror and reduce the sick leave risk by more than 20%. However, a supportive psychosocial work environment did not reduce the duration of sickness absence. The protective role of psychosocial work factors on sick leave may be most significant when employees are at work and interact with their work environment.

• Falk, Ragnhild Sørum; Mariampillai, Julian Eek; Prestgaard, Erik Edvard; Heir, Trond; Bodegard, Johan & Robsahm, Trude Eid [Show all 18 contributors for this article] (2021). The Oslo Ischaemia Study: cohort profile. BMJ Open. 11(10). doi: 10.1136/bmjopen-2021-049111. Full text in Research Archive Show summary

  Abstract Purpose The Oslo Ischaemia Study was designed to investigate the prevalence and predictors of silent coronary disease in Norwegian middle-aged men, specifically validating exercise electrocardiography (ECG) findings compared with angiography. The study has been important in investigating long-term predictors of cardiovascular morbidity and mortality, as well as investigating a broad spectrum of epidemiological and public health perspectives. Participants In 1972–1975, 2014 healthy men, 40–59 years old, were enrolled in the study. Comprehensive clinical examination included an ECG-monitored exercise test at baseline and follow-ups. The cohort has been re-examined four times during 20 years. Linkage to health records and national health registries has ensured complete endpoint registration of morbidity until the end of 2006, and cancer and mortality until the end of 2017. Findings to date The early study results provided new evidence, as many participants with a positive exercise ECG, but no chest pain (‘silent ischaemia’), did not have significant coronary artery stenosis after all. Still, they were over-represented with coronary disease after years of follow-up. Furthermore, participants with the highest physical fitness had lower risk of cardiovascular disease, and the magnitude of blood pressure responses to moderate exercise was shown to influence the risk of cardiovascular disease and mortality. With time, follow-up data allowed the scope of research to expand into other fields of medicine, with the aim of investigating predictors and the importance of lifestyle and risk factors. Future plans Recently, the Oslo Ischaemia Study has been found worthy, as the first scientific study, to be preserved by The National Archives of Norway. All the study material will be digitised, free to use and accessible for all. In 2030, the Oslo Ischaemia Study will be linked to the Norwegian Cause of Death Registry to obtain complete follow-up to death. Thus, a broad spectrum of additional opportunities opens.

• Bonsaksen, Tore; Ekeberg, Øivind; Bredal, Inger Schou; Skogstad, Laila; Heir, Trond & Grimholt, Tine Kristin (2021). Use of alcohol and addictive drugs during the COVID-19 outbreak in Norway: associations with mental health and pandemic-related problems. Frontiers in Public Health. 9:667729(429), p. 1–9. doi: 10.3389/fpubh.2021.667729. Full text in Research Archive Show summary

  Background: The outbreak of COVID-19 has had a major impact on people's daily life. This study aimed to examine use of alcohol and addictive drugs during the COVID-19 outbreak in Norway and examine their association with mental health problems and problems related to the pandemic. Methods: A sample of 4,527 persons responded to the survey. Use of alcohol and addictive drugs were cross-tabulated with sociodemographic variables, mental health problems, and problems related to COVID-19. Logistic regression analyses were used to examine the strength of the associations. Results: Daily use of alcohol was associated with depression and expecting financial loss in relation to the COVID-19 outbreak. Use of cannabis was associated with expecting financial loss in relation to COVID-19. Use of sedatives was associated with anxiety, depression, and insomnia. Use of painkillers was associated with insomnia and self-reported risk of complications if contracting the coronavirus. Conclusion: The occurrence of mental health problems is more important for an understanding of the use of alcohol and addictive drugs during the COVID-19 outbreak in Norway, compared to specific pandemic-related worries.

• Skogstad, Laila; Bredal, Inger Schou; Bonsaksen, Tore; Heir, Trond; Ekeberg, Øivind & Grimholt, Tine Kristin (2021). Concerns related to the COVID-19 in adult Norwegians during the first outbreak in 2020: A qualitative approach. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(8). doi: 10.3390/ijerph18084312. Full text in Research Archive Show summary

  Concerns related to the first outbreak of the COVID-19 pandemic in the Norwegian population are studied in a cross-sectional web-survey conducted between 8 April and 20 May 2020. The qualitative thematic analysis of the open-ended question “Do you have other concerns related to the pandemic?”, followed a six-step process. Concerns from 1491 informants were analyzed, 34% of women and 30% of men (p = 0.05) provided concerns. Respondents with higher educational level reported concerns more often (86% vs. 83%, p = 0.022). The qualitative analysis revealed five themes—society, health, social activities, personal economy and duration—and 13 sub-themes, mostly related to the themes “society” and “health” (724 and 704, respectively). Empathy for others was prominent, for society (nationally and globally), but also concerns related to infecting others and family members at risk for developing serious illness if infected. The responses to the open-ended question yielded additional information, beyond the information obtained from questions with pre-categorized response options, especially related to concerns about society and health. Themes arising from the qualitative analysis shed light on what are important concerns for people during the pandemic and this may serve as targeted measures for the authorities.

• Anker, Espen; Øgrim, Kjell Geir & Heir, Trond (2021). Verbal working memory and processing speed: Correlations with the severity of attention deficit and emotional dysregulation in adult ADHD. Journal of Neuropsychology. ISSN 1748-6645. doi: 10.1111/jnp.12260. Full text in Research Archive Show summary

  Objectives The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), emphasizes symptoms severity with regard to the diagnosis of attention deficit hyperactivity disorder (ADHD). Many clinicians use neuropsychological test results as objective measures of cognitive functions as part of the diagnostic work-up. The aim of this study was to investigate whether the psychometric test results regarding verbal working memory and processing speed are useful as indicators of the severity of attention deficits and emotional dysregulation in adults with ADHD. Methods This observational cross-sectional clinical study included 418 adults diagnosed with ADHD according to the DSM-5. Attention deficit severity was defined based on the inattentive subscale of the Adult ADHD Self-Report Scale. Emotional dysregulation was assessed with the Deficient Emotional Self-Regulation scale. Verbal working memory was measured with the Working Memory Index (WMI), and processing speed was measured with the Processing Speed Index (PSI) from the Wechsler Adult Intelligence Scale, third edition. Results The full-scale intelligence quotients of the participants were in the normal range, with expected reductions in verbal working memory and processing speed. Only processing speed was associated with attention deficits (β = −.056, p = .003). The association between the psychometric test result for verbal working memory and processing speed and that between the severity of attention deficits and emotional dysregulation were weak (R2 < .1) and mostly non-significant. Conclusion The psychometric index scores for verbal working memory (WMI) and processing speed (PSI) seem to have limited utility as indicators of the severity of attention deficits and emotional dysregulation in adult ADHD patients.

• Brunes, Audun; Hansen, Marianne Bang & Heir, Trond (2021). General self-efficacy in individuals with visual impairment compared with the general population. PLOS ONE. 16(7), p. 1–12. doi: 10.1371/journal.pone.0254043. Full text in Research Archive Show summary

  Background Knowledge about self-efficacy and its significance for the quality of life of people with visual impairment is lacking. The aims of the study were to compare general self-efficacy in individuals with visual impairment with the general population, and to investigate the association between self-efficacy and life satisfaction. Methods A telephone-based cross-sectional survey was conducted between January and May 2017 in a probability sample of adults who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about their sociodemographic characteristics, characteristics of vision loss, general self-efficacy (General Self-efficacy Scale), and life satisfaction (Cantril’s Ladder of Life Satisfaction). We obtained norm data from a representative survey of the general Norwegian population (N = 1792; mean age 53.2 years; 52.5% females). Results People with visual impairment had higher levels of general self-efficacy than people in the general population (Mean: 31.5 versus 29.0, p < .001). Results from linear regression analyses of the visual impairment population showed that higher education and residential in an urban municipality were associated with higher self-efficacy. Having additional impairments and a previous history of physical or sexual assaults were associated with lower self-efficacy. A linear dose-response relationship was found between self-efficacy and life satisfaction, in the visual impairment population as well as in the general population. Conclusions People with visual impairment have higher self-efficacy than people in the general population, possibly due to extensive mastery experience in how to handle life as visually impaired. Self-efficacy seems to be important in achieving the best possible life.

• Anker, Espen; Haavik, Jan & Heir, Trond (2020). Alcohol and drug use disorders in adult attention-deficit/hyperactivity disorder: Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation. World Journal of Psychiatry (WJP). 10, p. 202–211. doi: 10.5498/wjp.v10.i9.202. Full text in Research Archive
• Berge, Leon Alexander; Kulle, Bettina; Stenehjem, Jo S.; Heir, Trond; Furu, Kari & Juzeniene, Asta [Show all 11 contributors for this article] (2020). Use of Antidepressants and Risk of Cutaneous Melanoma: A Prospective Registry-Based Case-Control Study. Clinical Epidemiology. 12, p. 193–202. doi: 10.2147/CLEP.S241249. Full text in Research Archive Show summary

  Purpose: Melanoma is the cancer with the most rapidly rising incidence rate in Norway. Although exposure to ultraviolet radiation (UVR) is the major environmental risk factor, other factors may also contribute. Antidepressants have cancer inhibiting and promoting side effects, and their prescription rates have increased in parallel with melanoma incidence. Thus, we aimed to prospectively examine the association between use of antidepressants and melanoma by using nation-wide data from the Cancer Registry of Norway, the National Registry, the Norwegian Prescription Database and the Medical Birth Registry of Norway. Patient and Methods: All cases aged 18– 85 with a primary cutaneous invasive melanoma diagnosed during 2007– 2015 (n=12,099) were matched to population controls 1:10 (n=118,467) by sex and year of birth using risk-set sampling. We obtained information on prescribed antidepressants and other potentially confounding drug use (2004– 2015). Conditional logistic regression was used to estimate adjusted rate ratios (RRs) and 95% confidence intervals (CIs) for the association between overall and class-specific use of antidepressants and incident melanoma. Results: Compared with ≤ 1 prescription, ≥ 8 prescriptions of antidepressants overall were negatively associated with melanoma (RR 0.81 CI 0.75– 0.87). Class-specific analyses showed decreased RRs for selective serotonin reuptake inhibitors (RR 0.82 CI 0.73– 0.93) and mixed antidepressants (RR 0.77 CI 0.69– 0.86). The negative association was found for both sexes, age ≥ 50 years, residential regions with medium and highest ambient UVR exposure, all histological subtypes, trunk, upper and lower limb sites and local disease. Conclusion: Use of antidepressants was associated with decreased risk of melanoma. There are at least two possible explanations for our results; cancer-inhibiting actions induced by the drug and less UVR exposure among the most frequent users of antidepressants.

