Abstract: Abstract Objective: To explore the effect of ever having tried to conceive for more than 12 months on levels of anxiety and depressive symptoms and to investigate if symptom levels of anxiety and depression in infertile women who remain childless, or go on to have children, respectively, differ from symptom levels in mothers without reports of infertility. Methods: Analyses were based on information from 12 584 Norwegian women aged 19-45 years who participated in the North-Trondelag Health Study from 1995 to 1997 and data from the Medical Birth Registry of Norway. Anxiety and depressive symptoms were measured by the Hospital Anxiety and Depression Scale. Results: Having tried to conceive for more than 12 months (ever) was weakly associated with higher levels of depressive symptoms. In the categorical analyses, women with resolved infertility had higher levels of anxiety symptoms (B = 0.25 (95% confidence interval (CI) = 0.04-0.47)) and voluntarily childfree had lower levels of depressive symptoms (B = -0.05 (95% CI = -0.50 to -0.21)) than mothers without infertility. However, women with current primary or current secondary infertility had levels of anxiety and depression not significantly different from mothers without infertility. Conclusion: At the population level, and from a longitudinal perspective, unresolved infertility is less burdensome than findings from studies on women seeking help for infertility would suggest.

Abstract: BACKGROUND: It is well documented that both anxiety and depression are associated with headache, but there is limited knowledge regarding the relation between recurrent primary headaches and symptoms of anxiety and depression as well as behavioral problems among adolescents. Assessment of co-morbid disorders is important in order to improve the management of adolescents with recurrent headaches. Thus the main purpose of the present study was to assess the relationship of recurrent headache with anxiety and depressive symptoms and behavioral problems in a large population based cross-sectional survey among adolescents in Norway. METHODS: A cross-sectional, population-based study was conducted in Norway from 1995 to 1997 (Young-HUNT1). In Young-HUNT1, 4872 adolescents aged 12 to 17 years were interviewed about their headache complaints and completed a comprehensive questionnaire that included assessment of symptoms of anxiety and depression and behavioral problems, i.e. conduct and attention difficulties. RESULTS: In adjusted multivariate analyses among adolescents aged 12-14 years, recurrent headache was associated with symptoms of anxiety and depression (OR: 2.05, 95% CI: 1.61-2.61, p < 0.001), but not with behavioral problems. A significant association with anxiety and depressive symptoms was evident for all headache categories; i.e. migraine, tension-type headache and non-classifiable headache. Among adolescents aged 15-17 years there was a significant association between recurrent headache and symptoms of anxiety and depression (OR: 1.64, 95% CI: 1.39-1.93, p < 0,001) and attention difficulties (OR: 1.25, 95% CI: 1.09-1.44, p =0.001). For migraine there was a significant association with both anxiety and depressive symptoms and attention difficulties, while tension-type headache was significantly associated only with symptoms of anxiety and depression. Non-classifiable headache was associated with attention difficulties and conduct difficulties, but not with anxiety and depressive symptoms. Headache frequency was significantly associated with increasing symptoms scores for anxiety and depressive symptoms as well as attention difficulties, evident for both age groups. CONCLUSIONS: The results from the present study indicate that both anxiety and depressive symptoms and behavioral problems are associated with recurrent headache, and should accordingly be considered a part of the clinical assessment of children and adolescents with headache. Identification of these associated factors and addressing them in interventions may improve headache management.

Abstract: The aim of this paper was to investigate whether psychosocial functioning in adulthood (e.g., friends support, cohabitation, community connectedness and work satisfaction) could be predicted by mental health, subjective well-being, social relations and behavior problems in adolescence, and whether gender was a moderator in these associations. Data were obtained from a major population-based Norwegian study, the Nord-Trondelag Health Study (HUNT), in which 517 men and 819 women completed an extensive self-report questionnaires at baseline (mean age 14.4 years) and at follow-up (mean age 26.9 years). Community connectedness as well as work satisfaction were predicted by subjective well-being. Cohabitation was predicted by male gender and frequency of meeting friends in adolescence, and friends support was predicted by frequency of meeting friends. Gender had a minor effect as a moderator. Frequency of meeting friends and subjective well-being seemed to be the strongest adolescent predictors of psychosocial functioning in young adulthood. These findings may have implications both for prevention and intervention in adolescence, as well as for future research.

