Caring for a spouse diagnosed with dementia can be a stressful situation and can put the caregiving partner at risk of loss of mental health and wellbeing. The main aim of this study was to investigate the relationship between dementia and spousal mental health in a population-based sample of married couples older than 55 years of age. The association was investigated for individuals living together with their demented partner, as well as for individuals whose demented partner was living in an institution.
Data on dementia were collected from hospitals and nursing homes in the county of Nord-Tr?ndelag, Norway. These data were combined with data on spousal mental health, which were collected in a population-based health screening: the Nord-Tr?ndelag Health Study (HUNT). Of 6,951 participating couples (>55 years), 131 included one partner that had been diagnosed with dementia.
Our results indicate that after adjustment for covariates, having a partner with dementia is associated with lower levels of life satisfaction and more symptoms of anxiety and depression than reported by spouses of elderly individuals without dementia. Spouses living together with a partner diagnosed with dementia experienced moderately lower levels of life satisfaction (0.35 standard deviation [SD]) and more symptoms of depression (0.38 SD) and anxiety (0.23 SD) than did their non-caregiving counterparts. Having a partner with dementia that resided in a nursing home was associated with clearly lower life satisfaction. Compared with non-caregivers, these spouses reported lower levels of life satisfaction (1.16 SD), and also more symptoms of depression (0.38 SD), and more symptoms of anxiety (0.42 SD).
Having a partner with dementia is associated with loss of mental health and reduced life satisfaction. The risk of adverse mental health outcomes is greatest after the partner's nursing home admission.
Cites: Int J Epidemiol. 2013 Aug;42(4):968-7722879362
Longitudinal research on caregiver burden related to mental disorders based on representative samples is scarce. Previous results on the development of burden over time are inconsistent. This article aims to establish whether change in mental disorder status in the index persons predicts subjective burden in their spouses in terms of changed mental health over a period of 11 years. We compared change in spousal mental health between four groups from a Norwegian population based sample of 9144 couples, in which the index persons suffered from mental disorder at the first, second, both, or none of the two measurement times. Mental disorder was defined by a high score on a measure of global mental health combined with self reported impaired functioning due to mental health problems. Spouses of index persons who suffered from mental disorder at the second but not the first measurement time reported moderately impaired mental health, but those spouses with few friends reported a more severe impairment. Spousal mental health in the other groups did not change significantly. Effect sizes were moderate. The findings suggest that spouses of mentally disordered individuals in general experience only moderate levels of burden, and that the transition into a caregiving role is the period in which spouses are vulnerable to negative effects on their mental health. The results point to the treatment of mental health problems in couples as a supplement or alternative to individual treatment.
Some previous studies indicate that parental hearing loss may have negative consequences in the parent-child relationship. However, most of these studies are qualitative or have apparent methodological shortcomings.
This study is the first of its kind conducted in a large population-based sample with audiometrically measured hearing loss aimed at investigating the extent to which parental hearing loss affects adolescents' mental health.
Questionnaires were administered to the adult (>19 years) and adolescent (age 13-19 years) population of Nord-Trøndelag county, Norway (1995-97), which collected information on mental and somatic health, including hearing loss. For adults participating in the study, pure tone audiometry tests were also administered. In total, 4047 fathers and 4785 mothers with self-reported hearing loss data were identified. The corresponding numbers with measured hearing loss data included 4079 fathers and 4861 mothers. The associations between the degrees of self-reported or measured parental hearing loss and the mental health of their adolescent, measured by Hopkins Symptom Check List (SCL) 5, were estimated using generalized estimating equations. After adjusting for several covariates, the mental health symptoms of adolescents were compared by parental hearing loss (i.e., with versus without hearing loss).
Adolescents whose mothers had severe measured or self-reported hearing loss had significantly worse mental health than their counterparts whose mothers did not have a hearing loss. No corresponding effects were found in the adolescents whose mothers had only a slight/moderate hearing loss, neither measured nor self-reported. Paternal slight/moderate self-reported hearing loss was associated with a small significant reduction of mental health in the adolescents, although attenuated when adjusting for paternal distress. No significant effects were detected in the adolescents whose fathers had measured hearing loss.
Severe maternal hearing loss is associated with significantly increased adolescent distress.
