Health-related behaviors during adolescence and subsequent anxiety and depression: the HUNT study

Abstract Background Evidence on the predictors of common mental disorders using nationwide health registries are scarce in Norway. Identifying modifiable behaviours affecting mental health across the lifespan is paramount to develop tailored strategies to tackle mental illnesses. The aim of this study was to identify patterns of health-related behaviours in adolescence and their influence on anxiety and/or depression in adulthood. Methods This was a prospective study based on data from the Trøndelag Health Study (HUNT) and health register data (N = 2061). Patterns of health-related behaviours were assessed according to physical activity, consumption of wholegrain bread, fish, fruit, vegetables, and sugar sweetened beverages and insomnia. Participant’s use of healthcare system for anxiety and/or depression was recorded at least once in the health registries. The patterns of health-related behaviors were identified through latent class analysis. Multivariable logistic regression was used to test the association between patterns of health-related behaviors and depression or/and anxiety. Results Four classes of health-related behaviors were identified: class 1 (15.2%), class 2 (36.0%), class 3 (24.2%), class 4 (24.6%). Adolescents with unhealthy behaviors (classes 1, 2 and 3) had 82%, 34% and 84% higher odds of depression and/or anxiety during adolescence and early adulthood than those from the healthy-related behaviors group (class 4). Conclusions Our findings suggest that health-related behaviors are clustered among Norwegian adolescents. There was a meaningful association of the three patterns of unhealthy behaviors during adolescence with anxiety and depression in adulthood. Population strategies and policies aiming to tackle unhealthy behaviors among adolescents can positively impact on adult’s mental health. Key messages • Improving healthy behaviors during adolescence may reduce the burden of mental illness in adulthood. • Population strategies and policies aiming to tackle unhealthy behaviors among adolescents can positively impact on adult’s mental health.

Background: COVID-19 as a public mental health emergency has exacerbated existing mental health inequalities. The UK government invited local authorities with areas of high deprivation to apply for a year of funding, in order to address the mental health impacts of COVID-19 and incentivize investment in prevention and promotion interventions for better mental health. South Tyneside Council in North East England made a successful bid to the Better Mental Health Fund (BMHF), and distributed grants to 7 organisations delivering 13 programs. A qualitative evaluation of these programs aimed to answer the following questions: 1. How were the funded programs implemented? 2. What difference did they make to local beneficiaries? 3. How might these programs and their impacts be sustained into the future? 4. Has the BMHF led to any wider impacts on organisations and local communities? Methods: In-depth interviews with individuals, pairs and groups were conducted online or in person with service providers and beneficiaries. Non-verbatim transcripts were made from recordings, checked with verbatim transcripts from Teams and Zoom, and analyzed thematically to generate a coding frame. Throughout the analysis, comparisons were made between organizations and programs. Results: Fifteen interviews involving 22 participants lasting up to an hour each were conducted. The main themes identified as impactful were 1) community approaches based on supportive and good relationships between the local authority public health lead and participating organizations (mainly voluntary agencies), enabling 2) capacity-building for mental health resilience and 3) community empowerment. This was despite the short turnaround of the grant application process, limited time to deliver on targets, and anxieties about future sustainability. Conclusions: Short-term funding can build capacity in mental health resilience in deprived areas if administered by public health leaders who relate well with provider organizations. Key messages: Public health leaders who relate well with provider organizations are key drivers of community health promotion strategies that include mental health capacity building. Qualitative methods used in evaluations can inform public health commissioning by capturing the benefits and challenges of short-term funding for interventions promoting community mental health.

Background:
We are facing a growing popularity of gambling, partly due to the rapid rise of internet related technologies. This growth has been linked to a considerable increase in problem gambling and gambling disorder, which has been an established nonsubstance addiction. The aim of our study was to assess the prevalence rate of gambling disorder among the Slovenian population.

Methods:
National Survey on the Use of Tobacco, Alcohol and Other Drugs was conducted in 2018 on a nationally representative sample (n = 16,000; age: 15-64 years), using mixed-mode data collection (CAWI and CAPI). Responses were obtained from 9,161 respondents, of those 18.4% (n = 1,686) reported to have gambled in the last 12 months (i.e. gamblers). Gambling disorder symptoms were assessed using Berlin Inventory of Gambling Behavior -Screening, consisting of 14 items with a yes/no response option, which measure 9 gambling disorder criteria (DSM-V). Participants who reported at least 5 out of 9 gambling disorder criteria were classified as disordered.
Results: Data shows that 4.3% of Slovenian gamblers met the criteria for gambling disorder. Significantly higher shares were observed among men (5.9%; compared to 1.2% of women) and among younger generations (highest shares among 15-19 year olds (19.4%) and 20-24 year olds (14.5%)). The same goes for money spent for gambling. Namely, males (4.4% of men; compared to 0.6% of women) and younger generations (highest shares among 20-24 year olds (9.2%) and 30-34 year-olds (6.9%)) were more likely to spend more than 100 EUR in a day for gambling.