• Langeland, Willie; Jepsen, Ellen Kirstine Kjærulff; Brand, Bethany L.; Kleven, Linn; Loewenstein, Richard J. & Putnam, Frank W. [Show all 10 contributors for this article] (2020). The economic burden of dissociative disorders: A qualitative systematic review of empirical studies. Psychological Trauma. ISSN 1942-9681. 12(7), p. 730–738. doi: 10.1037/tra0000556. Full text in Research Archive Show summary

  Objective: Dissociative disorders (DDs) are associated with intensive, long-term treatment, suicidality, recurrent hospitalizations, and high rates of disability. However, little is known about the specifics of the economic burden associated with DDs. This worldwide, systematic review examines the results of studies in adults on direct and indirect costs associated with DDs. Method: We searched 6 databases and the reference lists of articles. We also approached researchers to identify unpublished studies. No language restrictions were imposed. Results: A total of 1,002 records met the search criteria, of which 29 papers were selected for full-text inspection. Ultimately, of these, we reviewed four empirical studies. We provide a narrative discussion of study findings. Our findings suggest that DDs are costly to society, and that there is a reduction in service utilization and associated costs over time with diagnosing of and specialized treatment for DDs. However, the overall quality of the economic evaluations was low; several types of DDs, comorbid conditions, and costs were not included; and men were underrepresented. Due to the heterogeneity among studies, we could not perform a meta-analysis. Conclusions: Due to the heterogeneity and low quality of the identified economic evaluations, no firm conclusions about the economic burden of DDs alone can be drawn. Higher quality research, including a detailed description of the study design, population, and primary outcome measures used, utilizing appropriate clinical alternatives and including major comorbidities, is urgently needed to more rigorously assess the economic impact of DDs.

• Bonsaksen, Tore; Heir, Trond; Skogstad, Laila; Grimholt, Tine K.; Ekeberg, Øivind & Lerdal, Anners [Show all 7 contributors for this article] (2020). Daily use of alcohol in the Norwegian general population: Prevalence and associated factors. Drugs and alcohol today. ISSN 1745-9265. doi: 10.1108/DAT-02-2020-0010. Full text in Research Archive Show summary

  Purpose: Harmful use of alcohol is a major public health problem. While harm is often researched in the context of heavy drinking episodes, high-frequency drinking, even when drinking moderate quantities, constitutes a health risk in a longer perspective. The aim of this study was to examine the prevalence of daily use of alcohol in the Norwegian general population, and to assess sociodemographic, mental health-related and personal resource variables associated with daily use of alcohol. Methodology: A cross-sectional survey concerned with health, illness and serious life events was distributed to 5,500 persons in the general population in Norway (response rate 36 %). Sociodemographic variables, personal resource variables (general self-efficacy, optimism, and extraversion) and psychological distress (current anxiety and/or depression) were assessed with regards to their associations with daily drinking in unadjusted and adjusted regression models. Findings: Daily use of alcohol was reported by 39 persons (2.2 %) in the sample (3.1 % of men and 1.4 % of women). While general self-efficacy, optimism and extraversion were unrelated to daily drinking, the adjusted model revealed that male sex (OR: 2.18, p < 0.05), being unemployed/not in education (OR: 3.10, p < 0.05) and reporting current anxiety and/or depression (OR: 3.12, p < 0.01) were associated with daily use of alcohol. Value: The study has contributed to the knowledge about daily drinkers in a representative sample of the Norwegian population. A proportion of 2.2 % was found to drink alcohol on a daily basis. Compared to their counterparts, the odds of daily drinking were higher for men, unemployed persons and persons reporting current psychological distress. Public health initiatives aiming at reducing harmful use of alcohol may pay particular attention to these subsets of the population.

• Falk, Ragnhild Sørum; Heir, Trond; Robsahm, Trude Eid; Tretli, Steinar; Sandvik, Leiv & Erikssen, Jan Emil [Show all 7 contributors for this article] (2020). Fasting serum levels of potassium and sodium in relation to long-term risk of cancer in healthy men. Clinical Epidemiology. 12, p. 1–8. doi: 10.2147/CLEP.S216438. Full text in Research Archive Show summary

  Purpose: To examine whether serum levels of potassium and sodium were associated with long-term cancer risk in initially healthy men. Patients and Methods: A cohort of 1994 initially healthy men with no use of medication, aged 40–59 years, was followed for cancer during 40 years of follow-up. Associations between fasting electrolyte levels and cancer risk were assessed with incidence rates and Cox proportional hazards models. Results: Potassium, but not sodium, was linearly associated with cancer risk. This association remained significant after adjustment of several potential confounding factors, and also after excluding the first 10 years of follow-up. The age-adjusted risk of all-site cancer increased with 16% for each SD increase in potassium level. Men with hyperkalemia showed an incidence rate that was 40% higher than for men with normal potassium levels. Conclusion: Fasting serum potassium level in healthy men was positively associated with long-term cancer risk. Potassium or potassium ion channels may have a role in cell proliferation or differentiation. These findings might imply future cancer strategies for targeting individuals with high serum potassium levels.

• Nissen, Alexander; Berthelsen, Mona; Dale, Maria Teresa Grønning; Hansen, Marianne Bang & Heir, Trond (2020). Is perceived safety and threat after workplace terrorism linked to employee sick-leave? A registry-based longitudinal study of governmental employees in Norway. European Journal of Psychotraumatology. 11:185249(1), p. 1–13. doi: 10.1080/20008198.2020.1785249. Full text in Research Archive Show summary

  Background A large body of research has shown that terrorism enhances fears and undermines perceived safety in a high proportion of both directly exposed individuals and individuals without any form of direct exposure (i.e. no geographical proximity to an attack). Some studies have further suggested that fear of terrorism may adversely affect health in those without direct exposure and that this may constitute an important public health burden because of the number who are indirectly exposed. Limited studies have investigated threat and safety perception after workplace terrorism and the possible consequences for employee health. Objective To explore whether perceived safety and threat in employees whose workplace was subjected to a terrorist attack are associated with subsequent sick-leave. Method A longitudinal questionnaire survey on governmental employees’ perceived safety and threat at work one (T1) and two (T2) years after the 2011 terrorist attack on the Norwegian ministries was linked to registry data on doctor-certified sick-leave for two 9-month periods following T1 and T2 (N = 1703). Results There was fairly strong evidence (0.004 < p < 0.034) that higher perceived safety was associated with a close to 30% reduction in sick-leave in fully adjusted models which included terror exposure and symptom-based PTSD. There was inconclusive evidence that lower perceived threat was associated with reduced sick-leave in the full models. Conclusions Reduced perceived safety in employees following workplace terrorism may have adverse health consequences of public health significance given how prevalent this perception seems to be. The study supports that post-terrorism response plans should include strategies on how to address the potentially large number of individuals suffering ill health after terror even if they were not directly exposed and do not meet criteria for PTSD.

• Bonsaksen, Tore; Skogstad, Laila; Grimholt, Tine Kristin; Heir, Trond; Ekeberg, Øivind & Lerdal, Anners [Show all 7 contributors for this article] (2020). Substance use in the Norwegian general population: Prevalence and associations with disease. Journal of Substance Use. ISSN 1465-9891. 26(2). doi: 10.1080/14659891.2020.1784303. Full text in Research Archive Show summary

  Objective: This study aimed to estimate the prevalence of substance use in the Norwegian general population and examine whether the risk of various psychiatric or somatic diseases varied according to alcohol- and substance use. Methods: A survey was distributed to 5500 persons in Norway, and a sample of 1792 persons responded (36% response rate). Data concerned with the use of substances were cross-tabulated with disease occurrence, and relative ratios (RR) of diseases in groups of lifetime substance users versus abstainers/ low frequent users were calculated. Results: Lifetime prevalence estimates were 83.5% for alcohol, 7.9% for cannabis, 8.5% for sedatives, 33.8% for strong analgesics and 2.4% for opioids and for stimulants. Drinking alcohol weekly or daily was associated with lower risk of several diseases, whereas lifetime use of sedatives, strong analgesics and opioids was associated with higher risk. Lifetime use of cannabis was associated with higher risk of depression and lower risk of diabetes and arthrosis. Conclusions: While frequent alcohol use was associated with reduced risk of several diseases, lifetime use of other substances was generally associated with higher risk of disease. The study provides evidence of increased risk of disease among users of illicit substances and prescription drugs.

• Bonsaksen, Tore; Heir, Trond; Bredal, Inger Schou; Ekeberg, Øivind; Skogstad, Laila & Grimholt, Tine K. (2020). Post-traumatic stress disorder and associated factors during the early stage of the COVID-19 pandemic in Norway. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(24), p. 1–10. doi: 10.3390/ijerph17249210. Full text in Research Archive Show summary

  The COVID-19 outbreak and the sudden lockdown of society in March 2020 had a large impact on people’s daily life and gave rise to concerns for the mental health in the general population. The aim of the study was to examine post-traumatic stress reactions related to the COVID-19 pandemic, the prevalence of symptom-defined post-traumatic stress disorder (PTSD), and factors associated with post-traumatic stress in the Norwegian population during the early stages of the COVID-19 outbreak. A survey was administered via social media channels, to which a sample of 4527 adults (≥18 years) responded. Symptom-defined PTSD was measured with the PTSD Checklist for the DSM-5. The items were specifically linked to the COVID-19 pandemic. We used the DSM-5 diagnostic guidelines to categorize participants as fulfilling the PTSD symptom criteria or not. Associations with PTSD were examined with single and multiple logistic regression analyses. The prevalence of symptom-defined PTSD was 12.5% for men and 19.5% for women. PTSD was associated with lower age, female gender, lack of social support, and a range of pandemic-related variables such as economic concerns, expecting economic loss, having been in quarantine or isolation, being at high risk for complications from COVID-19 infection, and having concern for family and close friends. In conclusion, post-traumatic stress reactions appear to be common in the Norwegian population in the early stages of the COVID-19 outbreak. Concerns about finances, health, and family and friends seem to matter.

