Omid Vakili Ebrahimi

• Syvertsen, Andre; Ebrahimi, Omid Vakili; Sagoe, Dominic; Kristensen, Joakim Hellumbråten & Pallesen, Ståle (2026). Undirected and directed networks of problem gambling: Follow the money trail. European psychiatry. ISSN 0924-9338. 69(1). doi: 10.1192/j.eurpsy.2026.12261. Full text in Research Archive Show summary

  Background: Psychometric network analysis offers a granular understanding of problem gambling (PG) by modeling individual symptoms within an interconnected system. Identifying central symptoms can help explain symptom co-occurrence and core symptoms relevant for escalating severity. Methods: We estimated undirected cross-sectional and directed cross-lagged network models based on four representative Norwegian population surveys (2013, 2015, 2019, and 2022; age range 16–74) and assessed network stability, accuracy, and generalizability. Cross-sectional samples ranged from n = 3,232 to 6,034 (47–50% women) and cross-lagged samples included n = 3,043 (2013–2015, 50% women) and n = 2,749 (2019–2022, 47% women). PG symptoms were measured with the Problem Gambling Severity Index alongside self-reported gambling expenditure. Results: Within undirected networks, financial problems showed the strongest strength centrality and these networks showed strong generalizability, including the 2019 and 2022 surveys per Network Comparison Test (p = .65), edge presence (φ = .79), and edge weight (r = .85) correlations. Within directed networks, borrowing money had the strongest association with symptoms at follow-up (out-strength), while guilt at follow-up was most strongly predicted by other symptoms (in-strength). Generalizability between the 2013–2015 and 2019–2022 networks was inconclusive, with low correlation in edge presence (φ = .08) and high correlation in edge weights (r = .74). Conclusions: Financial problems and borrowing money emerged as the most central PG symptoms in undirected and directed networks, respectively. Following further investigation, these symptoms may act as informative targets for screening, early intervention, and harm-reduction policy.

• Bjørndal, Ludvig Daae; Nes, Ragnhild Bang; Ebrahimi, Omid Vakili; Teulings, Irene Johanna Elisabeth & Røysamb, Espen (2026). Social processes in well-being (SoWell): A survey and ecological momentary assessment twin study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948261488979.
• Bridger, Emma K.; Maltby, John; Fried, Eiko I.; Ebrahimi, Omid V. & Bjørndal, Ludvig Daae (2026). Linking psychological distress and multilevel socioeconomic disadvantage: A representative population-based study of 15,851 U.K. adults. American Psychologist. ISSN 0003-066X. doi: 10.1037/amp0001705. Full text in Research Archive
• Magnúsdóttir, Ingibjörg; Nygaard, Anders Benteson; Hoffart, Asle; Murphy, Gillian; Kõiv, Kadri & Barker, Mary M. [Show all 38 contributors for this article] (2026). Acute COVID-19 severity and impaired cognitive function up to 32 months after diagnosis: an observational study. BMC Medicine. 24(1). doi: 10.1186/s12916-026-04856-2. Full text in Research Archive Show summary

  Background Cognitive dysfunction (“brain fog”) is a commonly reported post-COVID-19 symptom. Leveraging data from five general population cohorts across four European countries (Estonia, Iceland, Norway, and Sweden), we assessed long-term prevalence of impaired subjective cognitive function among individuals diagnosed with COVID-19 by acute illness severity. Methods The included cohorts consisted of adult participants recruited from March 2020 and followed with self-report measures of cognitive function and past COVID-19 infection (except one cohort consisting of clinically confirmed COVID-19 cases) through February 2023. In a cross-sectional analysis we contrasted the prevalence of impaired cognitive function among individuals with and without a COVID-19 diagnosis, overall and by illness severity up to 32 months post-diagnosis. We adjusted for age, gender, education, relationship status, binge drinking, body mass index, previous psychiatric diagnosis, number of chronic medical conditions, and response period. In a longitudinal analysis, we assessed potential changes in cognitive function scores before and after COVID-19 diagnosis. Results The study population consisted of 153,841 participants (71% women), with 31,359 (20.4%) reporting a positive COVID-19 test. Overall, a COVID-19 diagnosis was not statistically significantly associated with increased prevalence ratio (PR) of impaired cognitive function (PR 1.30 [95% CI: 0.98–1.71]). Individuals bedridden due to COVID-19 for 1–6 days (PR 1.38 [95% CI 0.96–1.99]) or ≥ 7 days (2.59 [1.55–4.33]) had higher prevalence of impaired cognitive function compared to those never diagnosed, while individuals never bedridden had a lower prevalence to those never diagnosed with COVID-19 (0.89 [0.80–1.00]). These findings were corroborated in the longitudinal analysis where a pre- to post diagnosis decline in cognitive function was observed among individuals bedridden due to COVID-19 (p < 0.0001). Conclusions The data indicates that a severe COVID-19 acute illness course is associated with impaired cognitive function up to 18–32 months after COVID-19 diagnosis.

• Karl, Valerie; Bjørndal, Ludvig Daae; Aksnes, Eira Ranheim; Teulings, Irene Johanna Elisabeth; MacSweeney, Niamh Anne & Beck, Dani [Show all 9 contributors for this article] (2026). Symptom-specific links between internalizing problems and functional connectivity in adolescents: a network analysis. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-026-02989-6. Full text in Research Archive
• Snuggerud, Therese Ruud; Ulitzsch, Esther; Nordahl, Henrik; Vrabel, Kari-Anne; Hoffart, Asle & Ebrahimi, Omid V. [Show all 9 contributors for this article] (2026). Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment. Journal of Anxiety Disorders. ISSN 0887-6185. 119, p. 103136–103136. doi: 10.1016/j.janxdis.2026.103136. Full text in Research Archive Show summary

