Grete Dyb

• Bryant, Richard A.; Shtefen, Iryna; Romanchuk, Oleh; Mykhniak, Oksana; Cresswell, Cathy & Danese, Andrea [Vis alle 15 forfattere av denne artikkelen] (2026). Understanding mental health needs in Ukraine: protocol for a longitudinal survey of mental health in children and caregivers during the war in Ukraine. European Journal of Psychotraumatology. 17(1), s. 2696096–2696096. doi: 10.1080/20008066.2026.2696096.
• Glad, Kristin Alve; Blix, Ines; Undset, Andrea Barsnes & Dyb, Grete Anita (2026). “I Could Have Killed Him” Survivors' Descriptions of Their Counterfactual Thoughts After a Terrorist Attack. Scandinavian Journal of Psychology. ISSN 0036-5564. doi: 10.1111/sjop.70131. Fulltekst i vitenarkiv
• Maamoen, Anniken; Bondjers, Kristina; Langerud, Anne Kathrine; Dyb, Grete Anita; Stensland, Synne Øien Blixt & Zwart, John Anker Henrik [Vis alle 12 forfattere av denne artikkelen] (2026). Turnover Intentions Among Intensive Care Healthcare Workers: Key Factors Influencing Decisions to Stay or Leave. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 70(7). doi: 10.1111/aas.70296. Fulltekst i vitenarkiv Vis sammendrag

  Background: Turnover among healthcare workers (HCWs) is highly prevalent in intensive care units (ICUs). Due to demanding workloads, stressful conditions, and increasing pressure to work more efficiently, this problem is likely to persist. Consequently, implementing proactive strategies to support HCWs retention is needed. This study aimed to examine associations between work environment factors and ICU HCWs’ intentions to quit. Methods: Based on data from a prospective, open‐cohort, multicenter study of hospital frontline workers conducted during the four main waves of the COVID‑19 pandemic in Norway, we analyzed self‐reported data from HCWs who completed the final survey, which included two outcomes relevant to turnover: (1) frequent thoughts of quitting and (2) intention to look for a new job. A work‐environment ‐factor tool assessing occupational risk and characteristics in emergencies (FORCE‐index). Hierarchical linear regression was used to examine associations between work environment factors and the two turnover outcomes. Results: Among 977 frontline HCWs (median age 45 years, 75% women, median 16 years of work experience), several work environment factors showed protective association with turnover intention. Across both outcomes, familiarity with colleagues and surroundings and social support from colleagues and immediate superiors were the most important protective factors, linked to fewer thoughts of quitting and a lower intention to seek a new job. For frequent thoughts of quitting, additional protective factors included better stress management, workload manageability, infection safety, and social safety. Younger age was a consistent risk factor for both outcomes, while working in the ICU and experiencing morally distressing situations were specifically associated with thoughts of quitting. Pandemic exposure variables were not significantly associated with either outcome. Conclusion: Turnover intention among ICU HCWs at four Norwegian university hospitals during the fourth time point of the COVID‑19 pandemic was associated with work environment factors. Work in the ICU, younger age, and morally distressing experiences were associated with frequent thoughts of quitting, whereas several work environment factors were protective. Familiarity and social support were also protective against actively looking for a new job, suggesting that strengthening these factors may be particularly important for reducing turnover intention and retaining HCWs in the ICU.

• Kassam-Adams, Nancy; Thompson, Kristi; Sijbrandij, Marit & Dyb, Grete Anita (2025). Sharing traumatic stress research data: assessing and reducing the risk of re-identification. European Journal of Psychotraumatology. 16(1). doi: 10.1080/20008066.2025.2499296. Fulltekst i vitenarkiv
• Shen, Jie; Valentim, Wander; Friligkou, Eleni; Overstreet, Cassie; Choi, Karmel W. & Koller, Dora [Vis alle 245 forfattere av denne artikkelen] (2025). Shared genetic architecture of posttraumatic stress disorder with cardiovascular imaging, risk, and diagnoses. Nature Communications. 16(1). doi: 10.1038/s41467-025-60487-w. Fulltekst i vitenarkiv Vis sammendrag

  Patients with post-traumatic stress disorder face increased cardiovascular risk. This study examines shared genetic regions between post-traumatic stress disorder and 246 cardiovascular conditions across electronic health records, 82 cardiac imaging, and health behaviors defined by Life’s Essential 8. Post-traumatic stress disorder is genetically correlated with cardiovascular diagnoses in 33 regions, imaging traits in 4 regions, and health behaviors in 44 regions. Potentially shared causal variants between post-traumatic stress disorder and 17 cardiovascular conditions were observed in 11 regions. Subsequent observational analysis in AllofUS cohort showed post-traumatic stress disorder is associated with 13 diagnoses even after accounting for socioeconomic factors and depression. Genetically regulated proteome expression in brain and blood tissues identified 33 blood and 122 brain genes shared between the two conditions, revealing neuronal, immune, metabolic, and calcium-related mechanisms, with several genes as targets for existing drugs. These findings exhibit shared risk loci and genes are involved in tissue-specific mechanisms.

• Zhang, Xinhe; Grove, Jakob; Gu, Yuanjun; Buus, Cornelia K.; Nielsen, Lea K. & Neufeld, Sharon A. S. [Vis alle 295 forfattere av denne artikkelen] (2025). Polygenic and developmental profiles of autism differ by age at diagnosis. Nature. ISSN 0028-0836. 646(8087), s. 1146–1155. doi: 10.1038/s41586-025-09542-6. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Although autism has historically been conceptualized as a condition that emerges in early childhood 1,2 , many autistic people are diagnosed later in life 3–5 . It is unknown whether earlier- and later-diagnosed autism have different developmental trajectories and genetic profiles. Using longitudinal data from four independent birth cohorts, we demonstrate that two different socioemotional and behavioural trajectories are associated with age at diagnosis. In independent cohorts of autistic individuals, common genetic variants account for approximately 11% of the variance in age at autism diagnosis, similar to the contribution of individual sociodemographic and clinical factors, which typically explain less than 15% of this variance. We further demonstrate that the polygenic architecture of autism can be broken down into two modestly genetically correlated ( r g  = 0.38, s.e. = 0.07) autism polygenic factors. One of these factors is associated with earlier autism diagnosis and lower social and communication abilities in early childhood, but is only moderately genetically correlated with attention deficit–hyperactivity disorder (ADHD) and mental-health conditions. Conversely, the second factor is associated with later autism diagnosis and increased socioemotional and behavioural difficulties in adolescence, and has moderate to high positive genetic correlations with ADHD and mental-health conditions. These findings indicate that earlier- and later-diagnosed autism have different developmental trajectories and genetic profiles. Our findings have important implications for how we conceptualize autism and provide a model to explain some of the diversity found in autism.

• Undset, Andrea Barsnes; Jensen, Tine; Birkeland, Marianne Skogbrott; Meiser-Stedman, Richard; Dyb, Grete Anita & Blix, Ines (2025). Maladaptive appraisals and posttraumatic stress reactions in young terror survivors across 8 years: a random intercepts cross-lagged analysis. European Journal of Psychotraumatology. 16(1). doi: 10.1080/20008066.2025.2459462. Fulltekst i vitenarkiv
• Stensland, Synne Øien Blixt; Bondjers, Kristina; Zwart, John Anker Henrik; Rosseland, Leiv Arne; Atar, Dan & Christensen, Jan Olav [Vis alle 11 forfattere av denne artikkelen] (2025). Development and psychometric validation of the frontline health workers’ occupational risk and characteristics in emergencies index (FORCE-index) – The covid Hospital cohort study. Public Health in Practice. 9. doi: 10.1016/j.puhip.2025.100582. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: A lack of tools for the systematic identification of frontline health workers' changing occupational risks, characteristics, and needs, poses a major barrier to supporting vital personnel to stay in practice through health emergencies and beyond. The current study reports on the development and psychometric evaluation of the Frontline health workers’ Occupational Risk and Characteristics in Emergencies index (FORCE-index). Study design: The Covid hospital study is a large, multisite, four-wave, open cohort study of frontline health workers responding to the first four waves of the COVID-19 pandemic (2020–2022). Methods: 2496 frontline health workers responded to questionnaires assessing various aspects of their work environment. Using exploratory factor analysis, we estimated the latent structure of the FORCE-index at the first and second waves. This structure was evaluated using confirmatory factor analysis at the third and fourth waves. The internal consistency of the instrument's subscales (e.g., factors) was evaluated using omega reliability, Cronbach's alpha coefficient, and mean inter-item correlation. Results: A nine-factor solution provided best fit to the data. These factors mapped onto the following aspects of the work environment; competency, stress management, familiarity, workload manageability, work performance, infection safety, personal protective equipment, social safety, and social support. Internal consistency for the full FORCE-index and the nine factors was satisfactory. Conclusions: The initial psychometric validation indicates that the FORCE-index is a valid measure which can be used by health authorities, services, and institutions to adequately and systematically assess central aspects of frontline health workers’ work environment that are commonly challenged in health emergencies.

• Bondjers, Kristina; Hyland, Philip; Atar, Dan; Christensen, Jan Olav; Nilsen, Kristian Bernhard & Reitan, Solveig Klæbo [Vis alle 12 forfattere av denne artikkelen] (2025). Burnout trajectories among healthcare workers during a pandemic, and predictors of change. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-12802-w. Fulltekst i vitenarkiv Vis sammendrag

  Background: While several cross-sectional studies have suggested high burnout levels among health-care workers (HCW) during the Covid-19 pandemic, fewer studies have examined longitudinal trajectories of burnout. Objectives: To examine (1) trajectories of change in levels of burnout among Norwegian HCW during a one-year period in the mid-phase of the Covid-19 pandemic (second, third, and fourth incidence rate peaks), and (2) how demographic and occupational variables, and pandemic-related experiences (e.g., own infection, severe infection in family, friend, or colleague, caring for deceased patient with Covid-19) were associated with such change. Methods: Burnout was measured by the Copenhagen Burnout Inventory. Latent growth curve modeling was used to estimate trajectories of burnout symptoms, and predictors of starting point and rate of change in burnout levels. Results: Starting points of burnout scores were, on average, low-to-moderate. Women, younger HCW, those living alone, and nurses had higher initial scores. Overall, burnout scores remained mostly unchanged across the study period. However, lower burnout scores at the initial assessment were associated with increasing scores over time. Being exposed to patients with Covid-19 and having a Covid-19 infection were associated with increased burnout over time. Conclusions: While burnout symptoms among frontline health workers remained stable across the peaks of the Covid-19 pandemic overall, the study identified higher risk of worsening symptoms over time among certain demographic (younger personnel, females, and nurses) and highly exposed individuals and groups. These findings may be helpful for identifying frontline workers at particular risk of burnout during future public health emergencies.