• Ormstad, Heidi; Eilertsen, Grethe; Heir, Trond & Sandvik, Leiv (2020). Personality traits and the risk of becoming lonely in old age: A 5-year follow-up study. Health and Quality of Life Outcomes. 18(47). doi: 10.1186/s12955-020-01303-5. Full text in Research Archive Show summary

  Background Although many people experience loneliness in old age, there is little knowledge of predisposing personality factors. The aim of the present study was to explore to what extent personality traits are associated with the risk of becoming lonely, in women and men aged 60–79 years at baseline. Methods The panel data are from The Norwegian study on Life course, Ageing and Generations (NorLAG). Our sample consisted of 516 men and 419 women aged 60–79 years, who were surveyed in both 2002–2003 (baseline) and 2007–2008 (follow-up), and who reported not being lonely at baseline. Personality traits were measured by the Big Five scale. Multivariable logistic regression analyses were used to investigate the association between a personality trait and the risk of becoming lonely, with adjustment for age, mental health and living with a partner. Results At follow-up 59 women and 54 men reported loneliness (14.1% vs. 10.5%, p = 0.092). Among women, high agreeableness at baseline was significantly associated with a higher risk of becoming lonely. Among men, low agreeableness, low conscientiousness and high neuroticism at baseline were significantly associated with a higher risk of becoming lonely. Conclusions Personality traits related differently to loneliness depending on gender. These findings may be useful when developing strategies for preventing loneliness in old age.

• Brunes, Audun & Heir, Trond (2020). Social interactions, experiences with adverse life events and depressive symptoms in individuals with visual impairment: A cross-sectional study. BMC Psychiatry. doi: 10.1186/s12888-020-02652-7. Full text in Research Archive Show summary

  Background Knowledge about the high rates of depression in people with visual impairment (VI) remains unclear. The study aimed to examine whether depressive symptoms in people with VI were associated with social isolation, perceived social support and lifetime exposure to bullying, physical abuse or sexual abuse. Methods An anonymous telephone survey was conducted from January to May 2017 in an age-stratified sample of adults with VI who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about social isolation, perceived social support, and past experiences with bullying and abuse. Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). We calculated unadjusted and full-adjusted exponentiated beta-values (Exp(β)) and corresponding 95% confidence intervals (CIs) using generalized linear models. Results Overall, 736 (61%) adults participated in the study. The mean depression scores were 5.24 (SD: 5.3, range: 0–27), 4.61 for men and 5.77 for women. Results from the full-adjusted model showed higher levels of depressive symptoms among participants who reported social isolation (Exp(β): 1.89, 95% CI: 1.63–2.20), lower levels of perceived social support (Exp(β): 1.55, 95% CI: 1.31–1.83), and past experiences of abuse (Exp(β): 1.41, 95% CI: 1.17–1.70). The strength of the associations between past exposure to bullying or abuse and depressive symptoms was similar for those with low and high levels of support. Conclusion Social isolation, perceived support and experiences of adverse events appear to be independently associated with depressive symptoms. Thus, social integration may be appropriate for the promotion of mental health among people with VI.

• Nissen, Alexander & Heir, Trond (2020). Security interventions and perceived safety and threat following workplace terrorism: a three-wave longitudinal study of ministerial employees in Norway. Journal of Risk Research. ISSN 1366-9877. p. 1–15. doi: 10.1080/13669877.2020.1848903. Full text in Research Archive Show summary

  Spending on counterterrorism interventions has increased markedly in recent decades despite limited evidence supporting their effectiveness. Effectiveness research is mostly based on statistical modelling of risk and risk reduction and tends to ignore the impact interventions have on the subjective consequences of terrorism in a population – e.g. increased fear and anxiety. Feeling fearful and unsafe is common after terrorism and has been shown to mediate negative health outcomes and reduce work functioning in violence-exposed workers. The primary aim of the present study was to explore if visible security measures and escape- and evacuation training are associated with perceived safety and threat in terror-exposed employees. Data from a three-wave longitudinal questionnaire-based observational study of ministerial employees conducted 10, 22 and 34 months after the terrorist attack on the government headquarters in Oslo, Norway in 2011 was combined with retrospective data on installed visible security measures and escape- and evacuation training in ministries for the same period. The main outcomes were employees’ perceived safety and threat at work, both scored on a 5-point Likert scale. Results were analyzed with multilevel mixed-effects ordered logistic regression. There was some evidence that more installed visible security measures were associated with higher employee perceived safety at work (.020 < p value < .061). The findings on the association between security measures and employee perceived threat were unclear, and there was no evidence that escape- and evacuation training was associated with employee perceived safety or threat. Contrary to what is oftentimes argued in the literature, our study suggests that the installation of visible security measures increases perceived safety in terror-exposed individuals and has no clear effect on perceived threat. Our findings may help close knowledge gaps in counterterrorism effectiveness research and aid decision-makers when discussing post-terrorism strategies and interventions.

• Brunes, Audun & Heir, Trond (2020). Visual impairment and depression: Age-specific prevalence, associations with vision loss, and relation to life satisfaction. World Journal of Psychiatry (WJP). 10(6), p. 139–149. doi: 10.5498/wjp.v10.i6.139. Full text in Research Archive
• Dale, Maria Teresa Grønning; Nissen, Alexander Frantz William; Berthelsen, Mona & Heir, Trond (2020). Post-traumatic stress reactions and doctor-certified sick leave after a workplace terrorist attack: Norwegian cohort study. BMJ Open. 10(2). doi: 10.1136/bmjopen-2019-032693. Full text in Research Archive Show summary

  To explore the association between the psychosocial work environment and the risk of sick leave among governmental employees with symptom-defined post-traumatic stress disorder (PTSD) after a workplace bomb attack.A prospective study on employees who met the symptom criteria for PTSD. Questionnaire data on the psychosocial work environment 10 months after the terrorist attack was linked to registry data on doctor-certified sick leave in the period 12–22 months after the attack.The bombing of the government ministries in Oslo, Norway, 22 July 2011.The study sample consists of 94 Norwegian governmental employees, all with symptom-defined PTSD from the Norwegian version of the PTSD checklist (Post-traumatic Stress Disorder Checklist-Specific) measured 10 months after the attack.After adjustment for sex and severity of PTSD symptoms, predictability at work reduced the odds of sick leave (adjusted OR=0.62, 95% CI 0.40 to 0.98). Sense of control over decisions at work was associated with fewer absence days for employees with sick leave (adjusted rate ratio=0.61, 95% CI 0.38 to 0.98).Employees with PTSD after workplace terrorism would benefit from control over their workplace conditions and increased predictability to reduce the risk of sick leave. The findings suggest that the work environment can facilitate employees’ work ability after stressful events, independent of severity of PTSD symptoms.

• Berge, Leon Alexander; Kulle, Bettina; Stenehjem, Jo S.; Heir, Trond; Karlstad, Øystein & Juzeniene, Asta [Show all 11 contributors for this article] (2020). Use of immunomodulating drugs and risk of cutaneous melanoma: A nationwide nested case-control study. Clinical Epidemiology. 12, p. 1389–1401. doi: 10.2147/CLEP.S269446. Full text in Research Archive Show summary

  Purpose: Cutaneous melanoma is among the fastest growing malignancies in Norway and ultraviolet radiation (UVR) exposure is the primary environmental risk factor. Immunomodulating drugs can increase skin photosensitivity and suppress immune responses, and by such mechanisms influence melanoma risk. We, therefore, aimed to examine the associations between use of immunomodulating drugs and melanoma risk, at a nationwide population level. Patients and Methods: In the Cancer Registry of Norway, we identified all cases aged 18– 85 with a first primary cutaneous melanoma diagnosed in 2007– 2015 (n=12,106). These were matched to population controls from the Norwegian National Registry 1:10 (n=118,564), on sex and year of birth using risk set sampling. Information on prescribed drugs (2004– 2015) was obtained by linkage to the Norwegian Prescription Database (NorPD). Conditional logistic regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for associations between use of immunomodulating drugs (immunosuppressants and corticosteroids) and melanoma risk, adjusted for ambient UVR and other drug use. Results: Compared with ≤ 1 prescription, use of ≥ 8 prescriptions of immunosuppressants was associated with increased risk of melanoma (RR 1.50, 95% CI 1.27, 1.77). Similar associations were found for subgroups of immunosuppressants: drugs typically prescribed to organ transplant recipients (OTRs) (RR 2.02, 95% CI 1.35, 3.03) and methotrexate (RR 1.27, 95% CI 1.04, 1.55). Similar results were found for high levels of cumulative doses and across all histological subtypes. Use of corticosteroids was not associated with melanoma risk. Conclusion: We found a positive association between use of immunosuppressants and melanoma risk, with the highest risk seen for drugs prescribed to OTRs. Knowledge about this risk increase is important for physicians and users of these drugs, for intensified surveillance, awareness and cautious sun exposure.

• Berthelsen, Mona; Hansen, Marianne Bang; Nissen, Alexander; Nielsen, Morten Birkeland; Knardahl, Stein & Heir, Trond (2020). Effects of exposure to workplace terrorism on subsequent doctor certified sickness absence, and the modifying role of psychological and social work factors: a combined survey and register study. BMC Public Health. 20(1). doi: 10.1186/s12889-020-08465-3. Full text in Research Archive Show summary

  Background Studies have shown that terrorist attacks affect the mental and physical health of persons exposed to terrorism. When terror strikes at the workplace where people spend much time, and should feel safe, the health consequences for those affected might be severe. The aim of the study was to determine whether psychological and social work factors moderates effects of exposure to a workplace terrorist attack on subsequent doctor-certified sickness absence. Methods The study design combined survey data with register data on sickness absence. Data on exposure to the attack, and psychosocial working conditions were collected by a web-based questionnaire 10 months after the attack. Survey data was linked to registry data on doctor-certified sickness absence over the one-year time period following baseline. The survey response rate was 56% (n = 1974), where 80.6% (1591) gave consent to link survey data to data on sickness absence. Exposure to the attack was assessed as “Directly-”, or “Indirectly exposed”. Psychological and social work factors were measured by the General Questionnaire for Psychological and Social factors at Work (QPSNordic). Data were analyzed with negative binominal hurdle regressions. Results Direct exposure to the attack increased the odds of becoming sick-listed if role clarity was average (OR = 1.50) or high (OR = 2.13), but not if low (OR = 1.17). Direct exposure was associated with higher sickness absence rates if control over work pace was low (RR = 1.61). Role conflict, support from co-workers, and -superior showed weaker evidence of moderating effects of exposure on sickness absence. Conclusions Exposure to the bomb explosion, as well as psychosocial working conditions affect the risk of employee sickness absence. Psychosocial working conditions seems to moderate effects of exposure to workplace terrorism on subsequent sickness absence. Organizations would benefit from striving for good psychological and social working conditions both as preventions against illness and sickness absence, and as measures in the aftermath of a workplace terrorist attack.