  Background Anxiety disorders are prevalent and associated with substantial distress and impairment. Within the metacognitive model of emotional disorders, the cognitive attentional syndrome (CAS) and associated metacognitions maintain anxiety. The Attention Training Technique (ATT) targets the CAS and related metacognitions. However, less is known about how symptoms and metacognitive mechanisms evolve across treatment phases. Objective The study aimed to explore temporal dynamics in emotional symptoms and metacognitive mechanisms during group ATT by estimating mean levels, variability, and coupling across the pre-, during-, and post-treatment phases using ecological momentary assessment (EMA). Method Nineteen young adults with social anxiety disorder, panic disorder with agoraphobia, or generalized anxiety disorder participated. EMA was completed four times daily over six weeks: two weeks before treatment, two weeks during treatment, and two weeks after treatment. Each assessment included ten items measuring emotional symptoms (e.g., nervousness) and metacognitive mechanisms (e.g., worry, uncontrollability). Results Three patterns of change emerged: (1) reduced mean levels without change in variability (nervousness, self-consciousness, and worry); (2) reduced mean levels and reduced variability (threat monitoring); and (3) reduced mean levels and reduced variability during treatment, followed by an increase in variability after treatment (uncontrollability, difficulty collecting thoughts, and meta-worry). Conclusions The findings provide new insights into dynamic patterns of change in symptoms and metacognitive mechanisms before, during, and after ATT. Patterns of change in both intensity and stability may be relevant for understanding treatment response and vulnerability following treatment, suggesting the potential clinical relevance of monitoring these mechanisms.

• Du, Xinkai; Skjerdingstad, Nora Paulsen; Freichel, René; Ebrahimi, Omid Vakili; Hoekstra, Ria H.A. & Epskamp, Sacha (2025). Moving From Exploratory to Confirmatory Network Analysis: An Evaluation of Structural Equation Modeling Fit Indices and Cutoff Values in Network Psychometrics. Psychological methods. ISSN 1082-989X. doi: 10.1037/met0000760. Full text in Research Archive
• Pålerud, Kenneth M.; Helmich, Marieke A.; Hoffart, Asle; Ebrahimi, Omid Vakili; Snuggerud, Therese Ruud & Johnson, Sverre Urnes (2025). Sudden Gains in Cognitive Behavioural Therapy and Metacognitive Therapy for Complex Anxiety Disorders. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 32(4). doi: 10.1002/cpp.70111. Full text in Research Archive
• Cloos, Leonie; Siepe, Björn S.; Piccirillo, Marilyn L.; Fried, Eiko; Wang, Shirley B. & Helmich, Marieke A. [Show all 9 contributors for this article] (2025). Accuracy and Consistency of Visual Analog Scales in Ecological Momentary Assessment and Digital Studies. Collabra: Psychology. ISSN 2474-7394. 11(1). doi: 10.1525/collabra.142735. Full text in Research Archive
• Skjerdingstad, Nora Paulsen; Johnson, Miriam Sinkerud; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2025). Daily dynamics of parental mental health: Investigating depressive symptoms and negative parental experiences. Journal of Psychiatric Research. ISSN 0022-3956. 190, p. 341–346. doi: 10.1016/j.jpsychires.2025.08.007. Full text in Research Archive
• Rajesh, Sakshi; Johnson, Sverre Urnes; Hoffart, Asle; Leigh, Eleanor & Ebrahimi, Omid Vakili (2025). Differential Associations of Anticipatory and Consummatory Anhedonia With Depression and Social Anxiety Symptoms: A Network Analysis of University Students. Depression and Anxiety. ISSN 1091-4269. 2025(1), p. 1–11. doi: 10.1155/da/5674096. Full text in Research Archive
• Belli, Stefano R.; Hoekstra, Ria H.A.; Pilling, Stephen; Saunders, Rob; Stott, Josh & Suh, Jae Won [Show all 8 contributors for this article] (2025). Using network analysis to identify processes of change in low-intensity CBT interventions for depression and anxiety disorders. Journal of Affective Disorders. ISSN 0165-0327. 398. doi: 10.1016/j.jad.2025.120937. Full text in Research Archive
• Halsøy, Øyvind; Ebrahimi, Omid Vakili; Johnson, Sverre Urnes; Hoffart, Asle; Moreira, Hugo Cogo & Fjermestad, Krister Westlye (2025). Depressive Symptoms in Individuals With Chronic Conditions During the Covid-19 Pandemic: A 2-Year Longitudinal Study. Stress and Health. ISSN 1532-3005. 41(4). doi: 10.1002/smi.70082. Full text in Research Archive
• Lu, Li; Wang, Yue; Ebrahimi, Omid V.; Shen, Qing; Unnarsdóttir, Anna Bára & Hauksdóttir, Arna [Show all 18 contributors for this article] (2025). Long-term psychological effects of COVID-19-related quarantine: an observational study of three cohorts in Norway and Iceland. BMC Medicine. 23. doi: 10.1186/s12916-025-04349-8. Full text in Research Archive Show summary