Abstract: Objective: Depression constitutes a major health problem for older people, in this study defined as people 65 years of age and older. Previous studies have shown that mental health among older people who live with animals could be improved, but contrary results exist as well. Therefore, the objective of the present population study was to compare the self-rated depression symptoms of both female and male non-pet owners, cat owners, and dog owners. Method: The participants in this cross-sectional population study included 12,093 people between the ages of 65 and 101. One thousand and eighty three participants owned cats and 814 participants owned dogs. Self-rated depression symptoms were measured using HADS-D, the scale of self-administered depression symptoms in HADS (Hospital Anxiety and Depression Scale). Results: The main results showed higher mean values on the HADS-D for cat owners than for both dog and non-pet owners. The latter group rated their depression symptoms the lowest. When dividing the ratings into low- and high-depression symptoms, the logistic regression analysis showed that it was more likely that males who owned cats perceived lower depression symptoms than females who owned cats. No interactions were recognized between pet ownership and subjective general health status, loneliness, or marital status. Conclusions: Our results provide a window into the differences in health factors between older females and males who own cats and dogs in rural areas. Results from population studies like ours might increase the available knowledge base when using cats and dogs in clinical environments such as nursing homes.

Abstract: PURPOSE: To study if physical activity within the recommended level over time was associated with risk of developing depression after the first myocardial infarction in older adults. METHODS: Men (n = 143) and women (n = 46) who had reached the age of 60 years in 2006-2008 who participated in the Nord-Trondelag Health Study (HUNT1, 1984-1986; HUNT2, 1995-1997; HUNT3, 2006-2008) without any mental illness or cardiovascular disease at baseline in HUNT2 and who experienced their first myocardial infarction before HUNT3 were included. Based on the patterns of physical activity from HUNT1 to HUNT2, the sample was divided into 4 groups: persistently inactive, from active to inactive, from inactive to active, and persistently active. The primary outcome, post-myocardial infarction depression symptoms, was measured with the Hospital, Anxiety and Depression Scale in HUNT3. RESULTS: In HUNT3, 11% of participants had depression. After multivariable adjustment, those who were persistently active had significantly lower odds of being depressed (odds ratio 0.28; 95% confidence interval, 0.08-0.98) compared with those who were persistently inactive. Additionally, a significant test for trend (P = .033) of lowering odds of depression was observed across all 4 categories of physical activity patterns at baseline. CONCLUSIONS: In this small sample of initially healthy adults, we observed a long-term protective effect of regular physical activity on the development of depression following myocardial infarction.

Abstract: AIM: The aim was to investigate the associations between perceived social support and depression in a general population in relation to gender and age. BACKGROUND: Social support is seen as one of the social determinants for overall health in the general population. Studies have found higher probability of experiencing depression among people who have a lack of social support; evidence from the general population has been more limited. Subjective perception that support would be available if needed may reduce and prevent depression and unnecessary suffering. DESIGN: A cross-sectional survey with self-reported health was used. METHOD: A total of 40,659 men and women aged 20-89 years living in Nord-Trondelag County of Norway with valid ratings of depression subscale of the Hospital Anxiety and Depression Scale in the The Nord-Trondelag Health Study 3 were used. Logistic regression was used to quantify associations between two types of perceived support (emotional and tangible) and depression. Gender, age and interaction effects were controlled for in the final model. RESULTS: The main finding was that self-rated perceived support was significantly associated with Hospital Anxiety and Depression Scale-defined depression, even after controlling for age and gender; emotional support (OR = 3.14) and tangible support (OR = 2.93). The effects of emotional and tangible support differ between genders. Interaction effects were found for age groups and both emotional and tangible support. CONCLUSION: Self-rated perceived functional social support is associated with Hospital Anxiety and Depression Scale-defined depression. In the group of older people who have a lack of social support, women seem to need more emotional support and men tangible support. RELEVANCE TO CLINICAL PRACTICE: Health care providers should consider the close association between social support and depression in their continuing care, particularly in the older people.