• Bredal, Inger Schou; Bonsaksen, Tore; Ekeberg, Øivind; Skogstad, Laila; Grimholt, Tine Kristin & Lerdal, Anners [Show all 7 contributors for this article] (2020). Sexual assault and the association with health, quality of life and self-efficacy in the general Norwegian population. Journal of Interpersonal Violence. ISSN 0886-2605. doi: 10.1177/0886260520926307. Full text in Research Archive Show summary

  The lifetime prevalence of sexual assault was examined in a representative sample of the general Norwegian adult population (n¼1,792), in addition to the association between sexual assault and health, quality of life, and general self-efficacy. Respondents completed questionnaires assessing these factors. Overall, 6.7% (n¼120) of the respondents (10.9% of women and 1.9% of men) reported an experience of sexual assault. Respondents in the sexual assault group reported significantly worse mental and physical health as well as poorer quality of life and lower self-efficacy, compared with those without sexual assault experience. The most prevalent mental problems in the sexual assault group were depression (61.7%), sleep problems (58.3%), eating disorders (26.7%), and posttraumatic stress disorder symptoms at a clinical level (25.0%). The most prevalent physical problems were chronic pain (47.5%) and musculoskeletal disease (30.8%). The proportions of physical and mental health problems were not significantly different between male and female victims. Results indicated that having experienced sexual assault during one’s life appears to be associated with lifetime occurrence of multiple health problems for both genders and reduces a person’s perceived general selfefficacy and quality of life.

• Nissen, Alexander; Hansen, Marianne; Nielsen, Morten Birkeland; Knardahl, Stein & Heir, Trond (2019). Employee safety perception following workplace terrorism. A longitudinal study. European Journal of Psychotraumatology. 10. doi: 10.1080/20008198.2018.1478584. Full text in Research Archive Show summary

  Terrorism at the workplace represents an extreme form of workplace violence potentially affecting large numbers of individuals. Evidence suggests that workplace violence adversely affects employees’ health and work functioning by increasing perceived threat and decreasing perceived safety. The objective of this study was to explore longitudinal associations between perceived safety at work among employees exposed to a workplace terrorist attack and their views on security measures and emergency preparedness. The study comprised a three-wave follow-up of earlier cross-sectional studies on perceived safety at work in ministerial employees exposed to a terrorist attack in Oslo, Norway, in 2011 (N = 3065). Linear mixed-effects modelling was used to explore how perceived safety at work was associated with employees’ perceptions on the prioritization of security measures at work, their knowledge of evacuation procedures, and the extent of escape and evacuation training. The more employees believed security measures were sufficiently prioritized at work and the better their knowledge of evacuation procedures, the higher they rated perceived safety at work. These findings applied both across employees (between-subject effects) and within employees across time (within-subject effects). Employees’ views on the extent of escape and evacuation training were not strongly associated with perceived safety at work. Secondary analysis showed that post-traumatic stress reactions were negatively associated with perceived safety at work, and that the positive association between knowledge of evacuation procedures and perceived safety at work was weaker in women and more educated employees. In conclusion, following terrorism at the workplace, employees’ perceived safety at work might be increased if employers prioritize security measures and provide good information on evacuation procedures. For employees with high levels of post-traumatic stress reactions, adequate treatment of these reactions will be likely to lead to enhanced perceived safety at work.

• Bredal, Inger Schou; Bonsaksen, Tore; Heir, Trond; Skogstad, Laila; Lerdal, Anners & Grimholt, Tine Kristin [Show all 7 contributors for this article] (2019). Optimists report fewer physical and mental health conditions than pessimists in the general Norwegian population. Health Psychology Report. ISSN 2353-4184. 7(1), p. 9–18. doi: 10.5114/hpr.2019.81003. Full text in Research Archive Show summary

  Background: Several studies have found that optimism is associated with better health. However, all those studies have investigated the subject in a specific context: gender, age group, diagnosis, situation, or population segment. Given the association found between optimism and physical health, mental health and well-being in previous studies, one would expect optimistic individuals in the general population to report fewer physical and mental health conditions during their lifetimes than pessimists. The aim of the present study was to test this hypothesis. Participants and procedure: A random sample of 1792 people participated in a survey on a broad variety of mental and physical health conditions. In addition they filled out the Life Orientation Test– Revised (LOT-R). Optimism was defined as a score of ≥ 17 on the LOT-R. Results: Optimists reported a lower prevalence of a wide range of mental and physical health conditions compared with pessimists. The associations between optimism and better health conditions persisted for the majority of health conditions investigated, even after adjustment for age, gender and education. Overall, pessimists had a greater estimated risk of disease in general. In addition 11.30% of the pessimists reported having had five or more different diseases during their lifetimes, compared with 3.90% of the optimists. Conclusions: Our results add to growing evidence that optimism plays an important role in health and support the view that fostering optimism is an appropriate strategy for promoting health.

• Heir, Trond; Bonsaksen, Tore; Grimholt, Tine Kristin; Ekeberg, Øivind; Skogstad, Laila & Lerdal, Anners [Show all 7 contributors for this article] (2019). Serious life events and post-traumatic stress disorder in the Norwegian population. BJPsych Open. 5(5), p. 1–7. doi: 10.1192/bjo.2019.62. Full text in Research Archive Show summary

  Background It has been suggested that countries with more resources and better healthcare have populations with a higher risk of posttraumatic stress disorder (PTSD). Norway is a high-income country with good public healthcare. Aims To examine lifetime trauma exposure and the point prevalence of PTSD in the general Norwegian population. Method A survey was administered to a national probability sample of 5500 adults (aged ≥18 years). Of 4961 eligible individuals, 1792 responded (36%). Responders and non-responders did not differ significantly in age, gender or urban versus rural residence. Trauma exposure was measured using the Life Events Checklist for the DSM-5. PTSD was measured with the PTSD Checklist for the DSM-5. We used the DSM-5 diagnostic guidelines to categorise participants as fulfilling the PTSD symptom criteria or not. Results At least one serious lifetime event was reported by 85% of men and 86% of women. The most common event categories were transportation accident and life-threatening illness or injury. The point prevalence of PTSD was 3.8% for men and 8.5% for women. The most common events causing PTSD were sexual and physical assaults, life-threatening illness or injury, and sudden violent deaths. Risk of PTSD increased proportionally with the number of event categories experienced. Conclusions High estimates of serious life events and correspondingly high rates of PTSD in the Norwegian population support the paradox that countries with more resources and better healthcare have higher risk of PTSD. Possible explanations are high expectations for a risk-free life and high attention to potential harmful mental health effects of serious life events.

• Grimholt, Tine Kristin; Bonsaksen, Tore; Bredal, Inger Schou; Heir, Trond; Lerdal, Anners & Skogstad, Laila [Show all 7 contributors for this article] (2019). Flight anxiety reported from 1986 to 2015. Aerospace Medicine and Human Performance. ISSN 2375-6314. 90(4), p. 384–388. doi: 10.3357/AMHP.5125.2019. Full text in Research Archive
• Brunes, Audun; Hansen, Marianne & Heir, Trond (2019). Einsamkeit bei Erwachsenen mit Sehbehinderung: Prävalenz, assoziierte Faktoren und Zusammenhang mit der Lebenszufriedenheit. Karger Kompass Ophthalmologie. ISSN 2297-0118. 5(3), p. 110–117. doi: 10.1159/000502498. Full text in Research Archive Show summary

  Hintergrund: Bisher ist wenig darüber bekannt, ob und in welchem Maße sich Einsamkeit auf das Leben von Menschen mit Sehbehinderung (SB) auswirkt. Das Ziel dieser Studie war es daher, die Prävalenz und die assoziierten Faktoren von Einsamkeit bei Erwachsenen mit SB sowie den Zusammenhang von Einsamkeit und Lebenszufriedenheit zu untersuchen. Methoden: In diese Querschnittsstudie wurde eine Wahrscheinlichkeitsstichprobe von 736 Erwachsenen (≥18 Jahre) mit SB eingeschlossen, die Mitglieder des Norwegischen Verbandes der Sehbehinderten und Blinden waren. Die Interviews fanden zwischen Januar und Mai 2017 statt; erhoben wurden Informationen über soziodemographische Faktoren, Merkmale der SB, negative Lebenserfahrungen, Einsamkeit laut Three Item Loneliness Scale und Lebenszufriedenheit laut Cantril's Ladder of Life Satisfaction. Die Prävalenz der Einsamkeit wurde mit Daten der norwegischen Allgemeinbevölkerung (N = 14 884; Durchschnittsalter 46,4 Jahre; 50,7% Frauen) verglichen. Ergebnisse: Die Prävalenz mittelschwerer und schwerer Einsamkeit in der SB-Population betrug 28,7% (95-%-Konfidenzintervall (KI): 25,4; 32,1) bzw. 19,7% (95-%-KI: 16,9; 22,8). Die Rate war durchgängig in allen Altersgruppen und für alle Schweregrade der Einsamkeit höher als in der Allgemeinbevölkerung. Jüngeres Lebensalter, vollständige Erblindung, Vorliegen weiterer Beeinträchtigungen, Arbeitslosigkeit sowie Mobbing- und Gewalterfahrungen waren mit Einsamkeit assoziiert. Zugleich waren höhere Einsamkeits-Scores mit geringerer Lebenszufriedenheit assoziiert (vollständig angepasstes β = −0,48; 95-%-KI: −0,55; −0,41). Schlussfolgerungen: Einsamkeit ist bei Erwachsenen mit SB weit verbreitet. Strategien, die geeignet sind, die Einsamkeit zu lindern, könnten die Lebenszufriedenheit der Menschen, die mit SB oder Blindheit leben, verbessern.