  Abstract Background Longitudinal assessments of psychological effects related to length and recency of quarantine experience in general populations are of importance. We aim to investigate if recency and duration of quarantine exposures during the COVID-19 pandemic were associated with mental health, across subgroups. Methods We included three prospective cohorts from Iceland and Norway with data on quarantine and symptoms of depression and anxiety from March 2020 to March 2022. We calculated prevalence ratios (PR) of probable depression and anxiety in relation to quarantine exposure, and performed longitudinal analyses in a subpopulation with repeated assessments to test the potential change in mental health burden due to quarantine over time while controlling for current quarantine status and other covariates. Results In total, 105,344 and 94,435 individuals were included in the analysis of probable depression and anxiety, respectively, with 18.2% and 40.0% reporting quarantine exposure before the most recent assessment of corresponding mental health symptoms. Overall, quarantine exposure was associated with probable depression (PR 1.19 [95% CI: 0.99–1.42]) and anxiety (PR 1.21 [1.08–1.36]). Compared to individuals without quarantine, being exposed to quarantine for 0–2, 2–4, or > 4 weeks was associated with incrementally higher prevalence of probable depression (PR 1.15 [0.93–1.43]; 1.34 [1.06–1.68]; 1.72 [1.35–2.18], respectively) and probable anxiety (PR 1.12 [1.01–1.23]; 1.28 [1.14–1.45]; 1.76 [1.56–1.98]) in a step-wise manner; those who were quarantined within the last 2 weeks, last 2–4 weeks, or earlier showed a higher prevalence of probable depression in a dose–response manner (PR 1.62 [1.32–1.99], 1.32 [1.07–1.63], and 1.23 [1.06–1.43], respectively). The prevalence of probable anxiety did not appear to differ by the recency of quarantine. The longitudinal analyses (mean follow-up: 20.5 months) confirmed significantly higher prevalence of probable depression but only among those who were quarantined for > 4 weeks (PR 1.61 [1.30–2.00]), and of probable anxiety among those quarantined 2–4 weeks (PR 1.29 [1.14–1.45]) and > 4 weeks (PR 1.56 [1.34–1.82]). Conclusions This study underscores the importance of monitoring mental well-being of populations recently quarantined, particularly those quarantined for prolonged periods. Greater emphasis should be placed on the detrimental psychological effects in the risk-cost–benefit analysis of quarantine as a mitigation strategy in future pandemics.

• Du, Xinkai; Ebrahimi, Omid V.; Hoffart, Asle; Birkeland, Marianne Skogbrott; Skogen, Jens Christoffer & Smith, Otto Robert Frans [Show all 7 contributors for this article] (2025). The acceptability and usefulness of ambulatory assessment: A large-scale investigation of a daily diary study with 2,816 adults. Psychological Assessment. ISSN 1040-3590. 37(12), p. 719–719. doi: 10.1037/pas0001405. Full text in Research Archive Show summary

  Despite the popularity of ambulatory assessment (AA), few studies have investigated how participants experience and perceive their participation, including the burdensomeness and utility of AA. This is important, as participants’ experience in the measurement process can directly impact participants’ well-being and data quality. In a 40-day diary study involving 2,816 individuals, participants reported their experience of the measurement process (acceptability) with six self-report items. We further investigated the demographic difference in acceptability using seemingly unrelated regression and logistic regression. We explored how compliance was related to acceptability and participant demographics with Poisson regression. Most participants found daily diary assessments to be beneficial in general (74.7%), specifically, for their self-understanding (60.0%) and self-reflection and experience sharing (68.5%). Most participants expressed willingness to participate in similar research again (83.9%). A minority of participants (11.7%) reported they felt participation worsened their problems, while twice as many (21.7%) participants reported that participation helped alleviate their mental health problems. Demographic predictors were predominantly insignificant, reflecting that the high acceptability of daily diary assessments was relatively stable across different populations. Adults across different subgroups predominantly found their participation in daily diary research to be beneficial for their mental health, with the majority of adults expressing reparticipation interest. One in five participants experienced an improvement in their psychiatric symptoms related to participation, while a minority of individuals expressed mental deterioration, presenting a critical avenue for future research to identify the characteristics of individuals who are more or less likely to benefit from AA research.

• Aksnes, Eira R.; Birkeland, Marianne Skogbrott; Ebrahimi, Omid V.; Bekkhus, Mona; Ferschmann, Lia & Beck, Dani [Show all 12 contributors for this article] (2025). Developmental dynamics of symptoms of emotional problems in childhood and adolescence: A longitudinal network analysis. JCPP Advances. doi: 10.1002/jcv2.70079. Full text in Research Archive Show summary

  Abstract Background Epidemiological studies document increasing incident rates of mental disorders across childhood and adolescence, with mood and anxiety disorders particularly increasing among adolescent females. Research also indicates that these emotional problems have become more prevalent in recent decades. Yet, there is still a lack of understanding of the interrelated development of distinct emotional symptoms from childhood to adolescence. Methods Here, we investigate and compare symptom dynamics in males and females. To accomplish this, we leveraged longitudinal data from the Avon Longitudinal Study of Parents and Children study ( N  = 11,120, 50.1% males at baseline). We used five items ( worries , unhappy , nervous , fearful , somatic complaints ) derived from the parent‐reported Strength and Difficulties Questionnaire emotional problems scale, measured at up to seven timepoints (mean age = 9.52, range = 4.0–18.3 years old). We estimated a panel Graphical Vector Autoregressive network model (GVAR) and statistically compared the networks of males and females. Results The temporal network revealed largely reciprocal associations among symptoms, with the strongest edges between fearful–nervous and unhappy–worries ( β  = 0.04–0.06). The contemporaneous and between‐person networks showed similar structures, although the between‐person network exhibited fewer but stronger associations, reflecting more stable individual differences. Somatic complaints were weakly connected in the temporal network but more strongly associated in contemporaneous and between‐person networks. Network invariance testing indicated no significant sex differences in average network structure. Conclusion The study delineates the developmental dynamics of emotional symptoms across childhood and adolescence, highlighting bidirectional influences between core symptoms of depression and anxiety, but did not find support for sex differences in their developmental interrelatedness.