**This is a prospective Norwegian study of a group of adolescents with an experience of parental divorce or separation (n=413) and a comparison group without this experience (n=1758). Mean age at T1 was 14.4 years and mean age at T2 was 18.4 years. Parental divorce was prospectively associated with a relative change in anxiety and depression, subjective well-being, self-esteem, and school problems. Considering boys separately, parental divorce was prospectively associated only with school problems. Among the girls, divorce was prospectively associated with all variables. The effect of divorce on relative change was partially mediated by paternal absence.
Concerns about the general psychological impact of genetic testing have been raised. In the Environmental Triggers of Type 1 Diabetes (MIDIA) study, genetic testing was performed for HLA-conferred type 1 diabetes susceptibility among Norwegian newborns. The present study assessed whether mothers of children who test positively suffer from poorer mental health and well-being after receiving genetic risk information about their children.
The study was based on questionnaire data from the Norwegian Mother and Child Cohort (MoBa) study conducted by the Norwegian Institute of Public Health. Many of the mothers in the MoBa study also took part in the MIDIA study, in which their newborn children were tested for HLA-conferred genetic susceptibility for type 1 diabetes. We used MoBa questionnaire data from the 30th week of pregnancy (baseline) and 6 months post-partum (3-3.5 months after disclosure of test results). We measured maternal symptoms of anxiety and depression (SCL-8), maternal self-esteem (RSES), and satisfaction with life (SWLS). The mothers also reported whether they were seriously worried about their child 6 months post-partum. We compared questionnaire data from mothers who had received information about having a newborn with high genetic risk for type 1 diabetes (N = 166) with data from mothers who were informed that their baby did not have a high-risk genotype (N = 7224). The association between genetic risk information and maternal mental health was analysed using multiple linear regression analysis, controlling for baseline mental health scores.
Information on genetic risk in newborns was found to have no significant impact on maternal symptoms of anxiety and depression (p = 0.9), self-esteem (p = 0.2), satisfaction with life (p = 0.2), or serious worry about their child (OR = 0.98, 95% CI 0.64-1.48). Mental health before birth was strongly associated with mental health after birth. In addition, an increased risk of maternal worry was found if the mother herself had type 1 diabetes (OR = 2.39, 95% CI 1.2-4.78).
This study did not find evidence supporting the notion that genetic risk information about newborns has a negative impact on the mental health of Norwegian mothers.
OBJECTIVE: To estimate effects of hearing loss on symptoms of anxiety, depression, self-esteem, and subjective well-being. METHODS: A normal population sample of 50,398 subjects, age 20 to 101 years, in Nord-Trøndelag completed audiometric tests and questionnaires. The association between hearing loss and mental health was assessed with multiple linear regression analyses, controlling for social background variables. RESULTS: Effects of hearing loss were mostly significant, but moderate in strength. Effects were stronger among young (20-44 years) and middle-aged (45-64 years) than among older (65+ years) people. Loss of high or middle frequency hearing had almost no impact on mental health measures if low frequency hearing was not also impaired. The strongest observed effect was a change of 0.1 SD in mental health per 10 dB hearing loss. CONCLUSIONS: Hearing loss is associated with substantially reduced mental health ratings among some young and middle-aged persons, but usually does not affect mental health much among older persons.
Divorce is associated with mental health problems, and heavy drinking is related to higher risk of divorce. Less is known about the effects of divorce in couples where one or both drinks heavily. There are, however, reasons to expect different consequences of divorce in heavy risk using couples compared to other couples. Spouses of abusers may experience the divorce as a relief, whereas abusers may find it extra difficult to be left single. The aim of the study is to compare the effect of divorce on mental health in heavy drinking couples to the effect in couples who drink less.
Registry data were matched with data from the Nord-Tr?ndelag Health Study (HUNT 1 (T1) and 2 (T2)), enabling longitudinal analyses of approximately 11,000 couples. Interaction terms between 1) alcohol use on T1 and divorce between T1 and T2 (11?year time lag), and 2) alcohol use on T1 and time since divorce at T2 for all divorced couples were tested to examine changes in mental health between T1 and T2 for a) spouses of high-risk compared to low-risk users, and b) high-risk compared to low-risk users themselves. Data were analyzed using multivariate analysis of variance.