• Stene, Lise Eilin; Glad, Kristin Alve; Stensland, Synne Øien Blixt; Nilsen, Lisa Govasli & Dyb, Grete Anita (2025). Proactive psychosocial follow-up of youth exposed to a terrorist attack: longitudinal study linking interviews and register-based data. BJPsych Open. 11(2). doi: 10.1192/bjo.2024.838. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Aakvaag, Helene Flood; Wentzel-Larsen, Tore; Dyb, Grete Anita & Thoresen, Siri (2024). What will others think of me? The longitudinal association between trauma-related shame and guilt and psychopathology after a terror attack. BJPsych Open. 10(1). doi: 10.1192/bjo.2023.624. Fulltekst i vitenarkiv
• Strøm, Ida Frugård; Wentzel-Larsen, Tore; Stensland, Synne; Dyb, Grete Anita & Stene, Lise Eilin (2024). Health care needs, experiences, and satisfaction after terrorism: a longitudinal study of parents of survivors of the Utøya attack. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10592-1. Fulltekst i vitenarkiv Vis sammendrag

  Background There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up. Methods Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up. Results Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported “very high/high” needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received. Conclusions Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.

• Glad, Kristin Alve; Wøien, Hilde; Stensland, Synne; Reitan, Solveig Klæbo; Zwart, John Anker Henrik & Atar, Dan [Vis alle 8 forfattere av denne artikkelen] (2024). Health care workers’ qualitative descriptions of ethically challenging situations evoking moral distress during Covid-19. Nursing Ethics. ISSN 0969-7330. 31(8), s. 1709–1721. doi: 10.1177/09697330241257567. Fulltekst i vitenarkiv Vis sammendrag

  Background: The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective: To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design: This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context: In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations: The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). Results: In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Conclusion: Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic.

• Stangeland, Helle Håve; Aakvaag, Helene Flood; Baumann-Larsen, Monica; Wentzel-Larsen, Tore; Ottesen, Akiah & Zwart, John Anker Henrik [Vis alle 9 forfattere av denne artikkelen] (2024). Prevalence and risk of psychiatric disorders in young people: Prospective cohort study exploring the role of childhood trauma (the HUNT study). British Journal of Psychiatry. ISSN 0007-1250. doi: 10.1192/bjp.2024.98. Fulltekst i vitenarkiv Vis sammendrag

  Background Better knowledge about childhood trauma as a risk factor for psychiatric disorders in young people could help strengthen the timeliness and effectiveness of prevention and treatment efforts. Aims To estimate the prevalence and risk of psychiatric disorders in young people following exposure to childhood trauma, including interpersonal violence. Method This prospective cohort study followed 8199 adolescents (age range 12–20 years) over 13–15 years, into young adulthood (age range 25–35 years). Data about childhood trauma exposure from adolescents participating in the Trøndelag Health Study (HUNT, 2006–2008) were linked to data about subsequent development of psychiatric disorders from the Norwegian Patient Registry (2008–2021). Results One in four (24.3%) adolescents were diagnosed with a psychiatric disorder by young adulthood. Regression analyses showed consistent and significant relationships between childhood exposure to both interpersonal violence and other potentially traumatic events, and subsequent psychiatric disorders and psychiatric comorbidity. The highest estimates were observed for childhood exposure to two or more types of interpersonal violence (polyvictimisation), and development of psychotic disorders (odds ratio 3.41, 95% CI 1.93–5.72), stress and adjustment disorders (odds ratio 4.20, 95% CI 3.05–5.71), personality disorders (odds ratio 3.98, 95% CI 2.70–5.76), alcohol-related disorders (odds ratio 3.28, 95% CI 2.06–5.04) and drug-related disorders (odds ratio 4.67, 95% CI 2.87–7.33). Conclusions These findings emphasise the importance of integrating knowledge about childhood trauma as a potent risk factor for psychopathology into the planning and implementation of services for children, adolescents and young adults.

• Bondjers, Kristina; Glad, Kristin Alve; Wøien, Hilde; Wentzel-Larsen, Tore; Atar, Dan & Reitan, Solveig Klæbo [Vis alle 10 forfattere av denne artikkelen] (2024). Moral distress and protective work environment for healthcare workers during public health emergencies. BMC Medical Ethics. 25(1). doi: 10.1186/s12910-024-01098-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. Objectives The current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. Methods We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. Results About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. Conclusions Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment.

• Porcheret, Kate Louise; Dyb, Grete Anita; Wentzel-Larsen, Tore & Stensland, Synne (2024). Predictors of early adulthood insomnia following exposure to a single mass violence attack during adolescence: 7–13 year follow-up from the Utøya and HUNT studies. European Journal of Psychotraumatology. 15(1). doi: 10.1080/20008066.2024.2312750. Fulltekst i vitenarkiv Vis sammendrag

  Background: The long-term impact of mass violence attacks is practically unknown, especially in children and adolescents. In a previous study, we found that 8.5 years after a terror attack targeting mainly adolescents, nearly half of the survivors met diagnostic criteria for insomnia. Objectives: The aims of this study were to investigate: (1) whether exposure to a single mass violence event during adolescence increases the risk of insomnia almost a decade later above that expected for a non-exposed population; and (2) whether prior interpersonal violence exposure and early post-traumatic reactions predict later insomnia. Method: Participants were survivors of the 2011 Utøya Island terrorist attack (n = 279) and controls from the HUNT Norwegian general population study (n = 35,664). Early adulthood insomnia was assessed using four items from the Karolinska Sleep Questionnaire 8.5 years after the attack. Participants who had also completed earlier data collection waves for both studies (n = 116 and 2382, respectively) were included in logistic regression models testing the associations between predictors during adolescence and later insomnia. Results: Nearly a decade after the Utøya attack, 38.4% (n = 56) of the survivors reported symptoms of insomnia indicative of probable insomnia compared to 20.5% (n = 5771) of controls. Terror exposure during adolescence was a significant predictor of later insomnia [odds ratio (OR) = 3.18, 95% confidence interval (CI) = 2.05–4.87, p < .001]. Early post-trauma symptoms of anxiety and depression (OR = 1.34, 95% CI = 1.02–1.76, p = .033) and weekly headaches (OR = 1.64, 95% CI = 1.08–2.47, p = .018) were also significant predictors while controlling for background factors and other predictors. Conclusion: Long-term assessment and treatment are needed for survivors of mass violence to improve resilience and recovery.

• Undset, Andrea Barsnes; Jensen, Tine; Dyb, Grete Anita; Wentzel-Larsen, Tore & Blix, Ines (2024). “What if…?”: Vividness and frequency of counterfactual thinking in survivors of terrorism. Applied Cognitive Psychology. ISSN 0888-4080. 38(1). doi: 10.1002/acp.4176. Fulltekst i vitenarkiv Vis sammendrag

  After traumatic experiences, it is common to think about alternative scenarios or outcomes of the event. This is often referred to as counterfactual thoughts (CFT), and CFT after trauma have been associated with posttraumatic stress reactions (PTSR). In this study, we aimed to: (1) investigate the relationship between the vividness and frequency of CFT and PTSR, and to (2) examine the associations between exposure, peri-traumatic reactions, physical injury and the loss of someone close, and the subsequent vividness and frequency of CFT. The participants (N = 289) were survivors of a terror attack in Norway. More vivid and frequent CFT were significantly and independently related to more PTSR. Exposure during trauma was significantly associated with more vivid CFT in the unadjusted regression model. No further significant relationships were found between exposure, peri-traumatic reactions, physical injury and the loss of someone close, and the vividness and frequency of CFT. As CFT are common after trauma and potentially cause distress, clinicians should identify and validate CFT, and provide coping assistance.

• Blix, Ines; Glad, Kristin Alve; Undset, Andrea Barsnes; Wentzel-Larsen, Tore; Ottesen, Akiah & Jensen, Tine [Vis alle 7 forfattere av denne artikkelen] (2024). ‘My child could have died’: counterfactual thoughts and psychological distress in parents of trauma survivors. European Journal of Psychotraumatology. 15(1). doi: 10.1080/20008066.2024.2326736. Fulltekst i vitenarkiv Vis sammendrag

  Background: After exposure to a potentially traumatic event, survivors may experience thoughts about ‘what could have happened’, referred to as counterfactual thoughts (CFTs). CFTs have been found to have a negative impact on survivors’ mental health. This is the first study to investigate whether parents of trauma survivors experience CFTs and the association with psychological distress in this group. Objective: The main aim of the present study is to investigate CFTs in parents of trauma survivors and the relationship between the frequency and vividness of CFTs and psychological distress. Method: The participants (N = 310, 191 females) were parents of the youths targeted in the terror attack on Utøya island, Norway, in 2011. Frequency and vividness of CFTs, posttraumatic stress reactions (PTSR), and symptoms of anxiety and depression were measured 8.5–9 years post-terror. Results: The majority of the parents (74%) reported having experienced CFTs at some time point since the attack. For almost one-third of the parents, CFTs were still present more than eight years after the attack. Higher frequency and vividness of CFTs were uniquely associated with higher levels of PTSR, anxiety, and depression. Conclusion: The present findings suggest that frequent and vivid CFTs may contribute to mental health problems in parents of trauma survivors and should be addressed in therapy.

