Edvard Hauff

• Mainali, Anustha; Søegaard, Erik Ganesh Iyer; Hauff, Edvard & Thapa, Suraj Bahadur (2024). A comparative study of comorbidities, symptom profiles, and childhood trauma in PTSD and non-PTSD trauma patients at Oslo University Hospital. Nordic Journal of Psychiatry. ISSN 0803-9488. s. 1–8. doi: 10.1080/08039488.2024.2415306. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To explore the differences in mental health symptom profiles, trauma profiles, childhood trauma and comorbidities in patients with PTSD and those without PTSD. Materials and methods A cross-sectional study was carried out on 110 adult patients with trauma backgrounds attending a mental health outpatient clinic in Southern Oslo, Norway. In addition to self- report questionnaires, several standardized validated diagnostic tools were used to assess mental disorders. Multiple linear regression models were used to assess the association between trauma history, the mental health symptom profile of the patients, and PTSD diagnosis. Bivariate logistic regression was used to examine if childhood trauma/adversities were associated with PTSD. Results Patients diagnosed with PTSD had significantly higher rates of comorbid major depressive disorder, panic disorder, agoraphobia disorder, and social phobia compared to those without PTSD. We also found a positive association between PTSD diagnosis and all the different mental health symptoms domains of the Symptom Checklist-90-Revised instrument. When adjusted for age, gender, education, smoking habits, immigration, relationship, and employment status, these associations persisted with varying effects. We did not find any association between PTSD and childhood trauma/adversities, however, sexual abuse trended towards an association. Conclusion Adult trauma patients with PTSD may have more comorbid disorders and mental health symptoms. Childhood trauma may be less critical for the PTSD diagnosis in this group. In clinical practice, personalized treatment plans addressing both the symptom burden and its comorbidities may be beneficial.

• Koirala, Rishav; Aass, Hans Christian; Søegaard, Erik Ganesh Iyer; Dhakal, Hari Prasad; Ojha, Saroj Prasad & Hauff, Edvard [Vis alle 7 forfattere av denne artikkelen] (2023). Association of pro-inflammatory cytokines with trauma and post-traumatic stress disorder visiting a tertiary care hospital in Kathmandu. PLOS ONE. 18(2). doi: 10.1371/journal.pone.0281125. Fulltekst i vitenarkiv Vis sammendrag

  Post-traumatic stress disorder (PTSD) is a mental disorder that can occur after trauma. Although inflammatory markers such as cytokines are found altered in trauma and PTSD, there is no consensus regarding which can be considered as biomarkers. Studies from South Asia region is also rare. We studied cytokines among trauma affected patients and matched healthy controls. Fifty patients (cases) with trauma, visiting the University hospital in Kathmandu and thirty-nine healthy controls were selected, and the levels of cytokines were determined using a Luminex IS 200. We compared the levels of the cytokines in thirty-four age and gender matched pairs of case and control among three groups: healthy volunteers, cases diagnosed as PTSD, and cases without PTSD. Among the 34 pair-matched cases and controls, IL-6 was significantly higher in both PTSD positive cases [2.43 (0.00–14.54) pg/ml; p = 0.004] and PTSD negative cases [3.00 (0.92–3.86) pg/ml; p = 0.005], than in controls [0.39 (0.00–11.38) pg/ml]. IL-1β was significantly higher in PTSD positive cases [0.17 (0.00–5.27) pg/ml; p = 0.011] than in controls 0.00 (0.00–0.12) pg/ml. Other cytokines did not show significant differences. IL-6 was higher in both the trauma affected groups and IL-1β was higher in the trauma affected group with PTSD when compared to healthy controls. This supports the immune system activation hypothesis after trauma.