There was a general effect of divorce on change in mental health between T1 and T2. We observed a significantly stronger worsening in mental health in female high-risk users and their spouses than in divorced low-risk users and their spouses. The results also suggest that the strain after divorce lasts longer in women with a high alcohol consumption and their spouses.
Divorce seems to affect couples where one or both drink heavily more than couples with a low consumption. Also there was some evidence of a slower healing of mental health problems after divorce in alcohol exposed couples than in other couples. The results only reached significance for female high consumers and their spouses, but due to limited statistical power, safe conclusions about gender specific effects cannot be drawn.
Cites: Drug Alcohol Depend. 2012 Apr 1;122(1-2):135-4122015176
A great number of questionnaires and instruments have been developed in order to measure psychological distress/mental health problems in populations. The Survey of Level of Living in 1998 conducted by Statistics Norway used both Hopkins Symptom Checklist (SCL-25) and the Short Form 36 (SF-36), including the five-item mental health index (MHI-5). Five-item and 10-item versions of the SCL-25 have also been used in Norwegian surveys. The purpose of this study was to investigate the correlation between the various instruments, and to assess and to compare psychometric characteristics. A random sample of 9735 subjects over 15 years of age drawn from the Norwegian population received a questionnaire about their health containing SCL-25 and SF-36. Response rate was 71.9%. Reliability of the SCLs and MHI-5 were assessed by Cronbach alpha. The scores from full and abbreviated instruments were compared regarding possible instrument-specific effects of gender, age and level of education. The correlations between the instruments were calculated. The capacity of the various instruments to identify cases was assessed in terms of sensitivity, specificity, predictive values, receiver operating characteristics (ROC) and area under the curve (AUC). The reliabilities were high (Cronbach alpha>0.8). All instruments showed a significant difference in the mean scores for men and women. The correlation between the various versions of SCL ranged from 0.91 to 0.97. The correlation between the MHI-5 and the SCLs ranged from -0.76 to -0.78. The prevalence rate was 11.1% for SCL-25 scores above 1.75 and 9.7% for scores below 56 in MHI-5. AUC values indicated good screening accordance between the measures (AUC>0.92). The results suggest that the shorter versions of SCL perform almost as well as the full version. The corresponding cut-off points to the conventional 1.75 for SCL-25 are 1.85 for SCL-10 and 2.0 for SCL-5. MHI-5 correlates highly with the SCL and the AUC indicate that the instruments might replace each other in population surveys, at least when considering depression. An operational advantage of the MHI-5 over the SCL instruments is that it has been widely used not only in surveys of mental health, but also in surveys of general health.
To assess how upper limb amputation affects mental health and life satisfaction.
Cross-sectional study comparing the mental health and perceived satisfaction with life among adult acquired major upper limb amputees in Norway with a control group drawn from the Norwegian general population. The scales used were the Satisfaction With Life Scale (SWLS) and the Hopkins Symptom Check List 25-item (SCL-25). The groups were compared using multiple linear regression analyses.
The amputees scored significantly lower on life satisfaction than the control group. A tendency to poorer mental health in the amputee group was observed, but there was no clear evidence of such a difference. The amputation effect on life satisfaction seemed to be mediated mainly by changes in occupational status and by the occurrence of short- or long-term complications related to the amputation.
Our findings imply that rehabilitation of upper limb amputees should emphasise facilitating return to work as well as the prevention of short- and long-term complications, and that this will be of importance not only for the amputees' physical function, but for the maintenance of acceptable life satisfaction. Further studies on the effect of upper limb amputation on mental health are recommended.
BACKGROUND: Several studies have shown that children who are relatively young within a school year are at greater risk for poorer school performance compared with their older peers. One study also reported that relative age within a school year is an independent risk factor for emotional and behavioral problems. The objective of this study was to test the hypothesis that relatively younger adolescents in the multiethnic population of Oslo have poorer school performance and more mental health problems than their relatively older classmates within the same school year. METHODS: This population-based cross-sectional study included all 10th-grade pupils enrolled in 2000 and 2001 in the city of Oslo. The participation rate was 88%. Of the 6,752 pupils in the study sample, 25% had a non-Norwegian background. Mental health problems were quantified using the abbreviated versions of Symptom Check List-25 (SCL-10) and the Strength and Difficulties Questionnaire (SDQ). Information on school performances and mental health problems were self-reported. We controlled for confounding factors including parental educational level, social support, gender, and ethnicity. RESULTS: The youngest one-third of pupils had significantly lower average school grades than the middle one-third and oldest one-third of their classmates (p
The association between mental distress and divorce is well established in the literature. Explanations are commonly classified within two different frameworks; social selection (mentally distressed people are selected out of marriage) and social causation (divorce causes mental distress). Despite a relatively large body of literature on this subject, selection effects are somewhat less studied, and research based on data from both spouses is scarce. The purpose of the present study is to investigate selection effects both at the individual level and the couple level.