• Bjørndal, Ludvig Daae; Wootton, Robyn; Ebrahimi, Omid V.; Piazza, Giulia G.; Hegemann, Laura Elizabeth & Corfield, Elizabeth Claire [Show all 11 contributors for this article] (2025). Unravelling symptom-specific polygenic effects on maternal mental health during the perinatal period and postpartum. Journal of Affective Disorders. ISSN 0165-0327. 392. doi: 10.1016/j.jad.2025.120228. Full text in Research Archive
• Bjørndal, Ludvig Daae; Ebrahimi, Omid V. & Bauermeister, Sarah (2025). The dynamic interplay between mental health difficulties and the family environment in early adolescence. JCPP Advances. 6(2). doi: 10.1002/jcv2.70037. Full text in Research Archive Show summary

  Background: Adolescents experiencing mental health problems have an elevated risk of persisting difficulties as they transition into adulthood, stressing the importance of identifying modifiable factors impacting mental health during adolescence. The family environment is recognised as a key influence on adolescent mental health in theory and interventions. Notably, few studies have disentangled within‐person and between‐person effects in relating adolescent mental health and the family environment. Methods: We analysed data from 1067 adolescents across three waves using panel graphical vector autoregressive modelling, separating contemporaneous and temporal within‐person and between‐person associations in relationships between mental health difficulties (i.e., emotional, hyperactivity/inattention, conduct problems) and family‐related factors (i.e., aspects of the general family environment, parent‐child relationships, and sibling dynamics). We also assessed how the different mental health difficulties and family environment factors were themselves interrelated over time. The mean age (in years) was 10.51 at Wave 1, 12.49 at Wave 2, and 14.49 at Wave 3. Results: Emotional symptoms predicted increases in hyperactivity/inattention and more sibling problems over time. Lack of family support and negative feelings towards family were reciprocally related, indicative of a reinforcing loop. Both mental health difficulties and family environment factors exhibited considerable stability. In contemporaneous within‐person associations, mental health difficulties were strongly interrelated, as were aspects of the family environment. Furthermore, conduct problems were linked to externalising behaviours (e.g., fighting with parents, bothering siblings) and emotional symptoms to internalising experiences of family dynamics (e.g., feeling negative towards family, being bothered by siblings). Negative feelings towards family and hyperactivity/inattention were strongly predicted by included variables, while emotional symptoms, fighting with parents, and lacking family support were predictive of other variables. Conclusions: Our findings point to the importance of emotional problems in adolescence, which may contribute to worsened hyperactivity/inattention and more problems with siblings over time, and the interrelatedness of mental health and the family environment. Alleviating internalising problems in affected adolescents may help mitigate development of other mental health difficulties and negative sibling dynamics.

• Chen, Si; Ebrahimi, Omid Vakili & Cheng, Cecilia (2025). New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 27. doi: 10.2196/70483. Full text in Research Archive
• Ebrahimi, Omid Vakili; Sandbakken, Ella Marie; Moss, Sigrun Marie; Johnson, Sverre Urnes; Hoffart, Asle & Bauermeister, Sarah [Show all 9 contributors for this article] (2025). Modifiable risk factors of vaccine hesitancy: insights from a mixed methods multiple population study combining machine learning and thematic analysis during the COVID-19 pandemic. BMC Medicine. 23(1). doi: 10.1186/s12916-025-03953-y. Full text in Research Archive Show summary

  Background Vaccine hesitancy, the delay in acceptance or reluctance to vaccinate, ranks among the top threats to global health. Identifying modifiable factors contributing to vaccine hesitancy is crucial for developing targeted interventions to increase vaccination uptake. Methods This mixed-methods multiple population study utilized gradient boosting machines and thematic analysis to identify modifiable predictors of vaccine hesitancy during the COVID-19 pandemic. Predictors of vaccine hesitancy were investigated in 2926 Norwegian adults (Mage = 37.91, 79.69% female), before the predictive utility of these variables was investigated in an independent sample of 734 adults in the UK (Mage = 40.34, 57.08% female). Two independent teams of authors conducted the machine learning and thematic analyses, blind to each other’s analytic procedures and results. Results The machine learning model performed well in discerning vaccine hesitant (n = 248, 8.48% and n = 109, 14.85%, Norway and UK, respectively) from vaccine uptaking individuals (n = 2678, 91.52% and n = 625, 85.15%), achieving an AUC of 0.94 (AUPRC: 0.72; balanced accuracy: 86%; sensitivity = 0.81; specificity = 0.98) in the Norwegian sample, and an AUC of 0.98 (AUPRC: 0.89; balanced accuracy: 89%; sensitivity = 0.83; specificity = 0.97) in the out-of-sample replication in the UK. The mixed methods investigation identified five categories of modifiable risk tied to vaccine hesitancy, including illusion of invulnerability, doubts about vaccine efficacy, mistrust in official entities, minimization of the societal impact of COVID-19, and health-related fears tied to vaccination. The portrayal of rare incidents across alternative media platforms as fear amplifiers, and the mainstream media’s stigmatizing presentation of unvaccinated individuals, were provided as additional motives underlying vaccine reluctance and polarization. The thematic analysis further revealed information overload, fear of needles, previous negative vaccination experiences, fear of not getting healthcare follow-up after vaccination if needed, and vaccine aversion due to underlying (psychiatric) illness (e.g., eating disorders) as motives underlying vaccine hesitance. Conclusions The identified influential predictors were consistent across two European samples, highlighting their generalizability across European populations. These predictors offer insights about modifiable factors that could be adapted by public health campaigns in mitigating misconceptions and fears related to vaccination toward increasing vaccine uptake. Moreover, the results highlight the media’s responsibility, as mediators of the public perception of vaccines, to minimize polarization and provide accurate portrayals of rare vaccine-related incidents, reducing the risk aggravating fear and reactance to vaccination.