• Søegaard, Erik Ganesh Iyer; Kan, Zhanna; Aass, Hans Christian Dalsbotten; Koirala, Rishav; Hauff, Edvard & Thapa, Suraj (2022). Abnormal Cytokines in Trauma Patients Explained by Obesity, Musculoskeletal Disease, Smoking, and Lung Disease. Neuropsychobiology. ISSN 0302-282X. 81(6), s. 516–530. doi: 10.1159/000526806. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Low-grade inflammation observed through abnormal plasma cytokine levels has been associated with post-traumatic stress disorder (PTSD). It is not clear whether PTSD independently causes the inflammation or if it is mainly through co-occurring somatic factors such as smoking and obesity. We wanted to explore the effects of biopsychosocial factors on cytokine levels in a clinical setting. Methods: The sample consisted of 51 patients with PTSD, 58 trauma patients without PTSD, and 40 matched controls. We selected cytokines and relevant risk factors for systemic inflammation through pairwise correlations. Then, we used linear regression to analyze the individual and combined effects of these on the (Log10) cytokines, particularly estimating the effect of PTSD adjusted for other factors. Results: Higher age, female gender, cigarette smoking, presence of lung and musculoskeletal disease, use of antipsychotic medication, and higher BMI were correlated with higher levels of interleukins IL-1RA, IL-2RA, and IL-6. In the adjusted regression analysis, higher BMI was associated with increased IL-1RA (B = 0.06, p < 0.01), IL-2RA (B = 0.01, p < 0.01), and IL-6 (B = 0.01, p = 0.03). Presence of musculoskeletal disease was associated with increased IL-1RA (B = 0.72, p < 0.01) and IL-6 (B = 0.16, p = 0.01), and decreased IL-2RA (B = −0.09, p < 0.01). Cigarette smoking (B = 0.16, p = 0.01) and presence of lung disease (B = 0.14, p = 0.02) were associated with increased IL-6. PTSD diagnosis was associated with decreased IL-2RA (B = −0.06, p = 0.04). Discussion/Conclusion: Altered cytokine levels in distressed trauma-affected individuals are probably mostly through co-occurring risk factors and not PTSD diagnosis. Increased BMI and musculoskeletal (pain) disease may be particularly strong risk factors and should be addressed.

• Sanhori, Zeinat Balla Mohamed Ahmed; Lien, Lars; Hauff, Edvard; Ayazi, Touraj; Mdala, Ibrahimu & Eide, Arne Henning (2022). Change in Disability Associated with Psychological Distress among Internally Displaced Persons in Central Sudan. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(9). doi: 10.3390/ijerph19095347. Fulltekst i vitenarkiv Vis sammendrag

  Individuals with disabilities are particularly vulnerable in conflict settings, and a high rate of psychopathology is well documented among persons with disabilities. The objective of this study was to explore the change in disability prevalence among IDPs in two settlement areas in central Sudan and the association between disability and psychological distress. In this one-year follow-up study, 1549 IDPs were interviewed twice using the General Health Questionnaire (GHQ) to investigate emotional distress. Disability was measured using the Washington Group Short Set. Households were randomly selected using the community health center as the starting point. All household members above eighteen years of age in the sampled households were interviewed. There is an increase in disability prevalence among internally displaced persons over time, associated with rural residency and poverty, low education, unemployment, IDP status, originating from western Sudan, young age, male gender, and being married. Disability was further found to be associated with psychological distress. Disability among displaced persons should be considered as a risk factor for increase in psychopathological disorders and is closely related to poverty. The study is limited to individual-level data and does not incorporate relevant environmental variables that may have influenced the changes in disability rates.