• Undset, Andrea Barsnes; Jensen, Tine; Dyb, Grete Anita; Wentzel-Larsen, Tore; Ormhaug, Silje Mørup & Stensland, Synne Øien Blixt [Vis alle 7 forfattere av denne artikkelen] (2024). A parallel investigation of trauma exposure, maladaptive appraisals and posttraumatic stress reactions in two groups of trauma-exposed adolescents. European Journal of Psychotraumatology. 15(1). doi: 10.1080/20008066.2024.2402193. Fulltekst i vitenarkiv Vis sammendrag

  Background: Maladaptive appraisals, such as thoughts about experiencing a permanent and disturbing change and about being a fragile person in a scary world, are associated with posttraumatic stress reactions (PTSR) for trauma-exposed children and adolescents. Less is known about what puts young people at risk for developing such appraisals, and the differential relationship between the types of appraisals and PTSR. Objective: The primary aim was to examine the role of age, gender and exposure to potentially traumatizing events (PTEs) for the levels of maladaptive appraisals. The secondary aim was to investigate the association between the levels of maladaptive appraisals (appraisals of a permanent change and appraisals about a scary world) and PTSR. Methods: We investigated these aims in two samples: survivors after the terror attack at Utøya island in Norway in 2011 (N = 165, mean age 17.65, SD = 1.19) and adolescents referred to treatment after mainly interpersonal trauma (N = 152, mean age 15.08, SD = 2.18). The aims were investigated using linear regression and partial correlation. Results: In the terror-exposed sample, female gender was significantly associated with higher levels of scary-world appraisals, witnessing or learning that someone close were exposed to physical violence was significantly associated with more permanent-change appraisals, and a higher number of PTEs was significantly associated with higher levels of both types of appraisals. For the clinical sample, we found no significant associations between exposure to PTEs, gender, age, and the level of maladaptive appraisals. Both types of maladaptive appraisals were highly associated with PTSR in both samples, and there was no significant difference in the strength of the associations between the types of appraisals and PTSR. Conclusions: The results have implications for identifying adolescents at risk for developing harmful maladaptive appraisals. Both scary-world appraisals and permanent-change appraisals were strongly associated with PTSR in both groups of trauma-exposed adolescents.

• Nievergelt, Caroline M.; Maihofer, Adam X.; Atkinson, Elizabeth G.; Chen, Chia-Yen; Choi, Karmel W. & Coleman, Jonathan R. I. [Vis alle 235 forfattere av denne artikkelen] (2024). Genome-wide association analyses identify 95 risk loci and provide insights into the neurobiology of post-traumatic stress disorder. Nature Genetics. ISSN 1061-4036. 56, s. 792–808. doi: 10.1038/s41588-024-01707-9. Fulltekst i vitenarkiv Vis sammendrag

  Post-traumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ancestry (137,136 cases) and 58,051 admixed individuals with African and Native American ancestry (13,624 cases). We identified 95 genome-wide significant loci (80 new). Convergent multi-omic approaches identified 43 potential causal genes, broadly classified as neurotransmitter and ion channel synaptic modulators (for example, GRIA1, GRM8 and CACNA1E), developmental, axon guidance and transcription factors (for example, FOXP2, EFNA5 and DCC), synaptic structure and function genes (for example, PCLO, NCAM1 and PDE4B) and endocrine or immune regulators (for example, ESR1, TRAF3 and TANK). Additional top genes influence stress, immune, fear and threat-related processes, previously hypothesized to underlie PTSD neurobiology. These findings strengthen our understanding of neurobiological systems relevant to PTSD pathophysiology, while also opening new areas for investigation.

• Glad, Kristin Alve; Dyb, Grete Anita; Boelen, Paul A.; Wentzel-Larsen, Tore & Stensland, Synne Øien Blixt (2024). Early Predictors of Prolonged Grief Among Bereaved Trauma Survivors 8.5 Years After a Terrorist Attack. Psychological Trauma. ISSN 1942-9681. doi: 10.1037/tra0001684. Fulltekst i vitenarkiv Vis sammendrag

  Objective: A better understanding of the development of prolonged grief disorder can help professionals identify bereaved in need of intervention efforts and improve the efficiency of services. We aimed to examine the prevalence of and risk factors for prolonged grief disorder in a sample of young, bereaved terrorist attack survivors almost a decade postloss. Method: In total, 165 bereaved survivors (Mage = 27.75, SD = 4.27; 45.5% females) of the 2011 terror attack on Utøya island, Norway, participated in face-to-face, semistructured interviews. At 4–5 months after the attack, early posttraumatic reactions were measured using the Brief Grief Questionnaire, University of California at Los Angeles PTSD Reaction Index, the Hopkins Symptom Checklist–8, and the eight-item Children’s Somatic Symptoms Inventory. At 8.5 years postloss, the Traumatic Grief Inventory–Self Report Plus was used to assess prolonged grief disorder. To explore the association between participants’ sociodemographic characteristics, early postloss clinical characteristics, and later prolonged grief reactions, we used multiple linear regression analyses. Results: We found that 4.8% of the participants fulfilled the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision diagnostic criteria for prolonged grief disorder 8.5 years after their traumatic loss. Lower age and high levels of early somatic complaints predicted higher prolonged grief reactions almost a decade postloss. Conclusions: Young, bereaved survivors may be at particularly high risk of experiencing persistent grief reactions following the traumatic loss of a peer. Pending replication of our findings, professionals should focus on identifying bereaved who experience intense somatic symptoms early after a traumatic loss. Targeting these symptoms may alleviate the exacerbation of persistent grief reactions several years after a traumatic loss.

• Strøm, Ida Frugård; Dyb, Grete Anita; Wentzel-Larsen, Tore; Stene, Lise Eilin; Schultz, Jon-Håkon & Stensland, Synne (2023). Terror leaves adolescents behind. Journal of Traumatic Stress. ISSN 0894-9867. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Dyb, Grete Anita; Hellevik, Per; Michelsen, Hilde & Stensland, Synne Øien Blixt (2023). “I Wish You Had Died on Utøya”: Terrorist Attack Survivors’ Personal Experiences with Hate Speech and Threats. Terrorism and Political Violence. ISSN 0954-6553. doi: 10.1080/09546553.2023.2214238. Fulltekst i vitenarkiv Vis sammendrag

  We aimed to explore how many of the politically active, highly media- exposed, young survivors of the terrorist attack on Utøya island, Norway, have had personal experiences with hate speech and threats post-terror. Further, we aimed to examine the nature of these experiences, and the impact and consequences they have had for the directly affected. Approximately 8.5 years after the politically motivated terrorist attack on Utøya island in 2011, 289 survivors (51.2 percent females, M age = 27.7, SD = 4.6) were interviewed about their personal experiences with hate speech and threats. Responses were systematically analyzed using thematic analysis. In total, ninety-nine participants (34 percent) had experienced hate speech and/or threats post-terror, of whom a majority believed that this was related to their status as a survivor of the attack. Thematically, the hate/ threats mainly revolved around wishes that the survivors had died in the attack, death threats, support for the terrorist, severe accusations related to the attack, and conspiracy theories. This had affected the survivors both emotionally (e.g., inducing fear and anger, but also robustness) and beha-viorally (e.g., social and political withdrawal). Immediate measures and long- term strategies need to be developed to mitigate the personal harm and threat to democracy that experiences with hate speech/threats may cause.

• Baumann, Monica; Storheim, Kjersti; Stangeland, Helle; Zwart, John Anker Henrik; Wentzel-Larsen, Tore & Skurtveit, Svetlana Ondrasova [Vis alle 8 forfattere av denne artikkelen] (2023). Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood. The HUNT study. Pain. ISSN 0304-3959. 165(6), s. 1317–1326. doi: 10.1097/j.pain.0000000000003131. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Porcheret, Kate Louise & Dyb, Grete Anita (2023). Prevalence and potency of trauma reminders 8.5 years after a terrorist attack. European Journal of Psychotraumatology. 14(2). doi: 10.1080/20008066.2023.2251774. Fulltekst i vitenarkiv Vis sammendrag

  Background:Empirical knowledge about the prevalence and potency of reminders severalyears post-trauma, and how experiences with reminders relate to mental health andfunctioning, is scarce.Objective:The aim of this study was threefold: (1) systematically describe the type andfrequency of trauma reminders experienced by survivors 8.5 years after a terrorist attack; (2)explore the intensity and duration of reactions evoked by various reminders; and (3)examine whether experiences with trauma reminders are associated with psychologicaldistress and level of functioning almost a decade post-trauma.Method:289 survivors (51.2% females,Mage= 27.7,SD= 4.6) of the 2011 massacre on Utøyaisland, Norway, were interviewed 8.5 years post-terror. Participants were presented with a list often potential trauma reminders and asked to rate how frequently they had experienced eachone in the past month, and the intensity and duration of the reactions evoked. Currentposttraumatic reactions were measured using the UCLA PTSD-RI and the HSCL-8.Associations between experiences with reminders, psychological distress, and functioning,were analysed by linear regressions.Results:At 8.5 years post-terror, approximately 90% of the participants had experiencedtrauma reminders within the past month (35.6% often or very often). Almost 30% hadbecome distressed, afraid, sad, or experienced bodily reactions to a great or very greatextent. The vast majority reported that the reactions only lasted for a few minutes or hours.Frequency of exposure to reminders, and the intensity of the reactions evoked, weresignificantly associated with psychological distress. Frequency of exposure to traumareminders was negatively related to the survivors’level of functioning.Conclusions:Trauma reminders can still be a central source of psychological distress andimpaired functioning among survivors almost a decade post-trauma. While everyone who isdirectly exposed to a terrorist attack does not need psychotherapy, most would probablybenefit from psychoeducation about reminders,

• Baumann-Larsen, Monica; Dyb, Grete Anita; Wentzel-Larsen, Tore; Zwart, John Anker Henrik; Storheim, Kjersti & Stensland, Synne Øien Blixt (2023). Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study. BMJ Open. 13(3). doi: 10.1136/bmjopen-2022-066058. Fulltekst i vitenarkiv Vis sammendrag

  Objective Frequent and increasing use of over-the- counter analgesics (OTCA) among adolescents is a public health concern. Prior research indicates that adolescents exposed to traumatic events may be at increased risk of suffering from headaches and musculoskeletal pain. In this study, we assessed the association between trauma exposure and use of OTCA for headaches and musculoskeletal pain. Design A cross-sectional population study among adolescents, self-reported data on trauma exposure, pain and use of OTCA. Setting and participants All 10 608 adolescents aged 13–19 years in a region of Norway were invited in this school-based survey, participation rate was 76%. Outcome measure Frequency of OTCA use for headache and musculoskeletal pain served as separate outcomes in ordinal logistic regression analyses. Results Trauma exposure was significantly and consistently related to higher frequency use of OTCA for headache and musculoskeletal pain, of which associations for bullying (OR 1.79, 95% CI 1.50 to 2.12, and OR 2.12, 95% CI 1.70 to 2.66), physical violence (OR 1.49, 95% CI 1.25 to 1.78 and OR 1.83, 95% CI 1.45 to 2.32) and sexual abuse (OR 1.83, 95% CI 1.55 to 2.18 and OR 1.53, 95% CI 1.18 to 1.90) were particularly strong. A dose–response relationship was found between interpersonal violence and OTCA use for headache (OR 1.46, 95% CI 1.29 to 1.66 for one type and OR 1.81, 95% CI 1.53 to 2.14 for two or more types) and musculoskeletal pain (OR 1.61, 95% CI 1.91 to 3.00 for one type and OR 2.39, 95% CI 1.91 to 3.00 for two or more types). The associations remained significant after adjustment for pain, although an attenuation in strength was observed. Conclusion Trauma exposed adolescents use OTCA for headaches and musculoskeletal pain more frequently than those not exposed. The higher frequency of pain conditions among trauma exposed only partially explained their more frequent OTCA use, indicating an increased risk relating to features beyond frequency of pain.