The current study is based on couple-level data from a Norwegian representative sample including 20,233 couples. Long-term selection effects were tested for by means of Cox proportional hazard models, using mental distress in both partners at baseline as predictors of divorce the next 16 years. Three identical sets of analyses were run. The first included the total sample, whereas the second and third excluded couples who divorced within the first 4 or 8 years after baseline, respectively. An interaction term between mental distress in husband and in wife was specified and tested.
Hazard of divorce was significantly higher in couples with one mentally distressed partner than in couples with no mental distress in all analyses. There was also a significant interaction effect showing that the hazard of divorce for couples with two mentally distressed partners was higher than for couples with one mentally distressed partner, but lower than what could be expected from the combined main effects of two mentally distressed partners.
Our results suggest that mentally distressed individuals are selected out of marriage. We also found support for a couple-level effect in which spouse similarity in mental distress to a certain degree seems to protect against divorce.
Cites: Ann Epidemiol. 2000 May;10(4):224-3810854957
Most people in industrialized societies grow up in core (parents only) families with few if any siblings. Based on an evolutionary perspective, it may be argued that this environment reflects a mismatch, in that the tribal setting offered a larger number of close affiliates. The present project examined whether this mismatch may have a negative impact on mental health.
We used data from the Norwegian Mother and Child Cohort Study (MoBa), which includes 114 500 children. The mothers were recruited during pregnancy and followed up with questionnaires as the infants grew older. Correlates between number and type of people living in the household and questions probing mental health were corrected for likely confounders.
The number of household members correlated with scores on good mental health at all ages tested (3, 5 and 8 years). The effects were distinct, highly significant, and present regardless of how mental issues were scored. The outcome could be attributed to having older siblings, rather than adults beyond parents. The more siblings, and the closer in age, the more pronounced was the effect. Living with a single mother did not make any difference compared to two parents. Girls were slightly more responsive to the presence of siblings than boys. Household pets did not have any appreciable impact.
A large household is associated with fewer mental problems in children.
Researchers generally agree that mental disorder represents a burden to the family. The present study concerns the subjective burden of living with a person with mental disorder, more specifically the association between mental disorder in the index person and subjective well-being and symptoms of anxiety and depression in the spouse.
Data were obtained from questionnaires administered to the adult population of Nord-Tr?ndelag County, Norway during the period 1995-1997. The present study is based on a subsample where 9,740 couples were identified. Subjective burden in spouses of persons with mental disorder was compared with subjective burden in spouses of persons without mental disorder, using analysis of variance (ANOVA). All analyses were stratified by sex.
Adjusting for several covariates, spouses of persons with mental disorder scored significantly lower on subjective well-being and significantly higher on symptoms of anxiety and depression compared to spouses of index persons without mental disorder. Although highly significant, the effect sizes were moderate, corresponding to a difference in standard deviations ranging from .34 - .51.
Our study supports the notion that there is an association between mental disorder in one partner and subjective burden in the spouse, but not to the same extent that have been reported in earlier studies, as our results do not indicate that a large proportion of the spouses reach a symptom level of anxiety and depression that reflects clinical mental disorder.
It is a widely held notion that alcohol abuse is related to mental distress in the spouse. Research has substantiated this notion by showing a tendency for spouses of alcohol abusers to experience more mental distress than spouses of non-abusers. However, the picture seems to be more complex, as some results do not show a significant effect or even less mental distress among spouses of alcohol abusers with the highest alcohol consumption. The present study investigates the association between spousal mental distress and both a high consumption of alcohol and having experienced alcohol related problems.