Abstract: AIMS: The nature of the association of depression and anxiety with risk for acute myocardial infarction (AMI) remains unclear. We aimed to study the prospective association of single and recurrent self-reported symptoms of anxiety and depression with a risk of AMI in a large Norwegian population based cohort. METHODS AND RESULTS: In the second wave of the Nord-Trondelag Health Study (HUNT2, 1995-97) baseline data on anxiety and depression symptoms, sociodemographic variables, health status including cardiovascular risk factors and common chronic disorders were registered for 57,953 adult men and women free of cardiovascular disease. The cohort was followed up during a mean (SD) 11.4 (2.9) years for a first AMI from baseline through 2008. A total of 2111 incident AMIs occurred, either identified at hospitals or by the National Cause of Death Registry. The multi-adjusted hazard ratios were 1.31 (95% CI 1.03-1.66) for symptoms of depression and 1.25 (CI 0.99-1.57) for anxiety. Two episodes of mixed symptoms of anxiety and depression (MSAD), reported 10 years apart, increased the risk for AMI by 52% (11-108%). After exclusion of the first 5 years of follow-up, the association of depression symptoms with AMI risk was attenuated. Relative risk for AMI with anxiety symptoms and MSAD weakened when participants with chronic disorders were excluded. CONCLUSION: Self-reported symptoms of depression and anxiety, especially if recurrent, were moderately associated with the risk of incident AMI. We had some indications that these associations might partly reflect reverse causation or confounding from common chronic diseases.

Abstract: OBJECTIVE: The purpose of the present study was to address 1) whether exercise provides protection against new-onset depression and anxiety and 2) if so, the intensity and amount of exercise required to gain protection and, lastly, 3) the mechanisms that underlie any association. METHOD: A “healthy” cohort of 33,908 adults, selected on the basis of having no symptoms of common mental disorder or limiting physical health conditions, was prospectively followed for 11 years. Validated measures of exercise, depression, anxiety, and a range of potential confounding and mediating factors were collected. RESULTS: Undertaking regular leisure-time exercise was associated with reduced incidence of future depression but not anxiety. The majority of this protective effect occurred at low levels of exercise and was observed regardless of intensity. After adjustment for confounders, the population attributable fraction suggests that, assuming the relationship is causal, 12% of future cases of depression could have been prevented if all participants had engaged in at least 1 hour of physical activity each week. The social and physical health benefits of exercise explained a small proportion of the protective effect. Previously proposed biological mechanisms, such as alterations in parasympathetic vagal tone, did not appear to have a role in explaining the protection against depression. CONCLUSIONS: Regular leisure-time exercise of any intensity provides protection against future depression but not anxiety. Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.

Abstract: The aim of this study was to assess the association of chronic pain with different lifestyle factors and psychological symptoms in a large, unselected adolescent population. Pain was evaluated as chronic non-specific pain, chronic multisite pain, and in additional analyses, chronic pain with high disability. The study was performed during 2006 to 2008 in Nord-Trondelag County, Norway. Adolescents aged 13 to 18 years were invited to participate. The response rate was 78%. The final study population consisted of 7,373. Sedentary behavior and pain were associated only in girls. In both sexes, overweight and obesity were associated with increased odds of pain. Whereas both smoking and alcohol intoxication showed strong associations with pain, the associations were attenuated after adjustments for psychosocial factors. Symptoms of anxiety and depression showed the strongest associations with pain (odds ratio 4.1 in girls and 3.7 in boys). The odds of pain increased gradually by number of unfavorable lifestyle factors reported. This study revealed consistent associations between lifestyle factors, anxiety and depression, and chronic pain, including multisite pain and pain with high disability. The consistency across the different pain categories suggests common underlying explanatory mechanisms, and despite the cross-sectional design, the study indicates several modifiable targets in the management of adolescent chronic pain. PERSPECTIVE: This study showed a clear and consistent relation between different lifestyle factors, anxiety and depression, and the pain categories chronic non-specific pain, multisite pain, and also pain with high disability. Independent of causality, it underlines the importance of a broad perspective when studying, preventing, and treating chronic pain in adolescents.