• Strøm, Ida Frugård; Dyb, Grete Anita; Wentzel-Larsen, Tore; Stene, Lise Eilin; Schultz, Jon Håkon & Stensland, Synne (2023). Terror leaves adolescents behind: Identifying risk and protective factors for high-school completion among survivors of terrorism. Journal of Traumatic Stress. ISSN 0894-9867. 36(4), s. 750–761. doi: 10.1002/jts.22935. Fulltekst i vitenarkiv Vis sammendrag

  Terror exposure increases the risk of somatic and psychological health problems in survivors. Yet, knowledge of how such exposure affects survivors’ ability to stay in school is lacking. This study examined whether exposure to the 2011 Utøya terrorist attack in Norway impacted survivors’ ability to complete high school. Further, it aimed to identify important peri- and posttraumatic risk and protective factors. Interview data from the Utøya study, collected 4–5 months postterror, were linked to individual educational registry data for 265 survivors. Chi-square tests and ordinal logistic regression analyses were used to examine (a) high school completion among younger survivors (n = 185, age range: 13–18 years, 52.4% female) compared to both older survivors (i.e., who had the possibility of completing high school before the terror attacks; n = 80, age range: 19–21 years, 40.0% female) and the national average and (b) associations between high school completion and physical injury, posttraumatic stress symptoms (PTSS), somatic symptoms, and social support among younger survivors. Younger survivors were significantly less likely to complete high school on time. Among younger adolescents, physical injury, aOR = 0.36, 95% CI [0.16, 0.81]; higherlevel PTSS, aOR = 0.54, 95% CI [0.33, 0.88]; and somatic symptoms, aOR = 0.51, 95% CI [0.29, 0.91], lowered the likelihood of on-time completion. Terror exposure in adolescence adversely affects long-term educational functioning in young survivors, which can severely hamper their future prospects. These findings reinforce the need for trauma-sensitive teaching and educator-provided support for adolescents exposed to trauma.

• Stangeland, Helle; Aakvaag, Helene Flood; Baumann, Monica; Wentzel-Larsen, Tore; Storheim, Kjersti & Zwart, John Anker Henrik [Vis alle 8 forfattere av denne artikkelen] (2023). Problematic alcohol use in young adults exposed to childhood trauma: The Trøndelag Health (HUNT) Study. Journal of Traumatic Stress. ISSN 0894-9867. 36(5), s. 968–979. doi: 10.1002/jts.22965. Fulltekst i vitenarkiv Vis sammendrag

  Problematic alcohol use (PAU) severely impacts the health, functioning, and long-term prospects of young people. Prior research indicates that childhood trauma exposure may be an important risk factor for PAU, but few longitudinal studies have looked at how specific trauma types influence this risk. The aim of this study was to investigate the association between childhood trauma exposure and PAU in a large, population-based cohort of young people. The study sam- ple included 1,913 adolescents who participated in the Trøndelag Health Study (HUNT) between 2006 and 2008 (age range: 12–20) and completed follow-up 10 years later as young adults (age range: 22–32). The results revealed an increased risk of PAU in young adults exposed to childhood trauma, especially direct phys- ical violence, OR = 2.38, [95% CI 1.56, 3.64]. Young adults who had witnessed violence, OR = 1.55, [95% CI 1.11, 2.17], or experienced an accident, disaster, or other traumatic event, OR = 1.60, [95% CI 1.19, 2.15], also had higher odds of PAU compared to those without such experiences. These associations remained consistent after adjusting for symptoms of headaches and pain as well as post- traumatic and general psychological distress as reported by the participants in adolescence. Future prevention efforts targeting PAU among adolescents and young adults should address violence and other trauma exposure as potential drivers of problematic drinking.

• Baumann, Monica; Zwart, John Anker Henrik; Dyb, Grete Anita; Wentzel-Larsen, Tore; Stangeland, Helle & Storheim, Kjersti [Vis alle 7 forfattere av denne artikkelen] (2023). Killing pain? A prospective population-based study on trauma exposure in childhood as predictor for frequent use of over-the-counter analgesics in young adulthood. The HUNT study. Psychiatry Research. ISSN 0165-1781. 327, s. 1–8. doi: 10.1016/j.psychres.2023.115400. Fulltekst i vitenarkiv Vis sammendrag

  Frequent and increasing use of over-the-counter analgesics (OTCA) is a public health concern. Pain conditions and psychological distress are related to frequent OTCA use, and as exposure to potentially traumatic events (PTE) in childhood appears to increase risk of experiencing such symptoms, we aimed to assess childhood PTEs and related symptoms in adolescence as predictors for frequent OTCA use in young adulthood. Prospective population survey data were used (n =2947, 59.1% female, 10–13 years follow-up). Exposure to PTEs, symptoms of post-traumatic stress, anxiety and depression, musculoskeletal pain and headache were assessed in adolescence (13–19 years). Use of OTCA was assessed in young adulthood (22–32 years) and use of OTCA to treat musculoskeletal pain and headache served as separate outcomes in ordinal logistic regression analyses. Overall, exposure to childhood PTEs, particularly direct interpersonal violence, was significantly and consistently related to more frequent use of OTCA to treat musculoskeletal pain and headaches in young adulthood. Adjusting for psychological symptoms and pain attenuated associations, indicating that these symptoms are of importance for the relationship between traumatic events and OTCA use. These findings emphasize the need to address symptomatology and underlying causes at an early age.

• Bondjers, Kristina; Lingaas, Ingebjørg; Stensland, Synne; Atar, Dan; Zwart, John Anker Henrik & Wøien, Hilde [Vis alle 7 forfattere av denne artikkelen] (2023). “I’ve kept going” – a multisite repeated cross-sectional study of healthcare workers’ pride in personal performance during the COVID-19 pandemic. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09246-5. Fulltekst i vitenarkiv Vis sammendrag

  Background For healthcare workers, working through a pandemic may include both challenges, such as coping with increased demands and a lack of control, and rewards, such as experiencing a sense of achievement and meaningfulness. In this study, we explore the accomplishments healthcare workers themselves are proud of achieving at work, in order to elucidate the positive aspects of working through a pandemic. Methods In June 2020 (T1), December 2020 (T2), and May 2021 (T3), healthcare workers (n = 1,996) at four Norwegian hospitals participated in a web-based survey assessing job strain, psychological health, and support during the pandemic. The survey included the open-ended question “During the past two weeks, what have you been feeling proud of achieving at work?”. Responses (1,046) to this item were analyzed using conventional content analysis, which resulted in 13 subthemes under 6 themes. Results For some, pride was found in their professional identity and dedication to their work. Others took pride in specific achievements, such as juggling their own needs (e.g., health, private life) with those of the workplace, contributing to cohesion and collaboration, their ability to learn and adjust, in being a useful resource at work, and in their efforts towards developing the organization and workplace. Implications The current findings shed light on what healthcare workers feel proud of achieving in their day-to-day work. Assessment of these factors provides insight on both positive and negative aspects of working clinically during a pandemic, and highlights specific targets for building sustainable and rewarding work environments for healthcare workers.

• Stene, Lise Eilin; Thoresen, Siri; Wentzel-Larsen, Tore & Dyb, Grete Anita (2022). Healthcare utilization after mass trauma: a register-based study of consultations with primary care and mental health services in survivors of terrorism. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-04358-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Knowledge on healthcare utilization after mass trauma is needed to strengthen the public health preparedness to such incidents. Using register-based data, this study had a unique opportunity to investigate how young survivors’ use of primary care physicians (PCP) and mental health services (MHS) changed after a terrorist attack. Methods We examined register-based data on PCP and MHS consultations among 255 survivors (52% male) of the 2011 Utøya youth camp attack in Norway 3 years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC− 2). Results The PCP and MHS consultation rates (CR) were higher in female than male survivors both acutely and at long-term. The mean yearly CRs increased from 2.25 to 4.41 for PCP and 1.77 to 13.59 for MHS the year before and after the attack in female survivors, and from 1.45 to 3.65 for PCP and 1.02 to 11.77 for MHS in male survivors. The third year post-attack CRs for PCP were 3.55 and 2.00; and CRs for MHS were 5.24 and 2.30 in female and male survivors, respectively. Among female survivors, 76% consulted PCP and 12% MHS the year preceding the attack; post-attack 93% consulted PCP and 73% MHS the first year; decreasing to 87 and 40% the third year. Among male survivors, 61% consulted PCP and 7% MHS the year preceding the attack; post-attack 86% consulted PCP and 61% MHS the first year, and 67 and 31% the third year. As for PCP consultations, there was a particular increase in psychological reasons for encounter following the attack. Conclusions This study indicates that it is important to anticipate an increased healthcare utilization several years following mass trauma, particularly of MHS. Both PCP and MHS practitioners played important roles in providing healthcare for psychological problems in young survivors of terrorism in a country with universal and largely publicly financed healthcare and a gatekeeping system. The healthcare utilization could be different in countries with other health systems or psychosocial care responses to mass trauma.