• Hoffart, Asle; Skjerdingstad, Nora Paulsen; Freichel, René; Johnson, Sverre Urnes; Epskamp, Sacha & Ebrahimi, Omid Vakili (2025). Mapping the Dynamics of Generalized Anxiety Symptoms and Actionable Transdiagnostic Mechanisms: A Panel Study. Depression and Anxiety. ISSN 1091-4269. 2025(1). doi: 10.1155/da/1885004. Full text in Research Archive
• Finnemann, Adam; Skjerdingstad, Nora; Speyer, Lydia G.; Zavlis, Orestis; Bartoš, František & Wiers, Reinout [Show all 12 contributors for this article] (2025). Urban-rural differences in anxiety and depression in the UK, New Zealand, and Norway. Journal of Affective Disorders. ISSN 0165-0327. 388. doi: 10.1016/j.jad.2025.119601. Full text in Research Archive Show summary

  As the global urban population surpasses 50 %, understanding the impact of urban environments on mental health is crucial. This study examines the relationship between urbanicity and the prevalence of depression and anxiety disorders in the United Kingdom (UK; N = 449,232), New Zealand (N = 33,042), and Norway (N = 13,238). This paper addresses a central limitation of previous research, which relied on dichotomous and varying definitions of urbanicity, by employing a continuous measure of urbanicity consistently across our three samples. Results revealed country-specific patterns: in the UK, a non-linear pattern showed a minimum in semi-urban areas but increased prevalences of anxiety and depression in both urban and rural regions; in New Zealand, only urban living was linked to a higher prevalence of anxiety, while depression rates remained consistent across settings; in Norway, increased mental health problems were associated with rural residency. These relationships were robust across various sensitivity analyses. Overall, the results underscore that there is no universal association between urbanicity and mental health; rather, the urban–rural gradient operates differently across countries. Future research should explore cross-national variation in urban environments toward identifying aspects of urban life that serve as favorable versus detrimental to mental health.

• Hoffart, Asle; Helmich, Marieke A.; Vrabel, KariAnne; Ebrahimi, Omid Vakili & Johnson, Sverre Urnes (2025). From a latent variable to a complex dynamic system conceptualization of the therapeutic alliance. Journal of psychotherapy integration. ISSN 1053-0479. doi: 10.1037/int0000357. Full text in Research Archive Show summary

  The aim of this study was to develop a complex dynamic system (CDS) model of the therapeutic alliance and compare it to the currently dominant latent state–trait (LST) model. A clinical example of a state of alliance rupture and repair is analyzed in terms of a LST model and a CDS model. Then, the implications of these two models in their application to clinical research and practice are compared. Adopting a CDS perspective offers significant advantages over the LST approach. Specifically, it provides stronger clinical face validity, aligns with Bordin’s (1979) conceptualization of the alliance, accounts for the interaction of state and trait alliance, and assures conceptual independence between causal entities. By examining the interactions among observable reactions, the coordination of these reactions into patterns that form alliance states, and how iterative state changes reshape the trait alliance landscape of attractor states, the CDS perspective offers actionable clinical recommendations across all three levels. However, CDS and LST hybrid theories are possible and may have merit. The CDS perspective provides a holistic approach that requires a specification of all influential components of the target system—the disorder addressed—and of the therapy system—the extended system of therapeutic components. It leads to a research program for developing models of therapeutic systems case by case using qualitative and quantitative methods. It also provides precise tests of complete models, including comparison of mathematically derived simulations to real-world data and empirical testing by newly developed network analytic methods.

• Bjørndal, Ludvig Daae; Røysamb, Espen; Nes, Ragnhild Bang; Soest, Tilmann Martin von & Ebrahimi, Omid V. (2025). Financial factors and depression and anxiety: A symptom-specific approach in the general population. SSM - Mental Health (SSM-MH). 8. doi: 10.1016/j.ssmmh.2025.100508. Full text in Research Archive
• Boehme, Blake A.E.; Ebrahimi, Omid Vakili; Carleton, R. Nicholas & Asmundson, Gordon J.G. (2025). Feeling Detached: The Central Role of Detachment in a Network Study of Posttraumatic Stress Symptoms in Public Safety Personnel. European Journal of Trauma & Dissociation. doi: 10.1016/j.ejtd.2025.100505. Full text in Research Archive
• Barker, Mary M.; Kõiv, Kadri; Magnúsdóttir, Ingibjörg; Milbourn, Hannah; Wang, Bin & Du, Xinkai [Show all 35 contributors for this article] (2024). Mental illness and COVID-19 vaccination: a multinational investigation of observational & register-based data. Nature Communications. 15(1). doi: 10.1038/s41467-024-52342-1. Full text in Research Archive Show summary

  Individuals with mental illness are at higher risk of severe COVID-19 outcomes. However, previous studies on the uptake of COVID-19 vaccination in this population have reported conflicting results. Using data from seven cohort studies (N = 325,298) included in the multinational COVIDMENT consortium, and the Swedish registers (N = 8,080,234), this study investigates the association between mental illness (defined using self-report measures, clinical diagnosis and prescription data) and COVID-19 vaccination uptake. Results from the COVIDMENT cohort studies were pooled using meta-analyses, the majority of which showed no significant association between mental illness and vaccination uptake. In the Swedish register study population, we observed a very small reduction in the uptake of both the first and second dose of a COVID-19 vaccine among individuals with vs. without mental illness; the reduction was however greater among those not using psychiatric medication. Here we show that uptake of the COVID-19 vaccine is generally high among individuals both with and without mental illness, however the lower levels of vaccination uptake observed among subgroups of individuals with unmedicated mental illness warrants further attention.

• Hafstad, Marius Duhovic; Ebrahimi, Omid V. & Fostervold, Knut Inge (2024). The Dialectical Relationship Between Burnout and Work Engagement: A Network Approach. Stress and Health. ISSN 1532-3005. doi: 10.1002/smi.3514. Full text in Research Archive
• Ebrahimi, Omid V.; Borsboom, Denny; Hoekstra, Ria H. A.; Epskamp, Sacha; Ostinelli, Edoardo G. & Bastiaansen, Jojanneke A. [Show all 7 contributors for this article] (2024). Towards precision in the diagnostic profiling of patients: Leveraging symptom dynamics as a clinical characterisation dimension in the assessment of major depressive disorder. British Journal of Psychiatry. ISSN 0007-1250. 224(5), p. 157–163. doi: 10.1192/bjp.2024.19. Full text in Research Archive
• Briganti, Giovanni; Scutari, Marco; Epskamp, Sacha; Borsboom, Denny; Hoekstra, Ria H. A. & Golino, Hudson Fernandes [Show all 22 contributors for this article] (2024). Network analysis: An overview for mental health research. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. doi: 10.1002/mpr.2034. Full text in Research Archive
• Ebrahimi, Omid V.; Freichel, René; Johnson, Sverre Urnes; Hoffart, Asle; Solbakken, Ole Andre & Bauer, Daniel J. (2024). Depressive Symptom Change Patterns during the COVID-19 Pandemic and Their Impact on Psychiatric Treatment Seeking: A 24-Month Observational Study of the Adult Population. Depression and Anxiety. ISSN 1091-4269. 2024. doi: 10.1155/2024/1272738. Full text in Research Archive
• Bjørndal, Ludvig Daae; Ebrahimi, Omid V.; Røysamb, Espen; Karstoft, Karen-Inge; Czajkowski, Nikolai Olavi & Nes, Ragnhild Bang (2024). Stressful life events exhibit complex patterns of associations with depressive symptoms in two population-based samples using network analysis. Journal of Affective Disorders. ISSN 0165-0327. 349, p. 569–576. doi: 10.1016/j.jad.2024.01.054. Full text in Research Archive Show summary