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

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

• Koirala, Rishav; Søegaard, Erik Ganesh Iyer; Kan, Zhanna; Ojha, Saroj Prasad; Hauff, Edvard & Thapa, Suraj (2021). Exploring complex PTSD in patients visiting a psychiatric outpatient clinic in Kathmandu, Nepal. Journal of Psychiatric Research. ISSN 0022-3956. 143, s. 23–29. doi: 10.1016/j.jpsychires.2021.08.030. Fulltekst i vitenarkiv Vis sammendrag

  Decades of research on trauma patients have shown that a post-traumatic stress disorder (PTSD) diagnosis does not always cover the full spectrum of symptoms after severe trauma. Complex PTSD (CPTSD) was recently introduced in the International Classification of Diseases 11th Revision. There have been no published studies on CPTSD in the South Asian region to date. The objective of this study was to evaluate CPTSD in a sample of trauma patients in Nepal. We also examined quality of life (QOL) and mental health comorbidities and their association with CPTSD caseness. One hundred patients with a history of trauma who visited the outpatient psychiatry clinic at a hospital in Kathmandu from 2017 to 2018 were assessed. The Composite International Diagnostic Interview Version 2.1 was used to evaluate PTSD, major depressive disorder, and generalized anxiety disorder (GAD). Disturbance of self-organization symptoms from the Structured Interview for Disorders of Extreme Stress (SIDES) together with the PTSD diagnosis was used to confirm CPTSD caseness. The World Health Organization (WHO) QOL Scale Brief Version (WHOQOL-BREF) was used to assess QOL in four domains. Among the 83 patients who had PTSD, 42 also had CPTSD. CPTSD was significantly associated with major depressive disorder, GAD, female gender, and lower QOL in all four domains. CPTSD was prevalent among these patients. Having CPTSD was significantly associated with worse outcomes in terms of QOL and comorbid mental disorders, even with similar trauma. There is a need to explore CPTSD symptoms and to address trauma patients with CPTSD in this region.

• Søegaard, Erik Ganesh Iyer; Kan, Zhanna; Koirala, Rishav; Hauff, Edvard & Thapa, Suraj Bahadur (2021). Gender differences in a wide range of trauma symptoms after victimization and accidental traumas: a cross-sectional study in a clinical setting. European Journal of Psychotraumatology. 12(1), s. 1–13. doi: 10.1080/20008198.2021.1975952. Fulltekst i vitenarkiv Vis sammendrag

  Background There are large gender differences in PTSD prevalence. Gender differences in a wide range of trauma symptoms including disturbances in self-organization have not been extensively researched. Objective To explore gender differences in a wide range of trauma symptoms by comparing victimization trauma (VT) with accidental trauma (AT). Method A cross-sectional study of 110 traumatized patients attending a mental health outpatient clinic in Oslo, Norway (38.2% men, Mage = 40.4, 40% ethnic Norwegians). The trauma was categorized as VT or AT based on the Life Events Checklist. The Structured Clinical Interview for DSM-IV-PTSD-module and Structured Interview for Disorders of Extreme Stress Not-Otherwise-Specified (DESNOS) assessed a wide range of trauma symptoms. First, we examined gender differences within the trauma categories, then MANCOVA for an adjusted two-by-two between-groups analysis. Results Among VT patients, men reported more symptoms of alteration of negative self-perception (p = .02, ES = 0.50) and alteration in systems of meaning (p < .01, ES = 1.04). Within the AT group, women reported more symptoms of affect and impulses (p = .01, ES = 0.94). The VT-AT difference was significantly higher in men in intrusion (p < .01, η2 = 0.04), affect and impulses (p < .01, η2 = 0.12), negative self-perception (p < .01, η2 = 0.11), difficulty in relations (p = .01, η2 = 0.10) and alterations in systems of meaning (p = .01, η2 = 0.14). Conclusion: Comparing the VT-AT differences between the genders, men with VT had relatively more symptoms of intrusion, self-organization, identity, ideology/meaning, cognition, and relations difficulties. Effect sizes were moderate to large. Men may be relatively more vulnerable to VT than AT, while women may be more equally affected by VT and AT. Acknowledging possible gender differences in a wider range of trauma symptoms depending on trauma category may have clinical benefits