• Robsahm, Trude Eid; Heir, Trond; Sandvik, Leiv; Prestgaard, Erik Edvard; Tretli, Steinar & Erikssen, Jan Emil [Show all 7 contributors for this article] (2019). Changes in midlife fitness, body mass index, and smoking influence cancer incidence and mortality: A prospective cohort study in men. Cancer Medicine. 8(10), p. 4875–4882. doi: 10.1002/cam4.2383. Full text in Research Archive Show summary

  Cancer prevention efforts include modification of unhealthy lifestyle, such as smoking cessation and resisting gain in body weight. Although physical activity is inversely related to risk of several cancers, it is poorly studied whether changes in physical activity or fitness influence future cancer risk. Thus, we aimed to investigate whether changes in midlife cardiorespiratory fitness (CRF), body mass index (BMI), and smoking habits influence cancer incidence and mortality. The study cohort includes 1689 initially healthy men, aged 40‐59 years. Measurements of CRF, BMI and information on smoking habits were collected in two repeated waves, 7 years apart. Cox regression models estimated associations as hazard rates (HR) with 95% confidence intervals (CI), between midlife changes in the modifiable lifestyle factors and cancer incidence and mortality. The men were followed prospectively for more than 30 years. Compared to CRF loss (>5%), improved CRF (>5%) was associated with lower cancer incidence (HR 0.81, 95% CI 0.67‐0.98) and mortality (HR 0.70, 95% CI 0.54‐0.92), and maintaining the CRF stable yielded lower cancer incidence (HR 0.76, 95% CI 0.61‐0.95). No association was seen for BMI gain, but maintaining the BMI stable was related to lower cancer incidence (HR 0.77, 95% CI 0.60‐0.98), compared to BMI loss. Continue smoking was associated with higher cancer incidence and mortality, compared to men who stopped smoking. In particular, this study adds new knowledge about the potential preventive role of CRF in cancer development and emphasizes lifestyle modification as a highly important effort in cancer prevention.

• Brunes, Audun; Hansen, Marianne & Heir, Trond (2019). Loneliness among adults with visual impairment: Prevalence, associated factors, and relationship to life satisfaction. Health and Quality of Life Outcomes. 17(1), p. 1–7. doi: 10.1186/s12955-019-1096-y. Full text in Research Archive Show summary

  Background Little is known about whether and to what extent loneliness impacts the lives of people with visual impairment (VI). Thus, the aim of this study was to examine the prevalence of and factors associated with loneliness in adults with VI, and to examine its association with life satisfaction. Methods This cross-sectional interview study included a probability sample of 736 adults (≥18 years old) with VI who were members of the Norwegian Association of the Blind and Partially Sighted. The interviews took place from January to May 2017, collecting information about sociodemographics, VI characteristics, adverse life events, loneliness (Three Item Loneliness Scale), and life satisfaction (Cantril’s Ladder of Life Satisfaction). The prevalence of loneliness was compared to data obtained from the general Norwegian population (N = 14,884; mean age 46.4 years; 50.7% females). Results The prevalence of moderate and severe loneliness in the VI population was 28.7% (95% CI: 25.4, 32.1) and 19.7% (95% CI: 16.9, 22.8), respectively. The rates were consistently higher across age groups compared to the general population. Loneliness was associated with younger age, blindness, having other impairments, unemployment, and a history of bullying or abuse. In addition, higher scores on loneliness were associated with lower levels of life satisfaction (fully adjusted β = − 0.48, 95% CI: − 0.55, − 0.41). Conclusions Loneliness is common in adults with VI. Strategies capable of reducing loneliness could improve life satisfaction among people who are blind or visually impaired.

• Bonsaksen, Tore; Ekeberg, Øivind; Skogstad, Laila; Heir, Trond; Grimholt, Tine Kristin & Lerdal, Anners [Show all 7 contributors for this article] (2019). Self-rated global health in the Norwegian general population. Health and Quality of Life Outcomes. 17(1). doi: 10.1186/s12955-019-1258-y. Full text in Research Archive Show summary

  Background. Prevalence studies are needed to assess the distribution of diseases. However, in a contrasting health promotion perspective, self-rated health is in itself an important field of study. This study investigated self-rated global health in the general population in Norway. Methods. As part of a national survey, a two-item measure of global health (score range 0–100) was administered to a general population sample, and 1776 of 4961 eligible participants (response rate 36%) responded. Group comparisons were conducted using independent t-tests and one-way analyses of variance, whereas factors associated with global health was investigated with linear regression analysis. Results. In the adjusted analyses, better global health was associated with higher age (β = 0.13, p <  0.001), having higher education (β = 0.10, p <  0.001), being employed (β = 0.21, p <  0.001), and living with a spouse or partner (β = 0.05, p <  0.05). Conclusions. While global health was similar for men and women in the Norwegian general population, other sociodemographic variables were linked with global health. In particular, the link between employment and self-rated global health was strong. The findings are considered representative for the Norwegian population.

• Bonsaksen, Tore; Heir, Trond; Ekeberg, Øivind; Grimholt, Tine Kristin; Lerdal, Anners & Skogstad, Laila [Show all 7 contributors for this article] (2019). Self-evaluated anxiety in the Norwegian population: Prevalence and associated factors. Archives of Public Health. ISSN 0778-7367. 77(10). doi: 10.1186/s13690-019-0338-0. Full text in Research Archive Show summary

  Background: Self-evaluations of mental health problems may be a useful complement to diagnostic assessment, but are less frequently used. This study investigated the prevalence of self-evaluated current and lifetime anxiety in the general Norwegian population, and sociodemographic and psychological factors associated with current anxiety. Methods: A cross-sectional population survey was conducted, using anxiety stated by self-evaluation as outcome. Single and multivariate logistic regression analyses were conducted to examine associations between sociodemographic and psychological variables and anxiety. Results: One thousand six hundred eighty-four valid responses (34% of the eligible participants) were analysed in this study. One hundred and eleven participants (6.6%) reported current anxiety, while 365 (21.7%) reported lifetime anxiety. Adjusting for sociodemographic and psychological variables, higher age reduced the odds of current anxiety (OR=0.87, 95% CI=0.75–0.99), whereas higher levels of neuroticism increased the odds (OR=2.04, 95% CI=1.77–2.36). Conclusions: The study concludes that higher age appears to protect against anxiety, whereas neuroticism appears to increase the odds of experiencing anxiety.

• Berge, Leon Alexander; Kulle, Bettina; Stenehjem, Jo S.; Larsen, Inger Kristin; Furu, Kari & Juzeniene, Asta [Show all 11 contributors for this article] (2019). Cardiovascular, antidepressant and immunosuppressive drug use in relation to risk of cutaneous melanoma: A protocol for a prospective case-control study. BMJ Open. 9:e025246(2), p. 1–8. doi: 10.1136/bmjopen-2018-025246. Full text in Research Archive Show summary

  The incidence of cutaneous melanoma (hereafter melanoma) has increased dramatically among fair-skinned populations worldwide. In Norway, melanoma is the most rapidly growing type of cancer, with a 47% increase among women and 57% among men in 2000–2016. Intermittent ultraviolet exposure early in life and phenotypic characteristics like a fair complexion, freckles and nevi are established risk factors, yet the aetiology of melanoma is multifactorial. Certain prescription drugs may have carcinogenic side effects on the risk of melanoma. Some cardiovascular, antidepressant and immunosuppressive drugs can influence certain biological processes that modulate photosensitivity and immunoregulation. We aim to study whether these drugs are related to melanoma risk.Methods and analysisA population-based matched case–control study will be conducted using nation-wide registry data. Cases will consist of all first primary, histologically verified melanoma cases diagnosed between 2007 and 2015 identified in the Cancer Registry of Norway (14 000 cases). Ten melanoma-free controls per case (on date of case melanoma diagnosis) will be matched based on sex and year of birth from the National Registry of Norway. For the period 2004—2015, and by using the unique personal identification numbers assigned to all Norwegian citizens, the case–control data set will be linked to the Norwegian Prescription Database for information on drugs dispensed prior to the melanoma diagnosis, and to the Medical Birth Registry of Norway for data regarding the number of child births. Conditional logistic regression will be used to estimate associations between drug use and melanoma risk, taking potential confounding factors into account.Ethics and disseminationThe project is approved by the Regional Committee for Medical Research Ethics in Norway and by the Norwegian Data Protection Authority. The study is funded by the Southeastern Norway Regional Health Authority. Results will be published in peer-reviewed journals and disseminated further through scientific conferences, news media and relevant patient interest groups.

• Bonsaksen, Tore; Grimholt, Tine Kristin; Skogstad, Laila; Lerdal, Anners; Ekeberg, Øivind & Heir, Trond [Show all 7 contributors for this article] (2018). Self-diagnosed depression in the Norwegian general population - associations with neuroticism, extraversion, optimism, and general self-efficacy. BMC Public Health. 18(1076). doi: 10.1186/s12889-018-5990-8. Full text in Research Archive Show summary

  Background: Multi-item rating scales for depression informs about the level of depression, but does not allow individuals to state by self-evaluation whether they feel depressed or not. The insider perspective on depression is rarely assessed. This study investigated the prevalence of self-diagnosed depression in the Norwegian general population, and associations with sociodemographic and psychological factors. Methods: As part of a national survey, the General Self-Efficacy Scale, the Life Orientation Test-Revised, a short version of the Eysenck Personality Questionnaire and a one-item measure of self-diagnosed depression was administered to 5. 500 persons in the general Norwegian population. Of the 4961 eligible participants ≥18 years of age, 1.787 (response rate 36%) participated in the survey, and 1.684 of these had valid scores on the relevant scales. The associations between sociodemographic factors and self-diagnosed depression were examined using univariate and multivariate logistic regression analyses. Results: One hundred and thirty-six participants (8.1%) reported depression during the preceding month. When adjusting for sociodemographic and psychological variables, higher age (OR=0.82), being in work (OR=0.57), and higher levels of general self-efficacy (OR=0.67) and optimism (OR=0.52) were associated with lower risk of self-diagnosed depression, whereas higher levels of neuroticism (OR=1.97) was associated with higher risk. Conclusions: The prevalence of self-diagnosed depression in the adult Norwegian population was higher for women than for men. Higher age, being in work and having higher levels of psychological resources appear to reduce the risk of selfdiagnosed depression, whereas neuroticism increases the risk.