  Background Stressful life events (SLEs) constitute key risk factors for depression. However, previous studies examining associations between SLEs and depression have been limited by focusing on single events, combining events into broad categories, and/or ignoring interrelationships between events in statistical analyses. Network analysis comprises a set of statistical methods well-suited for assessing relationships between multiple variables and can help surpass several limitations of previous studies. Methods We applied network analysis using mixed graphical models combining two large-scale population-based samples and >34,600 randomly sampled adults to investigate the associations between SLEs and current depressive symptoms in the general population. Results Numerous SLEs were uniquely associated with specific symptoms. Strong pairwise links were observed between SLEs during the past year and individual symptoms, e.g., between having experienced illness or injury and sleeping problems, having been degraded or humiliated and feeling blue, and between financial problems and hopelessness and being worried and anxious. Several SLEs, such as financial problems, sexual abuse, and having been degraded or humiliated, were associated with symptoms across more than one timepoint. More recent SLEs were generally more strongly associated with depressive symptoms. Several life events were strongly interrelated, such as multiple forms of abuse, and financial problems, unemployment, divorce, and serious illness or injury. Limitations Limitations include a retrospective SLE measure, cross-sectional data, a brief self-report measure of depressive symptoms, and possible attrition bias in the sample. Conclusions Our findings may have implications for public health efforts seeking to improve population mental health.

• Nordbø, Sara Ebling; Johnson, Sverre Urnes; Hoffart, Asle; Pallesen, Ståle & Ebrahimi, Omid Vakili (2024). The dynamic relationships between well-being, behavioral restrictions, and health behaviors during the COVID-19 pandemic: A large-scale intensive longitudinal network study. Applied Psychology: Health and Well-Being. ISSN 1758-0846. 16(4), p. 1801–1818. doi: 10.1111/aphw.12555. Full text in Research Archive Show summary

  The behavioral restrictions disrupting daily life during the COVID-19 pandemic have profoundly impacted well-being, and health behaviors have been advocated to prevent decline. To understand how processes related to fluctuation in well-being unfold within individuals, analyses on the within-person level are required. In this preregistered intensive longitudinal study, 1,709 individuals from the Norwegian adult population provided data daily over 40 consecutive days during the pandemic. The responses were modeled in a multilevel vector autoregressive model to estimate within-person networks, across and within-day, and a between-person network. All three networks revealed productivity, relatedness, and optimism as positively associated. Social distancing was contemporaneously negatively associated with productivity and relatedness. Among behavioral factors, being physically active predicted lower relatedness across days but displayed positive associations with relatedness, productivity, and optimism contemporaneously. Alcohol consumption predicted lower productivity across and within-day, although revealing a positive association with optimism within-day. Being social online and feeling related to others displayed a temporal negative bidirectional relationship. In contrast, being social online was positively associated with optimism, productivity, and relatedness contemporaneously. Our study emphasizes the dynamic nature of well-being and its complex associations with behavioral factors during the pandemic. The study shed light on opposing associations of behavioral factors at the within- and between-person level.

• Ebrahimi, Omid Vakili & Asmundson, Gordon J.G. (2024). Scaling up psychological interventions into the daily lives of patients with anxiety and related disorders. Journal of Anxiety Disorders. ISSN 0887-6185. doi: 10.1016/j.janxdis.2024.102916. Full text in Research Archive
• Johnson, Miriam Sinkerud; Skjerdingstad, Nora Paulsen; Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2024). Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19. Midwifery. ISSN 0266-6138. 131. doi: 10.1016/j.midw.2024.103951. Full text in Research Archive
• Cheng, Cecilia; Ying, Weijun; Ebrahimi, Omid Vakili & Wong, Kin Fai Ellick (2023). Coping style and mental health amid the first wave of the COVID-19 pandemic: a culture-moderated meta-analysis of 44 nations. Health Psychology Review. ISSN 1743-7199. doi: 10.1080/17437199.2023.2175015. Full text in Research Archive
• Cheng, Cecilia & Ebrahimi, Omid Vakili (2023). Gamification: a Novel Approach to Mental Health Promotion. Current Psychiatry Reports. ISSN 1523-3812. doi: 10.1007/s11920-023-01453-5. Full text in Research Archive
• Bandara, Shashika; Zeinali, Zahra; Blandina, Dian Maria; Ebrahimi, Omid Vakili; Essar, Mohammad Yasir & Senga, Joyeuse [Show all 9 contributors for this article] (2023). Imagining a future in global health without visa and passport inequities. PLOS Global Public Health. doi: 10.1371/journal.pgph.0002310. Full text in Research Archive
• Tang, Ming Chun; Ebrahimi, Omid Vakili & Cheng, Cecilia (2023). Symptomatology, risk, and protective factors of gaming disorder: A network analytical approach. Computers in Human Behavior. ISSN 0747-5632. 148. doi: 10.1016/j.chb.2023.107899. Full text in Research Archive
• Vrabel, KariAnne; Johnson, Sverre Urnes; Ebrahimi, Omid Vakili & Hoffart, Asle (2023). Anxiety and depressive symptoms among migrants during the COVID-19 pandemic in Norway: A two-wave longitudinal study. Psychiatry Research Communications. 3(2), p. 1–9. doi: 10.1016/j.psycom.2023.100115. Full text in Research Archive Show summary

