Section of Mental Health Research

Haugesund, Norway

Section of Mental Health Research

Haugesund, Norway
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Hartveit M.,Health Integrated | Hartveit M.,University of Bergen | Aslaksen A.,University of Bergen | Aslaksen A.,Haukeland University Hospital | And 10 more authors.
International Journal of Care Coordination | Year: 2015

Introduction: Several studies have indicated that medical referral letters do not convey the necessary information to ensure sufficient coordination of care. However, there is no definition of the core set of information items that should be communicated in a referral process, and no valid measurements to assess, and thus improve, the quality of such information. The present study aimed to develop and test an instrument to measure the quality of referral information provided by general practitioners to specialised mental health care services for adults. Methods: Based on a recommendation taking the users’ standpoint into account, a minimum set of items for referral communication seen as essential by experienced specialists (N = 42) was developed. An instrument to assess the quality of referral information for specialised mental health care for adults was then examined based on its psychometric properties. The examination was conducted within the region of Western Norway Regional Health Authority (www.helse-vest.no), representing the public specialised mental health care for approximately 1 million citizens. Results: Nineteen items were recommended, and the instrument was found valid and reliable. The inter-rater correlation varied, and the test–retest was found to be substantial or almost perfect for a majority of the raters. Discussion: This study embeds an exploration of improvement potential, impact of quality improvement efforts and sustainability of such efforts for facilitating effective communication in the interface between the two main health services for people with mental health problems. Further exploration on the instruments generalisability to other contexts and to the inter-rater correlation are recommended. © 2015, © The Author(s) 2015.


Skogen J.C.,University of Bergen | Skogen J.C.,Section of Mental Health Research | Skogen J.C.,University of Stavanger | Overland S.,University of Bergen | And 3 more authors.
Addictive Behaviors | Year: 2011

The aim of this study was to examine the psychometric properties of the CAGE questionnaire, and the questionnaire's concurrent validity with current and previous alcohol consumption. This study employed data from the Nord-Trøndelag Health Survey wave 1 (HUNT-1 in 1984-86: N = 24,900) and wave 2 (HUNT-2 in 1995-97: N = 36,350). The concurrent validity of the CAGE questionnaire was examined both as a dichotomous variable with the recommended cut-off (<2 affirmative answers) for alcohol problems, and as a categorical scale. The categorical scale was constructed by counting responses from 0 to 4, and a separate category for current abstainers in HUNT-2. Current self-reported consumption above the gender specific 80th percentile was defined as "current excessive consumption". "Previous excessive consumers" were defined by meeting at least one of the two following criteria at the time of HUNT-1: reporting drinking too much alcohol in any period of their life, or reporting a high level of alcohol consumption. The internal reliability of CAGE was adequate, and in relation to alcohol consumption, there was a linear relationship between the CAGE score and both the current and previous excessive consumption. In conclusion, this study indicates good concurrent validity and adequate psychometric properties of the CAGE questionnaire. The dose-response pattern seen between the CAGE score and alcohol consumption, suggests that it can be used as an ordinal measure, rather than with a cut-off of two or more. The concurrent validity of the CAGE is better in women than in men. © 2010 Elsevier Ltd.


Skogen J.C.,University of Bergen | Skogen J.C.,Section of Mental Health Research | Skogen J.C.,University of Stavanger | Knudsen A.K.,University of Bergen | And 4 more authors.
Addiction | Year: 2012

Aims To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption ('sick-quitting') could explain some of the increased risk for DP among abstainers. Design Prospective population-based study. Setting and participants Data were from two waves of the Nord-Trøndelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37729 (alcohol consumption) and 34666 (problem drinking) participants. Measurements Alcohol consumption was measured by self-reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health-related behaviour, socio-economic status and social activity. Findings Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92-1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08-3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48-2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01-2.74) were at higher risk for DP than constant abstainers. Conclusions Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by 'sick-quitting'. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.


Skogen J.C.,Section of Mental Health Research | Skogen J.C.,University of Stavanger | Skogen J.C.,University of Bergen | Mykletun A.,University of Bergen | And 7 more authors.
Psychological Medicine | Year: 2011

Background The beneficial outcomes associated with moderate compared with low alcohol intake or abstinence may be due to the inclusion of people as 'low consumers', who have stopped consumption because of poor health. We investigated the association between alcohol abstinence and symptoms of common mental disorder and personality disorder, distinguishing between lifelong abstinence and abstinence following previous consumption.Method Analyses were based on the British National Survey of Psychiatric Morbidity 2000, which sampled 8580 residents aged 16-74 years. Hazardous drinking (Alcohol Use Disorders Identification Test) was excluded. Symptoms of common mental disorder (depression/anxiety) were identified by the Clinical Interview Schedule. The screening questionnaire of the Structured Clinical Interview for Axis II Personality Disorders was used to identify potential personality disorder. Self-reported alcohol abstinence was divided into lifelong abstinence and previous consumption. Previous consumers were asked why they had stopped. Covariates included socio-economic status, social activity and general health status.Results After adjustment, alcohol abstinence was associated with both common mental disorder symptoms and any personality disorder, but only for previous consumers, in whom odds ratios were 1.69 (95% CI 1.23-2.32) and 1.45 (95% CI 1.09-1.94). Associations were non-specific, being apparent for most individual mental disorder symptoms and personality disorder categories. More detailed analysis indicated that associations were again limited to previous consumers who reported ceasing alcohol consumption for health reasons.Conclusions Worse mental health in low alcohol consumers, particularly those who have previously ceased for health reasons, should be taken into account when interpreting associations between moderate (compared with low) alcohol consumption and beneficial health outcomes. © 2010 Cambridge University Press.