• Brunes, Audun; Hansen, Marianne & Heir, Trond (2018). Post-traumatic stress reactions among individuals with visual impairments: A systematic review. Disability and Rehabilitation. ISSN 0963-8288. 41(18), p. 2111–2118. doi: 10.1080/09638288.2018.1459884. Full text in Research Archive
• Anker, Espen; Halmøy, Anne & Heir, Trond (2018). Work participation in ADHD and associations with social characteristics, education, lifetime depression, and ADHD symptom severity. ADHD Attention Deficit and Hyperactivity Disorders. ISSN 1866-6116. p. 1–7. doi: 10.1007/s12402-018-0260-2. Full text in Research Archive Show summary

  The literature refers to high rates of occupational failure in the population of adults with ADHD. The explanation for this is less known. The aim of the present study was to examine associations between social characteristics and clinical features of adults with ADHD and their occupational outcome. Out of 1050 patients diagnosed with ADHD in a specialized outpatient clinic between 2005 and 2017, 813 (77.4%) agreed to participate in the study. ADHD was diagnosed according to DSM-IV criteria, and ADHD subtypes recorded accordingly. Lifetime depression was diagnosed using the specific module of the Mini International Neuropsychiatric Interview. Occupational status and other social characteristics like marital status and living with children were recorded. Intelligence (IQ) and symptom severity of ADHD (ASRS score) were assessed in subsamples of participants (n = 526 and n = 567, respectively). In this sample of adults with ADHD (mean age 36.9 years, 48.5% women), 55.3% of the women and 63.7% of the men were working at the time of inclusion. Work participation was associated with being male, being married or cohabitant, or living with children, as well as a life story without major depression. Age, education, ADHD subtype, and ADHD symptom severity were not significantly associated with work participation. Neither was IQ when adjusted for other covariates. Occupational outcome in adults with ADHD appears to be more associated with social characteristics and a history of depression, rather than with IQ, ADHD subtype, or ADHD symptom severity.

• Hansen, Marianne; Berthelsen, Mona; Nissen, Alexander & Heir, Trond (2018). Sick leave before and after a work-place targeted terror attack. International Archives of Occupational and Environmental Health. ISSN 0340-0131. doi: 10.1007/s00420-018-1390-8. Full text in Research Archive Show summary

  Objectives: To estimate the rate of sick leave and sick leave diagnosis among employees before and after a work-place targeted terror attack, and to compare sick leave in subgroups of employees based on gender and trauma exposure. Methods: Data on sick leave and diagnosis in ministerial employees from the period 3 years before to 3 years after the 2011 bombing in the governmental district of Oslo was retrieved from the Norwegian Social Insurance Administration Registries. Results: Prior to the attack, sick leave was twice as high in women as in men. Compared to the period prior to the attack, sick leave increased the first year after the attack, for both women and men that were directly exposed to the event. Sick leave stabilized to the initial level 3 years after the incident. For indirectly exposed employees, i.e., those who were not present at the site of the attack, there was no significant increase in sick leave from before to after the attack. There were no statistical significant changes in diagnoses applied before and after the terrorist attack. However, there was a tendency towards an increase in sick leave due to psychological diagnoses among the directly exposed women. Conclusions: After a work-place terrorist attack a transient increase in sick leave may occur among employees who were present at the site of the attack. The increase may seem relatively modest and last for 1–3 years.

• Anker, Espen; Bendiksen, Bothild & Heir, Trond (2018). Comorbid psychiatric disorders in a clinical sample of adults with ADHD, and associations with education, work and social characteristics: A cross-sectional study. BMJ Open. 8(e019700). doi: 10.1136/bmjopen-2017-019700. Full text in Research Archive
• Brunes, Audun & Heir, Trond (2018). Sexual assaults in individuals with visual impairment: A cross-sectional study of a Norwegian sample. BMJ Open. 8(6). doi: 10.1136/bmjopen-2018-021602. Full text in Research Archive Show summary

  Objective: To examine the prevalence of sexual assaults among individuals with visual impairment (VI) compared with the general population and to investigate the association between sexual assault and outcomes of self-efficacy and life satisfaction. Design: Cross-sectional interview-based study conducted between February and May 2017. Participants: A probability sample of adults with VI (≥18 years) who were members of the Norwegian Association of the Blind and Partially Sighted. A total of 736 (61%) members participated, of whom 55% were of female gender. We obtained norm data for sexual assaults from a representative survey of the general Norwegian population. Outcome measures: Sexual assaults (Life Event Checklist for DSM-5), self-efficacy (General Self-Efficacy Scale) and life satisfaction (Cantril’s Ladder of Life Satisfaction). Results: The prevalence of sexual assaults (rape, attempted rape and forced into sexual acts) in the VI population was 17.4% (95% CI 14.0 to 21.4) among women and 2.4% (95% CI 1.2 to 4.7) among men. For women, the VI population had higher rates of sexual assaults across age strata than the general population. For men, no significant differences were found. In the population of people with VI, the risk of sexual assault was greater for those having other impairments in addition to the vision loss. Individuals with VI who experienced sexual assaults had lower levels of self-efficacy (adjusted relative risk (ARR): 0.18, 95% CI 0.05 to 0.61) and life satisfaction (ARR: 0.31, 95% CI 0.19 to 0.50) than others. Conclusions: The risk of experiencing sexual assault appears to be higher in individuals with VI than in the general population. Preventive measures as well as psychosocial care for those who have been exposed are needed.

• Brunes, Audun; Nielsen, Morten Birkeland & Heir, Trond (2018). Bullying among people with visual impairment. Prevalence, associated factors and relationship to self-efficacy and life satisfaction. World Journal of Psychiatry (WJP). 22(1), p. 43–50. doi: 10.5498/wjp.v8.i1.43. Full text in Research Archive Show summary

  AIM: To examine associated factors of bullying and to determine associations between bullying and psychosocial outcomes among individuals with visual impairments (VI). METHODS: We conducted an age-stratified cross-sectional survey of adults with VI who were recruited from the Norwegian Association of the Blind and Partially Sighted. Data were collected through structural telephone interviews in the period between February and May, 2017. Linear regression models were used to examine factors related to bullying and associations of bullying with self-efficacy and life satisfaction. RESULTS: A total of 736 individuals were interviewed. The lifetime and 6-mo prevalence of bullying was 41.7% and 8.2%, respectively. The majority of bullied participants reported VI-specific bullying (65.1%). Victimization of bullying was associated with young age, early onset-age of VI, and having other impairments. Participants who reported bullying had lower levels of self-efficacy [Adjusted relative risk (ARR): 0.40, 95% confidence interval (CI): 0.19-0.85] and life satisfaction (ARR: 0.68, 95%CI: 0.51-0.91). CONCLUSION: Bullying is highly prevalent among individuals with VI. Our findings suggest that interventions to reduce bullying may be beneficial for improving the well-being and life quality of people with VI.

• Bonsaksen, Tore; Lerdal, Anners; Heir, Trond; Ekeberg, Øivind; Skogstad, Laila & Grimholt, Tine Kristin [Show all 7 contributors for this article] (2018). General self-efficacy in the Norwegian population: Differences and similarities between sociodemographic groups. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/1403494818756701. Full text in Research Archive Show summary

  Aims: General self-efficacy (GSE) refers to optimistic self-beliefs of being able to perform and control behaviors, and is linked with various physical and mental health outcomes. Measures of self-efficacy are commonly used in health research with clinical populations, but are less explored in relationship to sociodemographic characteristics in general populations. This study investigated GSE in relation to sociodemographic characteristics in the general population in Norway. Methods: As part of a larger national survey, the GSE scale was administered to a general population sample, and 1787 out of 4961 eligible participants (response rate 36%) completed the scale. Group comparisons were conducted using independent t-tests and one-way analyses of variance. Linear regression analysis was used to examine factors independently associated with GSE. Results: GSE was lower for older compared to younger participants (p < 0.001). It was higher for men compared to women (p < 0.001), higher for those with higher levels of education compared to those with lower levels (p < 0.001) and higher for those in work compared to their counterparts (p < 0.001). Controlling for all variables, male gender and employment were independently associated with higher GSE. Age moderated the associations between gender and employment on one hand, and GSE on the other. The association between being male and having higher GSE was more pronounced in younger age, as was the association between being employed and having higher GSE. Conclusions: Male gender and being employed were related to higher GSE among persons in the general population in Norway, and these associations were stronger among persons of younger age. The findings are considered fairly representative for the Norwegian population.

• Falk, Ragnhild Sørum; Tretli, Steinar; Paulsen, Jan Erik; Sandvik, Leiv; Erikssen, Jan Emil & Heir, Trond (2017). Response to Intravenous Glucose-Tolerance Test and Risk of Cancer: A Long-Term Prospective Cohort Study. EBioMedicine. 21, p. 117–122. doi: 10.1016/j.ebiom.2017.06.018. Full text in Research Archive Show summary

  Background Impaired glucose regulation, measured with an oral glucose-tolerance test, has been associated with the risk of cancer. Here, we explored whether the response to an intravenous glucose-tolerance test (IVGTT) is associated with the risk of cancer. Methods A cohort of 945 healthy men, aged 40–59 years in 1972–75, was followed for 40 years. An IVGTT was performed at baseline. Blood samples for glucose determinations were drawn immediately before glucose injection and thereafter every 10 min for 1 h. Associations were assessed with incidence rate ratios (IRR) and Cox models. Findings Cancer incidence was higher among men with 10-min glucose levels below the median than in men with levels above the median (IRR: 1.5, 95% CI: 1.2–1.9). This association remained significant after adjusting for relevant confounders (HR: 1.6, 95% CI: 1.3–2.1) and when excluding the first 10 years of follow-up to minimize the possibility of reverse causality (HR: 1.5, 95% CI: 1.2–2.0). Interpretation Healthy middle-aged males that responded to an intravenous glucose injection with rapid glucose elimination during the first phase had an elevated risk of cancer during 40 years of follow-up. First phase response to a glucose load might be related to cancer development.