  This study was designed to examine the impact of the COVID-19 pandemic on the mental health of migrants living in Norway. We conducted a longitudinal two-waves survey among a sample of 574 migrants and multilevel modelling was used to analyse anxiety, health anxiety and depressive symptoms. Demographic and psychological predictors were investigated. The levels of anxiety, health anxiety and depressive symptoms among migrants decreased from the lockdown (strict social distancing protocols) to phaseout. Reductions in maladaptive coping strategies were related to parallel reductions in anxiety, health anxiety, and depression, and a reduction in loneliness was related to a reduction in depression. The results indicate that the elevated levels of anxiety, health anxiety and depressive symptoms among migrants in the first phase of the pandemic may be temporary.

• Lovik, Anikó; González-Hijón, Juan; Hoffart, Asle; Fawns-Ritchie, Chloe; Magnúsdóttir, Ingibjörg & Lu, Li [Show all 27 contributors for this article] (2023). Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients – an observational study of five cohorts across four countries. The Lancet Regional Health - Europe. 33. doi: 10.1016/j.lanepe.2023.100733. Full text in Research Archive Show summary

  Background Little is known regarding the mental health impact of having a significant person (family member and/or close friend) with COVID-19 of different severity. Methods The study included five prospective cohorts from four countries (Iceland, Norway, Sweden, and the UK) with self-reported data on COVID-19 and symptoms of depression and anxiety during March 2020–March 2022. We calculated prevalence ratios (PR) of depression and anxiety in relation to having a significant person with COVID-19 and performed a longitudinal analysis in the Swedish cohort to describe temporal patterns. Findings 162,237 and 168,783 individuals were included in the analysis of depression and anxiety, respectively, of whom 24,718 and 27,003 reported a significant person with COVID-19. Overall, the PR was 1.07 (95% CI: 1.05–1.10) for depression and 1.08 (95% CI: 1.03–1.13) for anxiety in relation to having a significant person with COVID-19. The respective PRs for depression and anxiety were 1.15 (95% CI: 1.08–1.23) and 1.24 (95% CI: 1.14–1.34) if the patient was hospitalized, 1.42 (95% CI: 1.27–1.57) and 1.45 (95% CI: 1.31–1.60) if the patient was ICU-admitted, and 1.34 (95% CI: 1.22–1.46) and 1.36 (95% CI: 1.22–1.51) if the patient died. Individuals with a significant person with hospitalized, ICU-admitted, or fatal COVID-19 showed elevated prevalence of depression and anxiety during the entire year after the COVID-19 diagnosis. Interpretation Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms.

• Johnson, Miriam Sinkerud; Skjerdingstad, Nora Paulsen; Hoffart, Asle; Ebrahimi, Omid Vakili & Johnson, Sverre Urnes (2023). Triggered by worry: A dynamic network analysis of COVID-19 pandemic-related anxiety and parental stress. Journal of Affective Disorders. ISSN 0165-0327. 346, p. 329–337. doi: 10.1016/j.jad.2023.10.127. Full text in Research Archive Show summary

  Background: Major disruptions to daily life routines made families and parents particularly vulnerable to psy- chological distress during the COVID-19 lockdowns. However, the specific psychopathological processes related to within-person variation and maintenance of anxiety symptomatology and parental distress components in the parental population have been largely unexplored in the literature. Methods: In this preregistered intensive longitudinal study, a multilevel dynamic network was used to model within-person interactions between anxiety symptomatology, psychopathological processes, parental distress, and protective lifestyle components in a sample of 495 parents—each responding to daily assessments over a 40-day period. A total of 30,195 observa- tions were collected across the subjects. Results: Extensive worry, threat monitoring, and uncontrollability of worry were identified as overreaching psychopathological processes related to the aggravation of other symptoms of anxiety and parental distress. A strong association was found between parental stress and parental burnout. Anger toward one's child was associated with both parental stress and parental burnout. Protective factors showed the lowest strength cen- trality, with few and weak connections to other symptoms and processes in the network. Limitations: Associations may exist between the study variables on a different time scale; hence, different time lags should be used in future research. Conclusions: Accessible, low-cost interventions that address worry, threat monitoring, and the uncontrollability of worry could serve as potential targets for reducing the symptom burden of anxiety and distress in the parental population.

• Shen, Qing; Joyce, Emily E.; Ebrahimi, Omid Vakili; Didriksen, Maria; Lovik, Anikó & Sævarsdóttir, Karen Sól [Show all 32 contributors for this article] (2023). COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark. The Lancet Regional Health - Europe. 35. doi: 10.1016/j.lanepe.2023.100756. Full text in Research Archive Show summary