• Koirala, Rishav; Søegaard, Erik Ganesh Iyer; Ojha, Saroj Prasad; Hauff, Edvard & Thapa, Suraj B. (2020). Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal. PLOS ONE. 15(6), s. e0234203–e0234203. doi: 10.1371/journal.pone.0234203. Fulltekst i vitenarkiv Vis sammendrag

  Background Nepal, like many other low-income countries, has a great burden of mental health issues but few resources to meet them. In addition, Nepal has endured several traumatic events in recent decades but the impact on mental health has not been studied in clinical settings. This study explores trauma-related psychiatric disorders and their correlates. Methods 100 patients with a history of trauma who visited the outpatient psychiatry clinic at a University hospital in Kathmandu were assessed. The Composite International Diagnostic Interview 2.1 (CIDI) was used to evaluate lifetime and current depressive disorder, generalized anxiety disorder (GAD) and lifetime post-traumatic stress disorder (PTSD). Current PTSD was evaluated using PSTD Checklist—Civilian Version (PCL-C). Results The median number of lifetime traumatic events was two. Natural disaster was the most common trauma type (84%) compared to other types of trauma. Rape was reported as the most traumatizing. Current PTSD was found in 15%, depression in 33% and GAD in 38% of the patients. The lifetime rates were PTSD 83%, depression 45% and GAD 40%. There was high comorbidity between the disorders. The 31 to 45 years age group, above high school education level and trauma types other than earthquake were independently associated with current PTSD. Marital status and upper socioeconomic status (SES) compared to upper-middle SES were independently associated with lifetime PTSD. Both lifetime and current depression rates were independently associated with the upper SES compared to upper-middle SES. Place of living, education above high school and lower-middle SES were significantly associated with lifetime and current GAD. Conclusion PTSD, depression and GAD were prevalent in a trauma exposed patient population visiting a psychiatric clinic in Nepal. High rates of comorbidities and several risk factors were identified. Our findings highlight the need for addressing trauma related disorders in clinical settings in developing countries.

• Fausiah, Fitri; Turnip, Sherly Saragih & Hauff, Edvard (2020). Gender differences and the correlates of violent behaviors among high school students in a post-conflict area in Indonesia. Asia-Pacific Psychiatry. ISSN 1758-5864. 12(3). doi: 10.1111/appy.12383. Fulltekst i vitenarkiv
• Sanhori, Zienat Balla Mohamed Ahmed; Hauff, Edvard; Eide, Arne Henning; Mdala, Ibrahimu; Abdelrahman, Abdullah & Brunborg, Cathrine [Vis alle 7 forfattere av denne artikkelen] (2020). Changes in prevalence of mental disorders among internally displaced persons in central Sudan: a 1-year follow-up study. Cambridge Prisms: Global Mental Health (GMH). 7. doi: 10.1017/gmh.2020.16. Fulltekst i vitenarkiv Vis sammendrag

  Background Sudan has one of the largest numbers of internally displaced persons (IDPs) in the world, estimated at five million. The main cause of displacement was the civil war. Attention to the health and in particular the mental health of IDPs has been lacking. That includes limited population longitudinal data describing the “natural” fluctuations of mental morbidity among these groups. The aim of this study is to investigate the level and stability of mental disorders among IDPs over a 1-year period. Method In this 1-year follow-up of IDPs in two settlement areas in central Sudan, 1549 persons 18 years or older were interviewed twice using the MINI International Neuropsychiatric Interview. Trained psychologists collected the data in a random household survey in the selected IDP areas. Results We found overall high stability among those having and those free of mental disorders in this 1-year follow-up study. There were, however, discernible and statistically significant increases in overall new cases of mental disorders from T1 to T2 as major depression increased by 1.4%, generalized anxiety by 2.8% and social phobia by 1.4%. Conclusion The study revealed continued high levels and increases of mental disorders over time, although with a pattern of substantial persistence among those initially ill and limited recovery. This might be due to a complex set of factors such as unavailability of mental health services, poverty, low educational level and social exclusion.

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