• Birkeland, Marianne Skogbrott; Hansen, Marianne; Blix, Ines; Solberg, Øivind & Heir, Trond (2017). For Whom Does Time Heal Wounds? Individual Differences in Stability and Change in Posttraumatic Stress after the 2011 Oslo Bombing. Journal of Traumatic Stress. ISSN 0894-9867. 30(1), p. 19–26. doi: 10.1002/jts.22158. Full text in Research Archive
• Birkeland, Marianne Skogbrott; Blix, Ines; Solberg, Øivind & Heir, Trond (2017). Does optimism act as a buffer against posttraumatic stress over time? A longitudinal study of the protective role of optimism after the 2011 Oslo bombing. Psychological Trauma. ISSN 1942-9681. 9(2), p. 207–213. doi: 10.1037/tra0000188. Full text in Research Archive
• DeMott, Melinda Ashley Meyer; Jakobsen, Marianne; Wentzel-Larsen, Tore & Heir, Trond (2017). A controlled early group intervention study for unaccompanied minors: Can Expressive Arts alleviate symptoms of trauma and enhance life satisfaction? Scandinavian Journal of Psychology. ISSN 0036-5564. 58(6), p. 510–518. doi: 10.1111/sjop.12395. Full text in Research Archive
• Birkeland, Marianne Skogbrott & Heir, Trond (2017). Making connections: exploring the centrality of posttraumatic stress symptoms and covariates after a terrorist attack. European Journal of Psychotraumatology. doi: 10.1080/20008198.2017.1333387. Full text in Research Archive
• Nygaard, Egil; Johansen, Venke A; Siqveland, Johan; Hussain, Ajmal & Heir, Trond (2017). Longitudinal relationship between self-efficacy and posttraumatic stress symptoms 8 years after a violent assault: An autoregressive cross-lagged model. Frontiers in Psychology. 8, p. 1–10. doi: 10.3389/fpsyg.2017.00913. Full text in Research Archive Show summary

  Self-efficacy is assumed to promote posttraumatic adaption, and several cross-sectional studies support this notion. However, there is a lack of prospective longitudinal studies to further illuminate the temporal relationship between self-efficacy and posttraumatic stress symptoms. Thus, an important unresolved research question is whether posttraumatic stress disorder (PTSD) symptoms affect the level of self-efficacy or vice versa or whether they mutually influence each other. The present prospective longitudinal study investigated the reciprocal relationship between general self-efficacy (GSE) and posttraumatic stress symptoms in 143 physical assault victims. We used an autoregressive cross-lagged model across four assessment waves: within 4 months after the assault (T1) and then 3 months (T2), 12 months (T3) and 8 years (T4) after the first assessment. Stress symptoms at T1 and T2 predicted subsequent self-efficacy, while self-efficacy at T1 and T2 was not related to subsequent stress symptoms. These relationships were reversed after T3; higher levels of self-efficacy at T3 predicted lower levels of posttraumatic stress symptoms at T4, while posttraumatic tress symptoms at T3 did not predict self-efficacy at T4. In conclusion, posttraumatic stress symptoms may have a deteriorating effect on self-efficacy in the early phase after physical assault, whereas self-efficacy may promote recovery from posttraumatic stress symptoms over the long term.

• Kristensen, Pål; Dyregrov, Atle; Weisæth, Lars; Straume, Marianne; Dyregrov, Kari & Heir, Trond [Show all 7 contributors for this article] (2017). Optimizing visits to the site of death for bereaved families after disasters and terror events. Disaster Medicine and Public Health Preparedness. ISSN 1935-7893. 12(2), p. 523–527. doi: 10.1017/dmp.2017.94. Full text in Research Archive
• Birkeland, Marianne Skogbrott; Blix, Ines; Solberg, Øivind & Heir, Trond (2017). Gender Differences in Posttraumatic Stress Symptoms after a Terrorist Attack: A Network Approach. Frontiers in Psychology. 8. doi: 10.3389/fpsyg.2017.02091. Full text in Research Archive
• Hansen, Marianne; Birkeland, Marianne Skogbrott; Nissen, Alexander; Blix, Ines; Solberg, Øivind & Heir, Trond (2017). Prevalence and course of symptom-defined PTSD in individuals directly or indirectly exposed to terror: A longitudinal study. Psychiatry. ISSN 0033-2747. 80(2), p. 171–183. doi: 10.1080/00332747.2016.1230983. Full text in Research Archive
• Jakobsen, Marianne; DeMott, Melinda Ashley Meyer & Heir, Trond (2017). Validity of screening for psychiatric disorders in unaccompanied minor asylum seekers: Use of computer-based assessment. Transcultural Psychiatry. ISSN 1363-4615. 54(5-6), p. 611–625. doi: 10.1177/1363461517722868. Full text in Research Archive
• Jakobsen, Marianne; DeMott, Melinda Ashley Meyer; Wentzel-Larsen, Tore & Heir, Trond (2017). The impact of the asylum process on mental health: A longitudinal study of unaccompanied refugee minors in Norway. BMJ Open. 7(6). doi: 10.1136/bmjopen-2016-015157. Full text in Research Archive
• Birkeland, Marianne Skogbrott; Nielsen, Morten Birkeland; Hansen, Marianne; Knardahl, Stein & Heir, Trond (2017). The impact of a workplace terrorist attack on employees' perceptions of leadership: A longitudinal study from pre- to postdisaster. Leadership Quarterly. ISSN 1048-9843. 28(5), p. 659–671. doi: 10.1016/j.leaqua.2017.01.002. Full text in Research Archive Show summary

  A terrorist attack targeting a workplace represents an organizational crisis that requires the leaders to manage emerging threats. The changing roles and expectations of the leaders are reflected in the employees' perceptions of them over time. The purpose of this study was to determine whether the 2011 Oslo bombing attack affected the targeted employees' perceptions of the leadership behaviors of their immediate superiors or the organizational managers' interest in the health and well-being of their workers. Ministerial employees (n ≈ 180) completed questionnaires on fair, empowering, and supportive leadership, in addition to human resource primacy, on two occasions several years prior to the terrorist attack. Assessments were then repeated one, two, and three years after the attack. Changes in the course of perceived leadership from predisaster to postdisaster were examined using bootstrapped t-tests and latent growth curve models. Furthermore, the general course of perceived leadership was compared with a nonexposed control sample of matched employees. Results showed that employees with high levels of posttraumatic stress perceived their immediate leader to be less supportive. However, overall perceptions of leadership were remarkably stable, which suggests that the effects of critical incidents on perceptions of leadership may be negligible.

• Bredal, Inger Schou; Heir, Trond; Skogstad, Laila; Bonsaksen, Tore; Lerdal, Anners & Grimholt, Tine Kristin [Show all 7 contributors for this article] (2017). Population-based norms of the Life Orientation Test–Revised (LOT-R). International Journal of Clinical and Health Psychology. ISSN 1697-2600. 17(3), p. 216–224. doi: 10.1016/j.ijchp.2017.07.005. Full text in Research Archive Show summary

  Background/Objective: The most common used instrument to measure optimism, both in psychological and medical research, is the Life Orientation Test- Revised (LOT-R). A multi-countries study using the future item from the LOT-R, found that level of optimism varied between countries. The provision of population-based norms is necessary, since norms enable the application of the LOT-R in individual diagnosis to compare individuals or special patient groups’ scores with reference data. Method: A representative population based survey was conducted in 2014-2015. Norwegian aged 18–94 years (N = 1,792) completed questionnaires assessing sociodemographic, optimism and health and quality of life. Results: The mean age was 53.2 (SD = 16.6) and 53% were women. Mean LOT-R score was 17.2 (SD 3.0). There were marginal age and no gender differences. Although optimism was associated with sociodemographic variables, these were considered negligible due to small effect size. Norm data are given for the entire population. Optimism was associated with better health and quality of life. Conclusions: This study provides age and gender specific norm values from a representative sample of the Norwegian population. The normative data may be used in comparisons of optimism between individuals or between different samples of patients or sub-groups of people.

• Robsahm, Trude Eid; Falk, Ragnhild Sørum; Heir, Trond; Sandvik, Leiv; Vos, Linda & Erikssen, Jan Emil [Show all 7 contributors for this article] (2017). Cardiorespiratory fitness and risk of site-specific cancers: a long-term prospective cohort study. Cancer Medicine. 6(4), p. 865–873. doi: 10.1002/cam4.1043. Full text in Research Archive Show summary

  Based on self-reported physical activity, there is epidemiologic evidence for a beneficial relation between physical activity and colon cancer in men, but find-ings for other cancers are inconclusive. Measured cardiorespiratory fitness (CRF) can provide knowledge about the cancer-preventive value of physical activity. We aimed to assess relationships between CRF and risk of site-specific cancers. A cohort of 1997 healthy Norwegian men, aged 40–59years at inclusion in 1972–1975, was followed for cancer throughout 2012 using data from the Cancer Registry of Norway. CRF was measured by a maximal exercise bicycle test at inclusion. Relationships between CRF and site-specific cancers were estimated using Cox regression, adjusted for age, body mass index, and smoking. During follow-up, 898 cancer cases were diagnosed in 758 men. When comparing men in CRF tertile 1 with men in tertiles 2 and 3, respectively, we found decreased risk of proximal colon cancer in tertile 2 (HR: 0.30, 95% CI: 0.13–0.73) and decreased risk of cancers of lung (0.39 95% CI: 0.22–0.66), pancreas (0.32 95% CI: 0.10–1.00), and bladder (HR: 0.40 95% CI: 0.21–0.74) in tertile 3. Further-more, a significant trend for lower risk by increasing CRF tertile was found for cancers of proximal colon, lung, and bladder (P-value for trend <0.05). For other cancer sites, no significant association was found. Our results indicate that high midlife CRF may have cancer-preventive value.

• Birkeland, Marianne Skogbrott; Nielsen, Morten Birkeland; Hansen, Marianne; Knardahl, Stein & Heir, Trond (2017). Like a bridge over troubled water? A longitudinal study of general social support, colleague support, and leader support as recovery factors after a traumatic event. European Journal of Psychotraumatology. 8(1). doi: 10.1080/20008198.2017.1302692. Full text in Research Archive Show summary

  Background: Whereas the association between social support and psychological distress has been well-established through both cross-sectional and longitudinal studies, less is known about whether social support influences rate of change in psychological distress over time. Nor is it clear whether social support predicts baseline psychological distress, or, more importantly, whether social support may contribute to more rapid recovery following trauma exposure. Objective: This study aimed to determine the extent to which social support contributed to the recovery process among individuals with psychological distress after being exposed to trauma. Methods: Prospective survey data from ministry employees were collected 10, 22, and 34 months after the 2011 Oslo bombing that targeted the governmental quarters. We explored recovery in a clinical subsample (N = 238) of individuals with elevated levels of psychological distress (defined as mean 10-item Hopkins symptom checklist score > 1.85) one year after the event. A linear latent growth curve of psychological distress with general social support from friends and family, colleague support, and leader support as predictors was examined. Results: High levels of general social support and leader support were independently associated with a more rapid decline in psychological distress over time. Conclusions: General social support, as well as support from a leader in one’s working life, may facilitate recovery from psychological distress after exposure to a traumatic event. Enhancing social support from family and friends, as well as in work settings, may benefit those with psychological distress following a traumatic workplace event.