• Stangeland, Helle; Handal, Marte; Skurtveit, Svetlana Ondrasova; Aakvaag, Helene Flood; Dyb, Grete Anita & Wentzel-Larsen, Tore [Vis alle 10 forfattere av denne artikkelen] (2022). Killing pain?: a population-based registry study of the use of prescription analgesics, anxiolytics, and hypnotics among all children, adolescents and young adults in Norway from 2004 to 2019. European Child and Adolescent Psychiatry. ISSN 1018-8827. s. 1–12. doi: 10.1007/s00787-022-02066-8. Fulltekst i vitenarkiv Vis sammendrag

  The ongoing opioid epidemic has been a global concern for years, increasingly due to its heavy toll on young people’s lives and prospects. Few studies have investigated trends in use of the wider range of drugs prescribed to alleviate pain, psychological distress and insomnia in children, adolescents and young adults. Our aim was to study dispensation as a proxy for use of prescription analgesics, anxiolytics and hypnotics across age groups (0–29 years) and sex over the last 15 years in a large, representative general population. The study used data from a nationwide prescription database, which included information on all drugs dispensed from any pharmacy in Norway from 2004 through 2019. Age-specific trends revealed that the prevalence of use among children and adolescents up to age 14 was consistently low, with the exception of a substantial increase in use of melatonin from age 5. From age 15–29, adolescents and young adults used more prescription drugs with increasing age at all time points, especially analgesics and drugs with higher potential for misuse. Time trends also revealed that children from age 5 were increasingly dispensed melatonin over time, while adolescents from age 15 were increasingly dispensed analgesics, including opioids, gabapentinoids and paracetamol. In contrast, use of benzodiazepines and z-hypnotics slightly declined in young adults over time. Although trends were similar for both sexes, females used more prescription drugs than their male peers overall. The upsurge in use of prescription analgesics, anxiolytics and hypnotics among young people is alarming.

• Porcheret, Kate Louise; Stensland, Synne; Wentzel-Larsen, Tore & Dyb, Grete Anita (2022). Insomnia in survivors 8.5 years after the Utøya Island terrorist attack: transition from late adolescence to early adulthood - the Utøya study. European Journal of Psychotraumatology. 13(1). doi: 10.1080/20008198.2021.2020472. Fulltekst i vitenarkiv Vis sammendrag

  Background Insomnia is a global health concern, associated with many mental and physical health conditions. Prevalence of insomnia is reported to increase during adolescence and early adulthood. High levels of insomnia are also reported in adolescents up to 2.5 years after a traumatic event. What is less well understood is the prevalence of insomnia in a trauma exposed population transitioning from adolescence to adulthood. Objective To assess insomnia in the survivors in the 2011 Utøya Island terrorist attack, 2.5 years and 8.5 years after the attack when the majority of survivors were transitioning from late adolescence to early adulthood. Method Participants were 336 survivors of the Utøya Island attack who completed the Utøya Study 2.5 years (T3) and 8.5 years (T4) after the attack. Participants completed a face-to-face interview including the Bergen Insomnia Scale (BIS), which was used to assess insomnia symptoms and prevalence of meeting diagnostic criteria for insomnia. Results Insomnia was indicated in 47.7% of survivors 8.5 years after the attack. Insomnia prevalence did not significantly change from 2.5 to 8.5 years after the attack, though insomnia symptoms (BIS sum score) were found to increase. Age was negatively associated with insomnia at T4, with older age being associated with less insomnia. No significant sex difference was found in insomnia prevalence at T4. Conclusion Almost a decade after the Utøya Island terrorist attack, nearly a half of the young survivors in our study reported insomnia and typical age- and sex-related differences in sleep were not always seen. This rate is almost double what is reported in the general population (20–30%) indicating a high level of unmet need in this population. The implications of such sleep disruption during a critical time for physical, mental, social and cognitive development are far reaching.

• Glad, Kristin Alve; Stensland, Synne & Dyb, Grete (2021). The Terrorist Attack on Utøya Island: Long-Term Impact on Survivors’ Health and Implications for Policy. Perspectives on Terrorism (PT). 15(3). Fulltekst i vitenarkiv Vis sammendrag

  In this article, we summarize some of the main findings from The Utøya Study, a comprehensive longitudinal study on the impact on the survivors of the July 22 Utøya Island terrorist attack, and describe some implications for future policy. In total, 398 (79%) of the survivors participated in one or more of the four data collections in the study. Their mean age at the time of the terrorist attack was 19.2 years (SD=4.3, range 13.1–56.7, 94.0% < 26 years of age), and 49.0% were female. The vast majority (88.9%) were of Norwegian origin. Participants were interviewed face-to-face at 4-5 months (T1), 14-15 months (T2), 30-32 months (T3), and 8.5 years (T4), post-attack. We found that the terrorist attack had negative repercussions for the survivors’ mental and somatic health for years after the attack, including symptoms of posttraumatic stress, anxiety, depression, complicated grief, headache, and other somatic symptoms. Exposure to the attack also led to long-term functional impairment for many, particularly in relation to the survivors’ academic performance and well-being at school. Furthermore, it had negative health consequences for people close to the survivors, such as their caregivers. An important factor associated with how survivors cope after a terrorist attack is the support and help they receive from their social network, but also from the health care system. In line with the national health outreach plan, most survivors had received early proactive outreach from their municipality, but many missed a broader and longer lasting follow-up. The comprehensive documentation of short- and long-term health and social consequences in this study underlines the challenges societies are faced with after terrorist attacks. This insight calls for actions from decision makers in providing adequate outreach programs in health and social services. In particular, survivors with a non- Norwegian origin reported higher levels of PTSD symptoms and were less satisfied with the follow-up. After future attacks, the official outreach should be proactive, long lasting, and consider the diverse needs and characteristics of the affected individuals. For example, there should be a particular focus on survivors with a minority background. Furthermore, the outreach should be broad, and include people in the survivors’ immediate social network, schools and workplaces.

• Glad, Kristin Alve; Stensland, Synne; Czajkowski, Nikolai Olavi; Boelen, Paul & Dyb, Grete Anita (2021). The Longitudinal Association Between Symptoms of Posttraumatic Stress and Complicated Grief: A Random Intercepts Cross-Lag Analysis. Psychological Trauma. ISSN 1942-9681. doi: 10.1037/tra0001087. Fulltekst i vitenarkiv
• Ousdal, Olga Therese; Milde, Anne Marita; Hafstad, Gertrud Sofie; Hodneland, Erlend; Dyb, Grete & Craven, Alexander R. [Vis alle 9 forfattere av denne artikkelen] (2020). The association of PTSD symptom severity with amygdala nuclei volumes in traumatized youths. Translational Psychiatry. 10:288(288), s. 1–10. doi: 10.1038/s41398-020-00974-4. Fulltekst i vitenarkiv Vis sammendrag

  The amygdala is a core component in neurobiological models of stress and stress-related pathologies, including post-traumatic stress disorder (PTSD). While numerous studies have reported increased amygdala activity following traumatic stress exposure and in PTSD, the findings regarding amygdala volume have been mixed. One reason for these mixed findings may be that the amygdala has been considered as a homogenous entity, while it in fact consists of several nuclei with unique cellular and connectivity profiles. Here, we investigated amygdala nuclei volumes of the basolateral and the centrocorticomedial complex in relation to PTSD symptom severity in 47 young survivors from the 2011 Norwegian terror attack 24–36 months post-trauma. PTSD symptoms were assessed 4–5, 14–15 and 24–36 months following the trauma. We found that increased PTSD symptom severity 24–36 months post-trauma was associated with volumetric reductions of all basolateral as well as the central and the medial nuclei. However, only the lateral nucleus was associated with longitudinal symptom development, and mediated the association between 4–5 months and 24–36 months post-trauma symptoms. The results suggest that the amygdala nuclei may be differentially associated with cross-sectional and longitudinal measures of PTSD symptom severity. As such, investigations of amygdala total volume may not provide an adequate index of the association between amygdala and stress-related mental illness.

• Glad, Kristin Alve; Czajkowski, Nikolai Olavi; Dyb, Grete & Hafstad, Gertrud Sofie (2020). Does event centrality mediate the effect of peritraumatic reactions on post-traumatic growth in survivors of a terrorist attack? European Journal of Psychotraumatology. 11(1). doi: 10.1080/20008198.2020.1766276. Fulltekst i vitenarkiv Vis sammendrag

  Background While self-reported post-traumatic growth (PTG) has been documented after a wide variety of potentially traumatic experiences, we need more knowledge on the mechanisms behind PTG to gain a better understanding of this phenomenon. Objective We aimed to investigate the hypothesized mechanism of perceived event centrality as a mediator on the pathway between peritraumatic reactions and later PTG. Method In total, 204 survivors of the 2011 massacre on Utøya island, participated 4–5 months (T1), 14–15 months (T2), and 30–32 months (T3) post-terror. We applied counterfactually based causal mediation analysis to explore the potential mediating role of survivors’ perceived centrality (T2) in linking their peritraumatic reactions (T1) and self-reported PTG (T3). Results The vast majority of the survivors reported experiencing some positive changes post-terror, and we found a positive, significant association between survivor’s peritraumatic reactions, perceived event centrality and self-reported growth. However, we did not find that centrality significantly mediated the longitudinal association between peritraumatic reactions and later PTG. Conclusion Reports of PTG are common post-terror, and peritraumatic reactions and perceptions of centrality may help explain individual differences in trauma survivors’ level of PTG. Perceived event centrality about one year post-trauma does not appear to explain the relationship between initial reactions to trauma and subsequent PTG.

• Stensland, Synne; Thoresen, Siri; Jensen, Tine Kristin; Wentzel-Larsen, Tore & Dyb, Grete (2020). Early Pain and Other Somatic Symptoms Predict Posttraumatic Stress Reactions in Survivors of Terrorist Attacks: The Longitudinal Utøya Cohort Study. Journal of Traumatic Stress. ISSN 0894-9867. 33, s. 1060–1070. doi: 10.1002/jts.22562. Fulltekst i vitenarkiv Vis sammendrag

  Survivors of traumatic events commonly suffer from long‐term pain and related somatic symptomatology. To test the predominant hypothesis that survivors’ pain comprises sequela of persistent posttraumatic stress symptoms (PTSS), we assessed the sequential order of symptom development among young survivors of a terrorist attack. All 490 survivors of the 2011 Utøya (Norway) attacks were invited to the longitudinal Utøya cohort study; 355 (72.4%) participated. The mean survivor age was 19.3 years (SD = 4.6) and 169 were female (47.6%). Somatic symptoms, including headache, other pain and fatigue, and PTSS, were measured 4–5 months (T1), 14–16 months (T2), and 32–33 months (T3) after the attack. Longitudinal associations between somatic symptoms and PTSS were assessed in cross‐lagged structural equation model (SEM) analyses, which were adjusted for known confounders. Higher pain levels and other somatic symptoms at T1 consistently predicted PTSS at T2 in SEM analyses, r = .473, p < .001. Beyond this early‐to‐intermediate posttraumatic phase, somatic symptoms did not significantly predict PTSS: T2–T3, r = .024, p = .831; T1–T3, r = −.074, p = .586. PTSS did not significantly predict later somatic symptomatology at T1–T2, r = .093, p = .455; T2–T3, r = .272, p = .234; or T1–T3, r = −.279, p = .077. The findings indicate that survivors’ early pain and related somatic symptoms strongly and consistently predict later psychopathology. After severe psychological trauma, early interventions may need to address individuals’ pain to hinder chronification.