Norwegian population-based questionnaire data from the Nord-Trøndelag Health Study (HUNT 2) were analyzed. In total 11,584 couples were eligible for analysis. Alcohol consumption was measured by numerical indicators of alcohol amount and frequency of drinking, whereas alcohol-related problems (i.e. having been criticized for excessive drinking) were measured by the CAGE Alcohol Screening Questionnaire. Multivariate hierarchical regression analyses were performed.
Results revealed that alcohol consumption was significantly associated with a decrease in spousal mental distress, whereas alcohol-related problems were associated with an increase in spousal mental distress when adjusted for each other. Interaction effects indicated that couples discordant for drinking problems experienced more mental distress than spouses concordant for drinking problems.
The results of our study indicate that alcohol-related problems constitute a clear risk factor for spousal mental distress. On the other hand, a high consumption of alcohol per se was related to lower levels of spousal mental distress, after adjusting for the alcohol-related problems perceived by the alcohol consumer him/herself. All effect sizes were small, but the trends were clear, challenging the notion that a high consumption of alcohol is exclusively and under all circumstances negative for the spouse.
Previous research has documented that people with diabetes report lower psychological well-being than do people with no reported disease. In recent years, new treatment regimens for diabetes have been introduced, including improved insulin and tablet treatment, easier blood sugar tests, and transfer of responsibility from doctor to patient. Have these improved methods for controlling diabetes resulted in enhanced psychological well-being for this group of patients? In this paper, we analyze changes in psychological well-being between 1984-1986 and 1995-1997 among diabetic patients. On these two occasions, the entire adult population of one county in Norway was invited to a health screening (the Nord-Tr?ndelag Health Studies, HUNT 1 and HUNT 2). Participants reached 77,224 and 65,599 persons, respectively (90.7% in HUNT 1 and 71.0% in HUNT 2). The participants responded to questionnaires, including questions on several diseases and impairments, as well as self-assessed health and psychological well-being. People with diabetes reported significantly lower well-being than people with no reported diabetes in HUNT 1 as well as in HUNT 2. However, the relationship between diabetes and well-being was significantly weaker in HUNT 2 than in HUNT 1. Self-reported Subjective health, the feeling of being strong and fit, the use of Tranquilizers, and Psychological distress had improved between the two surveys, for people with diabetes compared to people with no reported diabetes. Other outcome variables - Calmness, Cheerfulness, and Life satisfaction - were only weakly related to diabetes, and the relationship did not change significantly from HUNT 1 to HUNT 2.
The degree to which parental alcohol abuse is a risk factor for offspring mental distress is unclear, due to conflicting results of previous research. The inconsistencies in previous findings may be related to sample characteristics and lack of control of confounding or moderating factors. One such factor may be the gender of the abusing parent. Also, other factors, such as parental mental health, divorce, adolescent social network, school functioning or self-esteem, may impact the outcome. This study examines the impact of maternal and paternal alcohol abuse on adolescent mental distress, including potentially confounding, mediating or moderating effects of various variables.
Data from the Nord-Trøndelag Health Study (HUNT), a Norwegian population based health survey, from 4012 offspring and their parents were analyzed. Parental alcohol abuse was measured by numerical consumption indicators and CAGE, whereas offspring mental distress was measured by SCL-5, an abbreviated instrument tapping symptoms of anxiety and depression. Statistical method was analysis of variance.
Maternal alcohol abuse was related to offspring mental distress, whereas no effect could be shown of paternal alcohol abuse. Effects of maternal alcohol abuse was partly mediated by parental mental distress, offspring social network and school functioning. However, all effects were relatively small.
The results indicate graver consequences for offspring of alcohol abusing mothers compared to offspring of alcohol abusing fathers. However, small effect sizes suggest that adolescent offspring of alcohol abusing parents in general manage quite well.
To investigate to what degree alcohol use and mental distress are associated with non-response in a population-based health study.
From 1995 to 1997, 91,488 persons were invited to take part in a health study at Nord-Trøndelag, Norway, and the response rate was 69.2%. Demographics were available for everyone. Survey answers from a previous survey were available for most of the participants and a majority of non-participants. In addition, the survey responses from spouses and children of the invitees were used to predict participation in the aforementioned study. Crude and adjusted ORs for a number of predictors, among these alcohol consumption and mental distress, are reported.
Both heavy drinkers (OR = 1.27) and abstainers (OR = 1.64) had a higher probability of dropping out in comparison to people who usually do not drink. High levels of mental distress (OR = 1.84) also predicted attrition.