• Nielsen, Morten Birkeland; Birkeland, Marianne Skogbrott; Hansen, Marianne; Knardahl, Stein & Heir, Trond (2017). Victimization from workplace bullying after a traumatic event: time-lagged relationships with symptoms of posttraumatic stress. International Archives of Occupational and Environmental Health. ISSN 0340-0131. 90(5), p. 411–421. doi: 10.1007/s00420-017-1204-4. Full text in Research Archive Show summary

  Objective: This study examined relationships between victimization from bullying and symptoms of posttraumatic stress (PTSS) after exposure to a terror attack at the workplace. It was hypothesized that (1) victims of bullying report higher and more stable levels of PTSS over time compared to their non-bullied colleagues and (2) that PTSS provides an increased risk of subsequent victimization from bullying. Methods: The hypotheses were tested in a two-wave prospective sample comprising 2337 employees from Norwegian governmental ministries who were exposed to the 2011 Oslo terror attack. The two waves of data collection were conducted 10 and 22 months after the terror attack. Results: Hypothesis 1 was partially supported: victims of bullying reported significantly higher levels of PTSS than non-bullied employees at both measurement points, but bullying was not related to the stability in PTSS over time. In support of hypothesis 2, PTSS at 10 months was significantly associated with an increased risk of feeling victimized by bullying 1 year later. Conclusions: The results indicate that victimization from bullying is associated with elevated levels of PTSS in the aftermath of a workplace terror attack, but that bullying does not have any impact on the long-term development of PTSS. PTSS may be a potential antecedent of bullying. These findings suggest that organizations must give high priority to the psychosocial work environment of traumatized employees to prevent further detrimental health consequences.

• Birkeland, Marianne Skogbrott; Knatten, Charlotte Kristensen; Hansen, Marianne; Hem, Camilla & Heir, Trond (2016). Long-term relationships between perceived social support and posttraumatic stress after the 2011 Oslo bombing: A three-year longitudinal study. Journal of Affective Disorders. ISSN 0165-0327. 202, p. 230–235. doi: 10.1016/j.jad.2016.05.037. Full text in Research Archive
• Saur, Randi; Hansen, Marianne; Jansen, Anne & Heir, Trond (2016). Visually impaired individuals, safety perceptions and traumatic events: a qualitative study of hazards, reactions and coping. Disability and Rehabilitation. ISSN 0963-8288. 39(7), p. 691–696. doi: 10.3109/09638288.2016.1161836. Full text in Research Archive
• Heir, Trond; Blix, Ines & Knatten, Charlotte Kristensen (2016). Thinking that one's life was in danger: perceived life threat in individuals directly or indirectly exposed to terror. British Journal of Psychiatry. ISSN 0007-1250. 209(4), p. 306–310. doi: 10.1192/bjp.bp.115.170167. Full text in Research Archive
• Nygaard, Egil; Hussain, Ajmal; Siqveland, Johan & Heir, Trond (2016). General self-efficacy and posttraumatic stress after a natural disaster: a longitudinal study. BMC Psychology. 4(1). doi: 10.1186/s40359-016-0119-2. Full text in Research Archive Show summary

  Background Self-efficacy may be an important factor in individuals’ recovery from posttraumatic stress reactions after a natural disaster. However, few longitudinal studies have investigated whether self-efficacy predicts the course of posttraumatic recovery beyond lower initial levels of distress. The purpose of the present study was to investigate whether general self-efficacy is related to recovery from posttraumatic stress reactions from a longitudinal perspective. Methods A total of 617 Norwegians exposed to the 2004 Southeast Asian tsunami completed self-report questionnaires measuring their level of disaster exposure and general self-efficacy at 6 months and posttraumatic stress reactions 6 months and 2 years post-disaster. Predictors of changes in posttraumatic stress reactions were analyzed with multivariate mixed effects models. Results Self-efficacy at 6 months post-disaster was unrelated to trauma exposure and inversely related to posttraumatic stress reactions at 6 months and 2 years post-disaster. However, self-efficacy was not related to recovery from posttraumatic stress reactions between 6 months and 2 years post-disaster. Conclusions In conclusion, general self-efficacy is related to lower levels of posttraumatic stress reactions in the first months after a disaster but does not appear to be related to improved recovery rates over the longer term.

• Strandmoen, John-Filip; Askeland, Ingunn Rangul; Tjersland, Odd Arne; Wentzel-Larsen, Tore & Heir, Trond (2016). Intimate Partner Violence in Men Voluntarily Attending Treatment: A Study of Couple Agreement. Violence and Victims. ISSN 0886-6708. 31(1), p. 124–134. doi: 10.1891/0886-6708.VV-D-13-00193. Full text in Research Archive
• Hem, Camilla; Nielsen, Morten Birkeland; Hansen, Marianne & Heir, Trond (2016). Effort-reward imbalance and post-traumatic stress after a workplace terror attack. Disaster Medicine and Public Health Preparedness. ISSN 1935-7893. 10(2), p. 219–224. doi: 10.1017/dmp.2015.158. Full text in Research Archive Show summary

  Objective: Following adverse work conditions, health consequences can be explained by an imbalance between the effort made and the reward received. We investigated the association between extra effort, perceived reward, and post-traumatic stress disorder (PTSD). The Effort-Reward Imbalance Model was used to examine whether extra effort at work in the aftermath of a workplace-related terrorist attack affected the risk of PTSD and the effects of reward for extra effort from a leader or colleagues. Methods: Cross-sectional data were collected 10 months after a terrorist attack in Norway in 2011. Out of 3520 Ministry employees invited, 1927 agreed to participate. Employees reported any extra effort performed as a result of the bomb explosion and any reward received from a leader or colleagues. PTSD was assessed with the PTSD Checklist. Results: Employees who reported extra effort displayed increased risk for PTSD (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.15-2.55, P=0.008). Perceived reward for extra effort from a leader was associated with lower risk for PTSD (OR=0.39, 95% CI: 0.23-0.64, P<0.001) but not perceived reward from colleagues. Conclusions: Extra effort may increase the risk of PTSD, but reward from a leader may mitigate this effect. The Effort-Reward Imbalance Model appears to be an appropriate approach that may contribute to understanding of the etiology of work-related PTSD.

• Blix, Ines; Kanten, Alf Børre; Birkeland, Marianne Skogbrott; Solberg, Øivind; Nissen, Alexander & Heir, Trond (2016). Thinking About What Might Have Happened: Counterfactual Thinking and Post-traumatic Stress in Individuals Directly and Indirectly Exposed to the 2011 Oslo Bombing. Applied Cognitive Psychology. ISSN 0888-4080. 30(6), p. 983–991. doi: 10.1002/acp.3289. Full text in Research Archive
• Blix, Ines; Birkeland, Marianne Skogbrott; Solberg, Øivind; Hansen, Marianne & Heir, Trond (2016). The Launching and Ensnaring Effects of Construing a Traumatic Event as Central to One's Identity and Life Story. Applied Cognitive Psychology. ISSN 0888-4080. 30(4), p. 526–531. doi: 10.1002/acp.3224. Full text in Research Archive

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• Bendiksen, Bothild; Heir, Trond; Ziyada, Mai Mahgoub; Lien, Inger-Lise; Minteh, Fabakary & Kuye, Rex (2018). Trauma and Female Genital Cutting (FGC) in 12-year-old Gambian Girls. Full text in Research Archive
• Heir, Trond (2017). How to think about a terror attack and consequences for mental health. Full text in Research Archive
• Birkeland, Marianne Skogbrott & Heir, Trond (2017). Making connections: a network approach to posttraumatic stress symptoms and covariates after a terrorist attack. Full text in Research Archive
• Hansen, Marianne & Heir, Trond (2017). Traumatic experiences, mental health and coping among blind and visually impaired individuals. Full text in Research Archive
• Solberg, Øivind; Birkeland, Marianne Skogbrott; Blix, Ines; Hansen, Marianne & Heir, Trond (2016). The Longitudinal Course of Post Traumatic Stress Symptomatology and Functional Impairment after the 2011 Oslo Bombing. Full text in Research Archive
• Madelèn, Josefsen, & Heir, Trond (2026). Lege i Finnmark: Hvilke forhold påvirker rekruttering og stabilitet av legetjenesten i Finnmark? UiT Norges arktiske universitet. Full text in Research Archive Show summary

  Rekrutteringen til legestillinger i Finnmark er svak, og bruken av vikarleger er stor. Dette kan føre til hyppigere utskiftninger, mindre stabilitet i tjenesten, lav kulturkompetanse, sviktende lokalkunnskap og et dyrere og mindre effektivt helsevesen. Formålet med oppgaven er å belyse positive og negative sider ved utøvelse av legeyrket i Finnmark, for å bidra til mer kunnskap rundt arbeid i fylket for potensielle arbeidstakere, samt bidra til nye forslag til rekrutteringstiltak for kommuner i Finnmark. Formålet innebærer også å avdekke årsaker til den hyppige utskiftningen. Studiedesignet er en fenomenologisk kvalitativ studie, hvor det har blitt gjennomført kvalitative intervju, som deretter har blitt analysert etter prinsippene for tematisk analyse ved Braun & Clarke (1). Det ble intervjuet 4 leger med ulik bakgrunn, som jobber eller har jobbet som lege i Finnmark i mer enn 2 år sammenhengende. For leger som i fremtiden tenker på å ta arbeid i fylket kan det være verdt å merke seg at legearbeid i Finnmark bærer preg av rask faglig utvikling, gode arbeidsmiljø og god mulighet for familieliv, men at det også finnes flere utfordringer, særlig knyttet til de geografiske og demografiske forholdene i fylket. Dette inkluderte utfordringer rundt diagnostikk, behandling og transport av pasienter, samt vanskeligheter med å skille mellom rollen som lege og privatperson. Når det gjelder rekruttering, er det for kommunene viktig å ha fokus på lokal tilhørighet og rekruttering gjennom praksis og turnus. Økonomiske insentiver fungerte bra for rekruttering, mens gode arbeidsforhold, mulighet for fritid og godt arbeidsmiljø fremstår som viktige faktorer for stabilitet.

• Heir, Trond; Hansen, Marianne Bang; Bonsaksen, Tore; Saur, Randi & Brunes, Audun (2022). Synstap og psykisk helse. NKVTS, Nasjonal behandlingstjeneste for sansetap og psykisk helse. ISSN 9788281221673. Full text in Research Archive

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