Conclusions:
Data obtained in the present study indicates the extent of gambling disorder symptomatology and highlights key demographic groups with risk for gambling disorder. These findings are consistent with previous comparable studies and provide a basis for tailored public health measures in Slovenia with an emphasis on early intervention. Key messages: 4.3% of Slovenian residents, who engaged in gambling in the last 12 months met the criteria for gambling disorder. Males and younger generations were more likely to report gambling disorder symptoms and spent more money on gambling. The data shows the need for tailored public health measures.

Background:
Evidence on the predictors of common mental disorders using nationwide health registries are scarce in Norway. Identifying modifiable behaviours affecting mental health across the lifespan is paramount to develop tailored strategies to tackle mental illnesses. The aim of this study was to identify patterns of health-related behaviours in adolescence and their influence on anxiety and/or depression in adulthood.

Methods:
This was a prospective study based on data from the Trøndelag Health Study (HUNT) and health register data (N = 2061). Patterns of health-related behaviours were assessed according to physical activity, consumption of wholegrain bread, fish, fruit, vegetables, and sugar sweetened beverages and insomnia. Participant's use of healthcare system for anxiety and/or depression was recorded at least once in the health registries. The patterns of health-related behaviors were identified through latent class analysis. Multivariable logistic regression was used to test the association between patterns of healthrelated behaviors and depression or/and anxiety.

Conclusions:
Our findings suggest that health-related behaviors are clustered among Norwegian adolescents. There was a meaningful association of the three patterns of unhealthy behaviors during adolescence with anxiety and depression in adulthood. Population strategies and policies aiming to tackle unhealthy behaviors among adolescents can positively impact on adult's mental health.

Background:
Reporting a case of suicide on a newspaper could lead to an emulation effect (Werther effect). It is important to report suicide cases by following specific recommendations implemented by World Health Organization (WHO). This study aimed to analyze articles published on Italian newspapers to quantify the adherence to the WHO recommendations in suicide report.

Methods:
All the articles published in the three most important Italian newspapers from June 2019 to May 2020 that described one or more cases of suicide were included. Two researchers analyzed all the articles through an ad-hoc checklist, constructed on the basis of the WHO recommendations, that included 18 ''negative'' items (e.g. ''presence of suicide-related words in the title'') and nine ''positive'' items (e.g. ''the article reports the contacts of a suicide-prevention hotline''). For each negative item a ''-1'' point, and for each positive item a + 1 point, was assigned. Multivariable linear regressions were performed to identify factors related with a lower adherence to the WHO recommendations and with higher social engagement of the articles.

Results:
A total of 110 articles were analyzed. In the 73% of the cases, the individual was male. The 14.5% of the suicide cases were homicide-suicide, while 9% were femicide-suicide. The median score of the checklist was -6 (IQR 3). Only 5% of the articles had at least one positive item. The word ''suicide'' (or related words) were present in 90% of the titles. Multivariable analyses showed that female suicides were associated with a higher score of the checklist (coeff 0.816, p = 0.039). No correlation was retrieved between the score of the checklist and the social media engagement of the articles included.

Conclusions:
Italian newspapers do not follow WHO recommendations on how to report suicide cases, leading to a potential emulation effect. Public health professionals should raise decision makers' and journalists' awareness about the importance of these recommendations.

Background:
Suicide is an important medical and social problem responsible for nearly one million deaths per year globally. However, distal and proximal risk factors for suicide, expect being mentally diagnosed, are not enough studied. The aim of the study was to analyze the dynamics, structure, socio-demographic and clinical characteristics of all suicides committed by persons with mental disorder for 10-year period (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) in Pleven district.

Methods:
Retrospective analysis of medical records of all mentally ill persons who committed suicide was done. Data were extracted from the databases of all in-and outpatient mental health centers in the region. Data processing was performed by IBM SPSS Statistics v.25. Statistical associations between a number of socio-demographic and clinical characteristics and the age of suicide victims was studied by dispersion analysis and Mann-Whitney test. Statistical significance was set at p 0.05.

Results:
Among all 281 registered suicide cases during the studied period, 77 (28%) were with mental disorders. The most common were mood disorders (44%), followed by schizophrenia, anxiety disorders, substance abuse disorders and organic mental conditions. The mean age of all suicides was 55.62 years; significantly lower in males than in females (p = 0.042); lower in divorced or never married/single living persons compared to married or who had lived with a partner (F (2.74) = 17.682, p < 0.001]; the lowest in patients with schizophrenia (44.62 years), and the highest in organic disorders (66.83 years). Higher educational degree was associated with lower age of suicide (U = 3.713, p < 0.01) and the earlier age of onset of the psychiatric disorder (r = 0.754, p < 0.001). Most of the suicide cases had occurred in March and September. Tuesdays and Fridays were most suicidal.

Conclusions:
Severe mental disorders are major risk factors for suicide with the additional contribution of certain socio-demographic and disease related characteristics.
Key messages: Suicide monitoring should be constant in all patients with chronic and severe mental disorders. Suicide registration in Bulgaria needs to be improved in terms of collecting sufficient and reliable information about the mental health of suicide victims.