Alcohol use and mental distress are moderately associated with non-response, though probably not a major cause, as controlling for other variables weakened the associations. Nevertheless, the moderate but clear underrepresentation at the crude level of people with high alcohol consumption, abstainers and people with poor mental health should be taken into consideration when interpreting results from health surveys.
Cites: Twin Res. 2001 Apr;4(2):73-8011665339
Cites: Am J Epidemiol. 2010 Dec 1;172(11):1306-1420843863
The Norwegian Institute of Public Health in Oslo has an ongoing program of twin research using population-based cohorts of twins. The current database includes information on twins identified through the Medical Birth Registry of Norway and born from 1967-1979, altogether 15,370 twins. This is a longitudinal study with a cohort sequential design whereby new cohorts are recruited into the study at 5-6 year intervals. Sub-samples of these twins have participated in questionnaire studies and clinical assessment sub-projects. These projects include national and international collaborations. Our primary areas of interest include mental health and psychological well-being, obesity, asthma and allergies, health behaviors and health perceptions, comorbidity, and perinatal influences on health outcomes. This paper provides a brief overview of the data, sample, and the various research projects associated with this twin program of research.
Low socioeconomic status (SES), indicated by low income and education, has consistently been found to be a strong predictor of sick leave. Several possible pathways from SES to sick leave have been described in previous literature, but there are also evidence indicating that the association can be confounded by common underlying factors. This study utilizes a population-based sample of employed young adult twins to estimate (i) the degree to which education and income are prospectively related to sick leave granted for mental, somatic, and any disorder, and (ii) whether these associations are confounded by familial factors.
Registry data on educational attainment and income at age 30 and subsequent sick leave were available for 6,103 employed young adult twins, among which there were 2,024 complete twin pairs. The average follow-up time was 6.57?years. Individual-level associations and fixed effects within twin pairs were estimated.
Low education and income were associated with sick leave granted for both mental and somatic disorders, and with sick leave granted for any disorder. Associations were attenuated within dizygotic twin pairs and reduced to non-significance within monozygotic twin pairs, suggesting influence of familial factors on the associations between SES and sick leave.
Low SES is associated with a higher level of sick leave granted for both mental and somatic disorders among young adults, but these associations are confounded by factors that are common to co-twins. Education and income are therefore not likely to strongly affect sick leave in young adulthood.
Cites: PLoS One. 2011;6(8):e2314321850258
Cites: Proc Natl Acad Sci U S A. 2011 Feb 15;108(7):2693-821262822
Studies of caregiver burden and somatic illness tend to be based on relatively small, clinical samples. Longitudinal, population based studies on this topic are still scarce and little is known about the long-term impact of partner illness on spousal mental health in the general population. In this study we investigate whether spouses of partners who either have become somatically ill or cured from illness in an 11?year period - or who have long-term illness - have different mental health scores compared to spouses of healthy partners.
Approximately 9000 couples with valid self-report data on a Global Mental Health (GMH) scale and somatic illness status were identified. The diagnoses stroke, angina pectoris, myocardial infarction and severe physical disability, were transformed into a dichotomous 'any illness'-scale, and also investigated separately. Analyses of variance (ANOVA) stratified by sex were conducted with spousal GMH score at follow-up (1995-97, T2) as the outcome variable, adjusting for spousal GMH score at baseline (1984-86, T1) and several covariates.
Results showed that male and female spouses whose partners had become somatically ill since T1 had significantly poorer mental health than partners in the reference category, comprising couples healthy at both time points. Further, female spouses of partners who had recovered from illness since T1 had significantly better mental health than controls. Of the somatic conditions, physical disability had the most significant contribution on spousal GMH, for both sexes, in addition to stroke on male spouses' GMH. The effect sizes were small. Some of the loss of spousal mental health seems to be mediated by the ill persons' psychological distress.
The occurrence of partner illness during the follow-up period affect the mental health of spouses negatively, while partner recovery appeared to be associated with improved mental health scores for female spouses. Of the measured conditions, physical disability had the largest impact on spousal distress, but for some conditions the distress of the ill person mediated much of the loss of mental health among spouses.
Cites: Am J Public Health. 2002 Aug;92(8):1305-1112144989