• Dyb, Grete (2020). Déjà vu - Recalling being hit by terror. I Vermetten, Eric; Frankova, Iryna; Carmi, Lior; Chaban, Oleg & Zohar, Joseph (Red.), Risk Management of Terrorism Induced Stress: Guidelines for the Golden Hours (Who, What and When). IOS Press. ISSN 9781643680569. s. 165–172. doi: 10.3233/NHSDP200028. Fulltekst i vitenarkiv
• Kenardy, Justin; Kassam-Adams, Nancy & Dyb, Grete (2020). Preventative and Early Interventions. I Forbes, David; Bisson, Jonathan I.; Monson, Candice M. & Berliner, Lucy (Red.), Effective Treatments for PTSD. Practice Guidelines from the International Society for Traumatic Stress Studies.. Guilford Press. ISSN 9781462543571. Fulltekst i vitenarkiv
• Dyb, Grete & Jensen, Tine Kristin (2019). Å oppleve et overveldende traume - Hvordan blir livet etterpå? I Dyb, Grete & Jensen, Tine Kristin (Red.), Å leve videre etter katastrofen: Stressreaksjoner og oppfølging etter traumer. Gyldendal Akademisk. ISSN 9788205522602. s. 15–32. Fulltekst i vitenarkiv
• Thoresen, Siri; Dyb, Grete & Jensen, Tine Kristin (2019). Sosial støtte, svik og sosiale barrierer. I Dyb, Grete & Jensen, Tine Kristin (Red.), Å leve videre etter katastrofen: Stressreaksjoner og oppfølging etter traumer. Gyldendal Akademisk. ISSN 9788205522602. s. 85–94. Fulltekst i vitenarkiv
• Rueness, Janne; Myhre, Mia Cathrine; Strøm, Ida Frugård; Wentzel-Larsen, Tore; Dyb, Grete & Thoresen, Siri (2019). The mediating role of posttraumatic stress reactions in the relationship between child abuse and physical health complaints in adolescence and young adulthood. European Journal of Psychotraumatology. 10(1). doi: 10.1080/20008198.2019.1608719. Fulltekst i vitenarkiv Vis sammendrag

  Background: Child abuse is associated with physical health problems in adolescence and adulthood, but the mechanisms involved are unclear. A possible mediating effect of posttraumatic stress reactions (PTSR) linking child abuse with later physical health complaints has not been fully investigated. Objective: The current study investigated whether PTSR could be a potential mediator in the relationship between child abuse and physical health complaints in adolescents and young adults. If so, we also investigated whether this was the case for different child abuse types alone or in combination. Method: The study sample comprised 506 adolescents and young adult victims of child abuse and 504 unexposed matched controls aged 16–33 from a community sample. We measured child abuse retrospectively and current PTSR at wave 1 (2013), and current physical health complaints at wave 2 (2014/15). We tested a model of PTSR as a possible mediator between child abuse and physical health complaints and conducted causal mediation analysis to estimate direct and indirect pathways. Each child abuse type was studied in isolation and in combination with other abuse types. Results: PTSR had a notable, significant mediating effect on the relationship between child abuse and physical health complaints in our overall model (average causal mediation effect; ACME = 0.14, p < 0.001), accounting for 85% of the total effect. The mediated pathway was also significant in analyses of the different child abuse types. The mediating effect of PTSR was most prominent in individuals reporting exposure to more than one child abuse type. Conclusions: The current study indicates that PTSR may be an important mediator in the relationship between child abuse and physical health complaints. Health professionals should be aware of the important role that PTSR may have in maintaining or exacerbating physical health problems in child abuse victims. However, a reverse model could not be tested in this study and the results need confirmation in future prospective studies.

• Rueness, Janne; Myhre, Mia Cathrine; Strøm, Ida Frugård; Wentzel-Larsen, Tore; Dyb, Grete & Thoresen, Siri (2019). Child abuse and physical health: A population-based study on physical health complaints among adolescents and young adults. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/1403494819848581. Fulltekst i vitenarkiv
• Nilsen, Lisa Govasli; Hafstad, Gertrud Sofie & Dyb, Grete (2019). Sosiale medier etter katastrofer. I Dyb, Grete & Jensen, Tine Kristin (Red.), Å leve videre etter katastrofen: Stressreaksjoner og oppfølging etter traumer. Gyldendal Akademisk. ISSN 9788205522602. s. 118–124. Fulltekst i vitenarkiv
• Wisløff-Aase, Kristin; Ræder, Johan; Månum, Grethe; Løvstad, Marianne; Schanke, Anne-Kristine & Dyb, Grete [Vis alle 8 forfattere av denne artikkelen] (2019). Chronic pain among the hospitalized patients after the 22 july 2011 terror attacks in Oslo and at Utøya Island. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. doi: 10.1111/aas.13373. Fulltekst i vitenarkiv
• Månum, Grethe; Løvstad, Marianne; Wisløff-Aase, Kristin; Ræder, Johan; Schanke, Anne-Kristine & Larsen, Ingar H. [Vis alle 9 forfattere av denne artikkelen] (2019). Clinical characteristics and physical functioning in persons hospitalized following the Norwegian terror attacks in July 2011: A follow-up study. Journal of Rehabilitation Medicine. ISSN 1650-1977. 51(3), s. 225–233. doi: 10.2340/16501977-2521. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To describe the clinical characteristics and physical functioning in persons hospitalized after 2 terror attacks in Norway in 2011. Design: Cross-sectional study with retrospective acute medical data. Subjects: Surviving persons hospitalized with physical injuries. Methods: Medical and psychological assessments 3–4 years after injury, with data on injury type and severity collected from medical records. Results: A total of 30 out of 43 potential subjects participated (19 women, 11 men; age range 17–71 years (median 23 years)). Eighteen participants had suffered a severe injury, with New Injury Severity Scale (NISS) scores > 15. All body parts were affected. The number of surgical procedures ranged from 0 to 22 (median 3), and days in intensive care ranged from 0 to 59 (median 2.5), of which 16 had more than 24 h intensive care. Three to 4 years later, a majority of the participants had a broad spectrum of somatic and psychological problems and reduced physical functioning. Two-thirds of the participants reported their physical health to be unsatisfactory, and continuous need for healthcare and unmet needs were identified for all except 4 of the participants. Conclusion: Persons hospitalized following a terror attack experience a broad spectrum of somatic and psychological problems and need long-term physical and psychological follow-up. This study indicates specific needs for rehabilitation after injuries acquired under psychological traumatic circumstances.

• Jensen, Tine Kristin; Stene, Lise Eilin; Nilsen, Lisa Govasli; Haga, Jon Magnus & Dyb, Grete (2019). Tidlig intervensjon og behandling. I Dyb, Grete & Jensen, Tine Kristin (Red.), Å leve videre etter katastrofen: Stressreaksjoner og oppfølging etter traumer. Gyldendal Akademisk. ISSN 9788205522602. s. 141–165. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Czajkowski, Nikolai Olavi; Dyb, Grete & Hafstad, Gertrud Sofie (2019). Cross-Lagged Association Between Symptoms of Posttraumatic Stress Disorder and Perceived Centrality of a Terrorist Attack. Clinical Psychological Science. ISSN 2167-7026. doi: 10.1177/2167702619873590. Fulltekst i vitenarkiv Vis sammendrag

  Numerous cross-sectional studies have found a positive association between level of event centrality and symptoms of posttraumatic stress disorder (PTSD), but the temporal course of this relationship is unclear. We aimed to investigate the concurrent and longitudinal association between event centrality and symptoms of PTSD in a trauma-exposed sample. In total, 319 survivors of the 2011 massacre on Utøya island, Norway, were interviewed 14 to 15 and 30 to 32 months after the event. A cross-lagged panel model was used to explore the association between event centrality and PTSD symptoms over time. Level of event centrality was significantly associated with concurrent PTSD symptoms at both time points. PTSD symptoms were significantly associated with prospective levels of event centrality but not vice versa. This finding indicates that the degree to which survivors perceive a terrorist attack as central to their identity may be an effect, not a cause, of their PTSD symptoms.

• Stensland, Synne & Dyb, Grete (2019). Kroppen reagerer på fare. I Dyb, Grete & Jensen, Tine Kristin (Red.), Å leve videre etter katastrofen: Stressreaksjoner og oppfølging etter traumer. Gyldendal Akademisk. ISSN 9788205522602. s. 33–41. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Kilmer, Ryan P.; Dyb, Grete & Hafstad, Gertrud Sofie (2019). Caregiver-reported positive changes in young survivors of a terrorist attack. Journal of Child and Family Studies. ISSN 1062-1024. 28(3), s. 704–719. doi: 10.1007/s10826-018-1298-7. Fulltekst i vitenarkiv Vis sammendrag

  Self-reported positive change in the aftermath of trauma has been the focus of numerous studies, and the literature regarding posttraumatic growth (PTG, positive change resulting from the struggle with trauma) has grown meaningfully in the last decade. However, limited research has described behaviors associated with these positive changes, or documented reports of such changes by people in the survivor’s immediate social network. We sought to extend the extant research by exploring caregivers’ observed positive changes in youth and emerging adults exposed to a terrorist attack and detailing the nature of these changes. As part of a large-scale, longitudinal study of survivors of the terrorist attack at Norway’s Utøya Island, 284 caregivers (62.3% females, M age = 47.23 years, SD = 5.79) were asked whether they had observed any positive changes in their youth 2.5 years post-terror and, if so, if they could provide examples of these changes from their daily life. Caregivers’ statements were systematically coded and analyzed using thematic analysis. Most caregivers (64%) reported that they had observed positive post-trauma changes in their youth, and the dimensions described largely align with findings from the existing PTG literature. The caregivers most commonly described relational and personal changes in their children, including a stronger bond with family (e.g., more expressed affection); heightened compassion (e.g., greater interpersonal sensitivity); and greater maturity (e.g., increased reflectiveness). These findings suggest that PTG is an observable phenomenon among youth and emerging adults exposed to terror, and the rich examples of positive behavioral changes support the validity of the PTG construct.