Hartveit M.,Health Integrated | Hartveit M.,University of Bergen | Thorsen O.,University of Bergen | Biringer E.,Health Integrated | And 5 more authors.
BMC Health Services Research | Year: 2013

Background: In most Western countries, the referral letter forms the basis for establishing the priority of patients for specialised health care and for the coordination of care between the services. To be able to define the quality of referral letters, the potential impact of the quality on the organisation of care, and to improve the quality of the letters, we need a multidimensional definition of the ideal content. The study's aim was to explore what information is seen as most important and should be included in referral letters from primary care to specialised mental health care to facilitate prioritisation and planning of treatment and follow-up of the patients. Methods. Based on purposive sampling, four mixed discussion groups, which included general practitioners, mental health nurses from primary health care, psychiatrists and psychologists from specialised mental health care, managers and patient representatives, were formed; they were asked to identify the information they considered important in a mental health referral letter. In line with the Delphi technique, the importance of the themes was later individually rated by the participants. The study was conducted within The Western Norway Regional Health Authority. Results: The four groups identified 174 information themes. After excluding themes that were assessed as duplicates, replaceable or less important, 40 themes were suggested, organised in seven units. A set of check-off points of essential information is recommended as an introduction in the referral letter. Conclusion: Compared with general guidelines and guidelines for somatic care, the results of this study suggest that the referral letter to specialised mental health care should have a larger emphasis on the overall treatment plan, on the specific role of specialised health care in the continuum of care, and on patient involvement. Further research should evaluate the validity of these findings for other patient groups in need of integrated care and investigate how the quality of referral letters affects patient-related and organisational outcomes. Trial Registration. Trial Registration number: NCT01374035. © 2013 Hartveit et al.; licensee BioMed Central Ltd.


Hansen A.L.,University of Bergen | Kvale G.,University of Bergen | Stubhaug B.,Section of Mental Health Research | Stubhaug B.,University of Bergen | Thayer J.F.,Ohio State University
Journal of Psychophysiology | Year: 2013

In psychotherapy research, there is a general lack of studies that include objective measurements that provide information about the basic underlying mechanisms involved in behavioral and psychiatric conditions. In this pilot study, we investigated cardiovascular activity and self-reported fatigue in patients with Chronic Fatigue Syndrome (CFS) compared to normal healthy controls who served as a reference group. Furthermore, based on a one-group pre-post design, we investigated whether exposure to a Comprehensive Cognitive Behavior Therapy (CCBT) program resulted in any changes in cardiovascular activity and self-reported fatigue in CFS patients. Overall, 19 female CFS patients and 21 normal healthy controls were included in the study. Cardiovascular activity measurements were heart rate (HR), low frequency/high frequency (LF/HF ratio), and heart rate variability (the root mean of the squared successive differences; rMSSD). Fatigue was measured using the Chalder Fatigue Questionnaire. Analyses of the results indicated that, compared to normal healthy controls, CFS patients were characterized by higher HR and self-reported fatigue prior to exposure to the CCBT. Interestingly, CFS patients showed a significant decrease in LF/HF ratio indicating a shift in sympathovagal balance toward greater vagal activation, and levels of experienced fatigue subsequent to CCBT. © 2012 Federation of European Psychophysiology Societies.


PubMed | Section of Mental Health Research
Type: Journal Article | Journal: Psychological medicine | Year: 2011

The beneficial outcomes associated with moderate compared with low alcohol intake or abstinence may be due to the inclusion of people as low consumers, who have stopped consumption because of poor health. We investigated the association between alcohol abstinence and symptoms of common mental disorder and personality disorder, distinguishing between lifelong abstinence and abstinence following previous consumption.Analyses were based on the British National Survey of Psychiatric Morbidity 2000, which sampled 8580 residents aged 16-74 years. Hazardous drinking (Alcohol Use Disorders Identification Test) was excluded. Symptoms of common mental disorder (depression/anxiety) were identified by the Clinical Interview Schedule. The screening questionnaire of the Structured Clinical Interview for Axis II Personality Disorders was used to identify potential personality disorder. Self-reported alcohol abstinence was divided into lifelong abstinence and previous consumption. Previous consumers were asked why they had stopped. Covariates included socio-economic status, social activity and general health status.After adjustment, alcohol abstinence was associated with both common mental disorder symptoms and any personality disorder, but only for previous consumers, in whom odds ratios were 1.69 (95% CI 1.23-2.32) and 1.45 (95% CI 1.09-1.94). Associations were non-specific, being apparent for most individual mental disorder symptoms and personality disorder categories. More detailed analysis indicated that associations were again limited to previous consumers who reported ceasing alcohol consumption for health reasons.Worse mental health in low alcohol consumers, particularly those who have previously ceased for health reasons, should be taken into account when interpreting associations between moderate (compared with low) alcohol consumption and beneficial health outcomes.

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