Abstract: AIM: To prospectively examine whether depressive symptoms increase the risk of diabetes and a diabetic foot ulcer. METHODS: The Nord-Trondelag Health Study (HUNT) is a community-based longitudinal study. The Hospital Anxiety and Depression Scale (HADS-D subscale) assessed depressive symptoms. We followed individuals with complete HADS-D data from HUNT2 (1995-97) and assessed whether they reported diabetes with or without a history of diabetic foot ulcer (DFU) in HUNT3 (2006-08) (n=36,031). Logistic regression was used to investigate the effect of depressive symptoms on subsequent development of diabetes and of DFU. RESULTS: Unadjusted odds for reporting diabetes at follow-up was higher among individuals who reported a HADS-D score>/=8 at baseline (OR 1.30 95% CI, 1.07-1.57) than among those reporting a lower score. After adjusting for age, gender and BMI, this association was no longer significant. The odds of developing a DFU was almost two-fold (OR=1.95 95% CI, 1.02-3.74) for those reporting a HADS-D score of 8-10, and 3-fold (OR=3.06 95% CI, 1.24-7.54) for HADS-D scores>/=11, compared to HADS-D scores<8, after adjusting for age, gender and serum glucose. CONCLUSIONS: Symptoms of depression at baseline are associated with an increased risk of a diabetic foot ulcer in a dose response manner during this 11-year follow-up.

Abstract: Antihypertensive drugs have been suggested to modulate symptoms of depression and anxiety. It is disputed whether this is due to the hypertension per se, its treatment, or both. The aim of this study was to investigate these associations in a large population sample. 55,472 participants in the Nord-Trondelag Health Study (HUNT 2, 1995-1997), Norway, who completed the Hospital Anxiety and Depression rating Scale, were divided into 3 groups according to their diastolic blood pressure and antihypertensive treatment status. A cut-off of >/=90 mmHg diastolic blood pressure was used to identify hypertensive status. Differences in anxiety and depression symptom levels in untreated and treated hypertensives (all treatments) versus the normotensive reference group were explained by differences in age and gender distribution in the three groups in this study. However, the receipt of two or more antihypertensive drugs was associated with depressive symptoms alone (OR = 1.40, 95% CI = 1.03-1.90), but not with symptoms of anxiety (OR = 1.14, 95% CI = 0.83-1.57) or mixed anxiety and depression (OR = 1.19, 95% CI = 0.82-1.72) in the fully adjusted model, compared to untreated hypertension. Antihypertensive monotherapy (all agents) nor any single antihypertensive drug class were associated with symptoms of depression, anxiety, or mixed anxiety and depression. There may be a positive association between multi antihypertensive drug use and symptoms of depression, whereas this was not found in persons with symptoms of anxiety or mixed anxiety and depression. This might reflect poor antihypertensive treatment adherence leading to polypharmacy, or other unfavorable health behaviors in people with symptoms of pure depression.

Abstract: Background: A growing body of research suggests that the children of parents with chronic pain are at risk for internalizing symptoms. The mechanisms of such associations have not been as thoroughly examined. The aim of the present study was to investigate whether adolescents' social competence mediates the association between parental chronic pain and offspring internalizing symptoms as well as whether these associations are moderated by adolescent gender. Methods: The current study was based on cross-sectional data from the Nord-Trondelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in 2006-2008. The present sample comprised adolescents who had both parents participating (n=9,681). Structural equation modeling was used for the data analysis. Results: Our results indicated that the association between concurrent maternal and paternal chronic pain and offspring's symptoms of anxiety and depression was partly mediated by low social competence for girls (b(SE)=0.060 [0.030], P=0.043) but not for boys (b(SE)=-0.059 [0.040], P=0.146). This suggests that these associations are moderated by offspring gender. Conclusion: The study extends the existing literature on the possible pathways between parental chronic pain and internalizing symptoms in the offspring. Identifying protective factors in the pathways between parental chronic pain and mental distress in children could guide measures that promote the wellbeing of the child and family of chronic pain sufferers.