• Nilsen, Lisa Govasli; Thoresen, Siri; Wentzel-Larsen, Tore & Dyb, Grete (2019). Trust after Terror: Institutional trust among young terror survivors and their parents after the 22nd of July terrorist attack on Utøya island, Norway. Frontiers in Psychology. 10:2819, s. 1–10. doi: 10.3389/fpsyg.2019.02819. Fulltekst i vitenarkiv Vis sammendrag

  In the aftermath of terrorist attacks and disasters, public institutions play an important role in re-establishing safety and justice. However, little is known about the importance of institutional trust for victims’ potential for healing in the aftermath of mass trauma. This study examines levels of post-terror trust in the police and in the justice system among young survivors from the 2011 Utøya terror attack and their parents. Furthermore, it investigates how institutional trust develops over time among directly affected populations, and whether it is associated with psychological distress. 325 survivors and 463 parents were interviewed face-to-face at wave one (4–5 months post-terror) and 285 survivors and 435 parents at wave two (14–15 months). Levels of institutional trust in victims were compared to general population data from the European Social Survey adjusted for age, gender, and ethnic background. Measures included trust in the police and justice system, post-traumatic stress reactions, anxiety and depression, and quality of life. Trust in the police among survivors and parents was higher than or comparable to trust levels in the general population at wave one, but decreased for survivors and parents at wave two. Trust in the justice system was higher among those directly affected than in the general population, and increased from wave one to wave two. Levels of institutional trust were negatively associated with distress for survivors in both waves and for parents in wave two. Levels of institutional trust were positively associated with perceived quality of life in parents and survivors. Directly affected groups’ institutional trust differed from that of the general population following the terrorist attack, although being directly affected did not necessarily imply weakened institutional trust. This study found trust to be institution specific, however, trust in institutions changed with time, and the passing of time might be an important factor in better understanding whether trust will generalize across institutions or not. Institutional trust was negatively associated with psychological distress. This finding highlights the potential for institutions to create a healing post-disaster environment.

• Thoresen, Siri; Holt, Tonje; Jensen, Tine Kristin & Dyb, Grete (2019). Foreldreskap - Å være forelder når barnet ditt er i livsfare. I Dyb, Grete & Jensen, Tine Kristin (Red.), Å leve videre etter katastrofen: Stressreaksjoner og oppfølging etter traumer. Gyldendal Akademisk. ISSN 9788205522602. s. 42–56. Fulltekst i vitenarkiv
• Stensland, Synne; Zwart, John-Anker; Wentzel-Larsen, Tore & Dyb, Grete (2018). The headache of terror: A matched cohort study of adolescents from the Utøya and the HUNT Study. Neurology. ISSN 0028-3878. 90(2), s. e111–e118. doi: 10.1212/WNL.0000000000004805. Fulltekst i vitenarkiv Vis sammendrag

  Exposure to Terror May Increase Risk of Migraine, Other Headaches MINNEAPOLIS – Survivors of a terror attack have an increased risk of frequent migraine and tension headaches after the attack, according to a study published in the December 13, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study involved the teenage survivors of Norway’s largest mass killing. In 2011, a lone gunman opened fire at a youth summer camp on Utøya Island, killing 69 people and severely wounding 33. All survivors experienced terror, many lost friends and some risked drowning as they tried to escape the island. “We know a lot about the psychological effects of terror attacks and other extreme violence on survivors, but we don’t know much about the physical effects of these violent incidents,” said study author Synne Øien Stensland, MD, PhD, of the Norwegian Centre for Violence and Traumatic Stress Studies in Oslo. “Our study shows that a single highly stressful event may lead to ongoing suffering with frequent migraines and other headaches, which can be disabling when they keep people from their work or school activities.” The 358 teenage survivors were invited to participate in the study. Of the 213 who participated, the average age was 18 and six percent were severely injured in the attack. Participants were interviewed about their headache frequency four to five months after the attack. Their responses about headache type and frequency were compared to the responses of 1,704 young people of same sex and age who had not experienced terror. The teens who had been exposed to terror were four times more likely to have migraines and three times more likely to have frequent tension headaches than the teens who were not exposed to terror. These findings remained the same after adjusting for injury, sex, prior exposure to physical or sexual violence, and psychological distress. Among the female participants, 80 of the 109 who were exposed to terror, or 73 percent, had recurrent headaches, compared to 325 of the 872 who were not exposed, or 37 percent. For male participants, 43 of the 104 terror survivors had headaches, or 41 percent, compared to 158 of the 832 with no exposure, or 19 percent. The terror survivors were much more likely to have daily or weekly headaches than those with no exposure. “We suspected that headaches would increase for terror survivors, and the increase was over and above what might be expected based on psychological distress and other risk factors,” said Stensland. “This suggests that we may need to figure out ways to help people right after events like terror attacks to help reduce the potential of frequent and disabling headaches. In many cases with severe headaches, treatments can be most helpful early on before the condition becomes chronic.” One limitation of the study was the lower response rate among survivors with high symptom levels, which could have led to an underestimation of risk. The study was supported by the Norwegian Directorate of Health and the Norwegian Research Council. To learn more about headache, visit www.aan.com/patients. The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 34,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

• Stene, Lise Eilin; Schultz, Jon-Håkon & Dyb, Grete (2018). Returning to school after a terror attack: a longitudinal study of school functioning and health in terror‑exposed youth. European Child and Adolescent Psychiatry. ISSN 1018-8827. s. 1–10. doi: 10.1007/s00787-018-1196-y. Fulltekst i vitenarkiv Vis sammendrag

  Terrorist attacks and mass shootings often involve youth. Knowledge is needed on how this may impact their health and functioning. This study investigates perceived academic performance and school wellbeing in 237 terror-exposed survivors of the Utøya youth camp attack according to their sociodemographic characteristics, health and mental health service (MHS) utilization. Semi-structured interviews were conducted after 4–5 and 14–15 months. The year following the attack, 143 (61%) survivors reported impaired academic performance and 66 (29%) impaired school wellbeing. Female survivors more often reported impaired performance. Non-Norwegian origin, being financially disadvantaged and less social support were associated with impaired wellbeing. Sleep problems, posttraumatic stress, anxiety/depression, somatic symptoms, and lower life satisfaction were associated with both impaired performance and impaired wellbeing. Survivors who had received MHS were more likely to report impaired or improved academic performance and school wellbeing. Higher age and posttraumatic stress reactions were associated with impaired academic performance after multivariate logistic regression adjustments for gender, somatic symptoms and social support. When additionally adjusting for impaired school wellbeing, age and impaired wellbeing were associated with impaired performance. Only posttraumatic stress reactions were associated with impaired wellbeing after similar adjustments. Non-Norwegian origin and being financially disadvantaged were not significantly associated with impaired wellbeing after adjusting for posttraumatic stress reactions, age and gender. Our findings demonstrate how a terrorist attack can considerably deteriorate young survivors’ performance and wellbeing at school, which is associated with poorer health. Consequently, it is important to provide appropriate school support, and coordinate MHS with follow-up at school.

• Bugge, Ingrid; Jensen, Tine Kristin; Nilsen, Lisa Govasli; Ekeberg, Øivind; Dyb, Grete & Diseth, Trond H (2018). Psychosocial care for hospitalized young survivors after the terror attack on Utøya Island: A qualitative study of the survivors’ experiences. Injury. ISSN 0020-1383. s. 1–8. doi: 10.1016/j.injury.2018.10.024. Fulltekst i vitenarkiv

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• Dyb, Grete & Jensen, Tine Kristin (2019). Å leve videre etter katastrofen: Stressreaksjoner og oppfølging etter traumer. Gyldendal Akademisk. ISBN 9788205522602. 216 s. Fulltekst i vitenarkiv

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• Dyb, Grete Anita; Løberg, Magnus; Feiring, Eli; Bjaalie, Jan G. & Harbo, Hanne-Cathrin Flinstad (2025). Revidert regelverk for ph.d.utdanningen. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 14(14). doi: 10.4045/tidsskr.25.0652. Fulltekst i vitenarkiv
• Grødeland, Gunnveig; Harbo, Hanne-Cathrin Flinstad; Diaz, Esperanza; Dyb, Grete Anita; Berg, Are Stuwitz & Svineng, Gunbjørg [Vis alle 13 forfattere av denne artikkelen] (2024). Pandemi, krig og terror: Helsefakultetenes betydning for beredskap. Fulltekst i vitenarkiv
• Undset, Andrea Barsnes; Jensen, Tine; Dyb, Grete Anita; Wentzel-Larsen, Tore & Blix, Ines (2023). Thoughts about what could have happened among survivors of terrorism: Vividness and frequency of counterfactual thinking, and the role of exposure and reactions. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Undset, Andrea Barsnes; Wentzel-Larsen, Tore; Jensen, Tine; Dyb, Grete Anita & Berg, Akiah Ottesen (2023). “My child could have died”: Counterfactual thinking and mental health in caregivers of young terrorism survivors. Fulltekst i vitenarkiv
• Stangeland, Helle; Aakvaag, Helene Flood; Baumann-Larsen, Monica; Wentzel-Larsen, Tore; Storheim, Kjersti & Zwart, John Anker Henrik [Vis alle 8 forfattere av denne artikkelen] (2023). Problematic alcohol use in young adults exposed to childhood trauma: The Trøndelag Health (HUNT) Study, poster at the ISTSS 39th annual meeting. Fulltekst i vitenarkiv
• Stangeland, Helle; Aakvaag, Helene Flood; Baumann-Larsen, Monica; Wentzel-Larsen, Tore; Storheim, Kjersti & Zwart, John Anker Henrik [Vis alle 8 forfattere av denne artikkelen] (2023). Problematic alcohol use in young adults exposed to childhood trauma: The Trøndelag Health (HUNT) Study, poster på den 12. Nasjonale forskningskonferansen om muskelskjeletthelse 2023 (MUSS). Fulltekst i vitenarkiv
• Undset, Andrea Barsnes; Jensen, Tine; Dyb, Grete Anita; Wentzel-Larsen, Tore & Blix, Ines (2023). Vividness and frequency of counterfactual thinking –the role of exposure and peri-trauma reactions, and associations with posttraumatic stress symptoms. Fulltekst i vitenarkiv
• Feiring, Eli; Løberg, Magnus; Bjaalie, Jan G.; Dyb, Grete Anita & Harbo, Hanne-Cathrin Flinstad (2023). Kjønn og helse, utdanning og forskning. 143(11). doi: 10.4045/tidsskr.23.0408. Fulltekst i vitenarkiv
• Stangeland, Helle; Handal, Marte; Skurtveit, Svetlana Ondrasova; Aakvaag, Helene Flood; Dyb, Grete Anita & Wentzel-Larsen, Tore [Vis alle 10 forfattere av denne artikkelen] (2022). Killing pain? A 15-year population-based registry study of the use of prescription analgesics, anxiolytics and hypnotics among young people in Norway, oral presentation. Fulltekst i vitenarkiv
• Stene, Lise Eilin; Thoresen, Siri; Wentzel-Larsen, Tore & Dyb, Grete Anita (2022). Changes in healthcare utilization after mass trauma: A register-based study of young survivors’ utilization of primary care and mental health services before and after the Utøya attack in Norway. Fulltekst i vitenarkiv
• Wøien, Hilde; Rosseland, Leiv Arne; Bondjers, Kristina; Lingaas, Ingebjørg; Dyb, Grete Anita & Zwart, John Anker Henrik [Vis alle 7 forfattere av denne artikkelen] (2022). Stress reactions and health problems in hospital personel during the Covid-19 pandemic; a longitudinal, multicenter study. Fulltekst i vitenarkiv
• Dyb, Grete Anita (2021). Hvor står forskningen? Eksisterende forskning på de som ble rammet 22. juli. Fulltekst i vitenarkiv
• Stangeland, Helle; Handal, Marte; Skurtveit, Svetlana Ondrasova; Aakvaag, Helene Flood; Dyb, Grete Anita & Wentzel-Larsen, Tore [Vis alle 10 forfattere av denne artikkelen] (2021). Killing pain? A population-based registry study of the use of prescription analgesics, anxiolytics, and hypnotics among children, adolescents and young adults in Norway from 2004-2019, poster på den 10. Nasjonale forskningskonferansen innen muskelskjeletthelse 2021 (MUSS). Fulltekst i vitenarkiv
• Bondjers, Kristina; Stensland, Synne; Zwart, John Anker Henrik; Rosseland, Leiv Arne; Wøien, Hilde & Atar, Dan [Vis alle 11 forfattere av denne artikkelen] (2021). Hvordan gikk det? Støtte og stolthet gjennom pandemien - rapport fra en longitudinell studie av 2000 sykehuspersonell. Fulltekst i vitenarkiv
• Stensland, Synne; Bondjers, Kristina; Zwart, John Anker Henrik; Rosseland, Leiv Arne; Wøien, Hilde & Atar, Dan [Vis alle 11 forfattere av denne artikkelen] (2021). Did hospital personnel receive adequate help and support to reduce work-related stress during the Covid-19 pandemic? The Norwegian Study of Hospital Personnel. Fulltekst i vitenarkiv
• Bondjers, Kristina; Lingaas, Ingebjørg; Stensland, Synne; Wøien, Hilde; Muller, Ashley Elizabeth & Atar, Dan [Vis alle 8 forfattere av denne artikkelen] (2021). Is it all bad? - sense of accomplishment among health-care workers during the Covid-19 pandemic. Fulltekst i vitenarkiv
• Bondjers, Kristina; Stensland, Synne; Zwart, John Anker Henrik; Rosseland, Leiv Arne; Wøien, Hilde & Atar, Dan [Vis alle 11 forfattere av denne artikkelen] (2021). Psychological impact of the Covid-19 pandemic on healthcare workers. Fulltekst i vitenarkiv
• Bondjers, Kristina; Stensland, Synne; Zwart, John Anker Henrik; Rosseland, Leiv Arne; Wøien, Hilde & Atar, Dan [Vis alle 11 forfattere av denne artikkelen] (2021). Hvordan gikk det? Støtte og stolthet gjennom pandemien - rapport fra en longitudinell studie av 2000 sykehuspersonell. Fulltekst i vitenarkiv
• Stangeland, Helle; Handal, Marte; Skurtveit, Svetlana Ondrasova; Aakvaag, Helene Flood; Dyb, Grete Anita & Wentzel-Larsen, Tore [Vis alle 10 forfattere av denne artikkelen] (2020). Bruk av smertestillende og vanedannende medikamenter til barn og unge i Norge: En populasjonsbasert studie over 15 år (2004-2019), foredrag på den 9. Nasjonale forskningskonferansen innen muskelskjeletthelse 2020 (MUSS). Fulltekst i vitenarkiv
• Ingierd, Helene; Aarli, Ragna; Staksrud, Elisabeth; Mikkelsen, Øyvind; Dyb, Grete & Anfinset, Nils (2020). Hvor ble det av forskningsetikken? Fulltekst i vitenarkiv
• Glad, Kristin Alve; Stensland, Synne; Czajkowski, Nikolai Olavi; Boelen, Paul & Dyb, Grete (2020). The longitudinal association between symptoms of posttraumatic stress and complicated grief. A random intercepts cross-lag analysis. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Thoresen, Siri & Dyb, Grete (2020). «Slitsomt» «Ubehagelig» «Plagsomt» Slik beskriver Utøya-overlevende møtet med mediene etter 22. juli. Fulltekst i vitenarkiv
• Ingjerd, Helene; Aarli, Ragna; Staksrud, Elisabeth; Mikkelsen, Øyvind; Dyb, Grete & Anfinset, Nils (2020). Hvor ble det av forskningsetikken? Fulltekst i vitenarkiv
• Stensland, Synne; Lingaas, Ingebjørg; Undset, Andrea Barsnes; Andreassen, Anne Lie & Dyb, Grete (2019). Informasjonsfilm om Utøyastudien. Fulltekst i vitenarkiv
• Stensland, Synne; Andreassen, Anne Lie; Lingaas, Ingebjørg; Undset, Andrea Barsnes & Dyb, Grete (2019). Instruksjonsvideo for bruk av aktigraf. Fulltekst i vitenarkiv
• Thoresen, Siri; Stensland, Synne; Birkeland, Marianne Skogbrott; Wentzel-Larsen, Tore & Dyb, Grete (2019). Trauma in social relationships. Longitudinal associations between social support and posttraumatic stress in young survivors of a terrorist attack: The Utøya Study. Fulltekst i vitenarkiv
• Stensland, Synne; Thoresen, Siri; Jensen, Tine Kristin; Wentzel-Larsen, Tore; Zwart, John-Anker & Dyb, Grete (2019). Smerte og posttraumatiske stress reaksjoner etter terror Utøyastudien. Fulltekst i vitenarkiv
• Stensland, Synne; Glad, Kristin Alve; Wentzel-Larsen, Tore & Dyb, Grete (2019). In quest for rest Frequent use of alcohol and medication to sleep and rest among survivors of a terrorist attack. The longitudinal Utøya cohort study. Fulltekst i vitenarkiv
• Stensland, Synne; Glad, Kristin Alve; Porcheret, Kate; Wentzel-Larsen, Tore & Dyb, Grete (2019). No rest for the weary Long-term sleep problems in survivors of the Utøya terrorist attack. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Stensland, Synne; Czajkowski, Nikolai Olavi; Boelen, Paul & Dyb, Grete (2019). The longitudinal association between complicated grief and symptoms of posttraumatic stress. A random-intercept cross-lag analysis. Fulltekst i vitenarkiv
• Aakvaag, Helene Flood; Stensland, Synne & Dyb, Grete (2019). Shame after a terrorist attack: Associations with event characteristics and interpersonal violence in young survivors three years after the Utøya Island attacks. Fulltekst i vitenarkiv
• Stensland, Synne; Thoresen, Siri; Jensen, Tine Kristin; Wentzel-Larsen, Tore & Dyb, Grete (2018). Early somatic symptoms predict posttraumatic stress over time. The Utøya study. Fulltekst i vitenarkiv
• Kassam-Adams, Nancy; Borja, Susan; Dyb, Grete & Alisic, Eva (2018). Data Sharing and Open Science Practices: Implications for the Traumatic Stress Field. Fulltekst i vitenarkiv
• Rueness, Janne; Myhre, Mia Cathrine; Strøm, Ida Frugård; Wentzel-Larsen, Tore; Dyb, Grete & Thoresen, Siri (2018). The physical health impact of child abuse: A population survey on physical health complaints among adolescents and young adults. Fulltekst i vitenarkiv
• Rueness, Janne; Myhre, Mia Cathrine; Strøm, Ida Frugård; Wentzel-Larsen, Tore; Dyb, Grete & Thoresen, Siri (2018). PTSR mediate the relationship between child abuse and physical Health complaints in adolescence and early adulthood. Fulltekst i vitenarkiv
• Stensland, Synne; Zwart, John-Anker; Wentzel-Larsen, Tore & Dyb, Grete (2018). Hodepine etter terror. Fulltekst i vitenarkiv
• Stene, Lise Eilin; Schultz, Jon-Håkon & Dyb, Grete (2018). School functioning and health in survivors of the Utøya youth camp attack. Fulltekst i vitenarkiv
• Dyb, Grete (2018). Déjà vu - recalling being hit by terror. Fulltekst i vitenarkiv
• Dyb, Grete; Ingebrethsen, Christian & Aune, Oddvin (2018). – Bør tenke seg nøye om før de ser Utøya-filmen. [Internet]. NRK.no. Fulltekst i vitenarkiv
• Nilsen, Lisa Govasli; Hafstad, Gertrud Sofie; Staksrud, Elisabeth & Dyb, Grete (2018). Bruk av sosiale medier etter terror. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Czajkowski, Nikolai O.; Dyb, Grete & Hafstad, Gertrud Sofie (2018). Cross-lagged association between PTSD symptoms and perceived centrality of a terrorist attack. Fulltekst i vitenarkiv
• Dyb, Grete Anita; Glad, Kristin Alve; Lingaas, Ingebjørg & Stensland, Synne Øien (2022). SURVIVORS AND THE AFTERMATH OF THE TERRORIST ATTACK ON UTØYA ISLAND, NORWAY Report for the Mass Casualty Commission. NKVTS. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Hafstad, Gertrud Sofie; Dyb, Grete & Czajkowski, Nikolai Olavi (2020). Transformed by trauma. A longitudinal study of posttraumatic stress, growth and perceived event centrality among youths and emerging adults after the terrorist attack on Utøya island. Damnett. Fulltekst i vitenarkiv

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