  Background Although the persistence of physical symptoms after SARS-CoV-2 infection is a major public health concern, evidence from large observational studies beyond one year post diagnosis remain scarce. We aimed to assess the prevalence of physical symptoms in relation to acute illness severity up to more than 2-years after diagnosis of COVID-19. Methods This multinational study included 64,880 adult participants from Iceland, Sweden, Denmark, and Norway with self-reported data on COVID-19 and physical symptoms from April 2020 to August 2022. We compared the prevalence of 15 physical symptoms, measured by the Patient Health Questionnaire (PHQ-15), among individuals with or without a confirmed COVID-19 diagnosis, by acute illness severity, and by time since diagnosis. We additionally assessed the change in symptoms in a subset of Swedish adults with repeated measures, before and after COVID-19 diagnosis. Findings During up to 27 months of follow-up, 34.5% participants (22,382/64,880) were diagnosed with COVID-19. Individuals who were diagnosed with COVID-19, compared to those not diagnosed, had an overall 37% higher prevalence of severe physical symptom burden (PHQ-15 score ≥15, adjusted prevalence ratio [PR] 1.37 [95% confidence interval [CI] 1.23–1.52]). The prevalence was associated with acute COVID-19 severity: individuals bedridden for seven days or longer presented with the highest prevalence (PR 2.25 [1.85–2.74]), while individuals never bedridden presented with similar prevalence as individuals not diagnosed with COVID-19 (PR 0.92 [0.68–1.24]). The prevalence was statistically significantly elevated among individuals diagnosed with COVID-19 for eight of the fifteen measured symptoms: shortness of breath, chest pain, dizziness, heart racing, headaches, low energy/fatigue, trouble sleeping, and back pain. The analysis of repeated measurements rendered similar results as the main analysis. Interpretation These data suggest an elevated prevalence of some, but not all, physical symptoms during up to more than 2 years after diagnosis of COVID-19, particularly among individuals suffering a severe acute illness, highlighting the importance of continued monitoring and alleviation of these targeted core symptoms.

• Ebrahimi, Omid Vakili (2023). Systems-based thinking in psychology and the mental health sciences. Nature Reviews Psychology. doi: 10.1038/s44159-023-00193-w. Full text in Research Archive
• Hoffart, Asle; Skjerdingstad, Nora Paulsen; Freichel, René; Mansueto, Alessandra C.; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2023). Depressive Symptoms and Their Mechanisms: An Investigation of Long-Term Patterns of Interaction Through a Panel-Network Approach. Clinical Psychological Science. ISSN 2167-7026. doi: 10.1177/21677026231208172. Full text in Research Archive
• Günak, Mia Maria; Ebrahimi, Omid Vakili; Pietrzak, Robert H. & Fried, Eiko I. (2023). Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning. Journal of Anxiety Disorders. ISSN 0887-6185. 99. doi: 10.1016/j.janxdis.2023.102768. Full text in Research Archive
• Freichel, René; Skjerdingstad, Nora Paulsen; Mansueto, Alessandra C.; Epskamp, Sacha; Hoffart, Asle & Johnson, Sverre Urnes [Show all 7 contributors for this article] (2023). Use of Substances to Cope Predicts Posttraumatic Stress Disorder Symptom Persistence: Investigating Patterns of Interactions Between Symptoms and Its Maintaining Mechanisms. Psychological Trauma. ISSN 1942-9681. p. 1–10. doi: 10.1037/tra0001624. Full text in Research Archive
• Bjørndal, Ludvig Daae; Ebrahimi, Omid Vakili; Lan, Xiaoyu; Nes, Ragnhild Bang & Røysamb, Espen (2023). Mental Health and Environmental Factors in Adults: A Population-Based Network Analysis. American Psychologist. ISSN 0003-066X. doi: 10.1037/amp0001208. Full text in Research Archive
• Hoffart, Asle; Burger, Julian; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2022). Daily dynamics and mechanisms of anxious symptomatology in the general population: A network study during the COVID-19 pandemic. Journal of Anxiety Disorders. ISSN 0887-6185. doi: 10.1016/j.janxdis.2022.102658. Full text in Research Archive
• Ebrahimi, Omid Vakili (2022). Visa bureaucracy makes scientific conferences inaccessible for too many researchers. Science. ISSN 0036-8075. doi: 10.1126/science.caredit.adf9304. Full text in Research Archive
• Nordbø, Sara Ebling; Ebrahimi, Omid Vakili; Johnson, Sverre Urnes; Skjerdingstad, Nora & Hoffart, Asle (2022). Psychological well-being in times of COVID-19: Associated factors and levels in the general population. Frontiers in Public Health. 10:86086, p. 1–12. doi: 10.3389/fpubh.2022.860863. Full text in Research Archive Show summary

  The COVID-19 pandemic and living under social distancing restrictions have been hypothesized to impact well-being and mental health in the general population. This study investigated the general Norwegian adult population's well-being after implementing and lifting strict social distancing restrictions. The study was conducted through digital surveys; during the implementation of strict social distancing restrictions in March 2020 (T1) and 3 months later, when the preponderance of strict distancing restrictions was discontinued (T2). Well-being was measured at T2. Four thousand nine hundred twenty-one individuals participated, and a sensitivity analysis was conducted to ensure that the sample reflects the true Norwegian adult population. Hierarchical regression analyses show that contemporaneous employment status and positive metacognitions at T2 were associated with higher well-being. Negative metacognitions and the use of unhelpful coping strategies at T2 had a contemporaneous association with lower mental well-being. Negative metacognitions at T1 were associated with lower well-being scores, while positive metacognitions at T1 were positively associated with higher well-being. An indirect association between social distancing and lower well-being was found through heightened depressive symptoms. These results contribute to understanding how social distancing restrictions relate to general well-being, which may further contribute to designing proper strategies to strengthen mental health and well-being during challenging and unavoidable societal conditions.

• Nordahl, Henrik; Ebrahimi, Omid V.; Hoffart, Asle & Johnson, Sverre Urnes (2022). Trait Versus State Predictors of Emotional Distress Symptoms: The Role of the Big-5 Personality Traits, Metacognitive Beliefs, and Strategies. Journal of Nervous and Mental Disease. ISSN 0022-3018. 210(12), p. 943–950. doi: 10.1097/NMD.0000000000001557. Full text in Research Archive Show summary

  To enhance formulation and interventions for emotional distress symptoms, research should aim to identify factors that contribute to distress and disorder. One way to formulate emotional distress symptoms is to view them as state manifestations of underlying personality traits. However, the metacognitive model suggests that emotional distress is maintained by metacognitive strategies directed by underlying metacognitive beliefs. The aim of the present study was therefore to evaluate the role of these factors as predictors of anxiety and depression symptoms in a cross-sectional sample of 4936 participants collected during the COVID-19 pandemic. Personality traits (especially neuroticism) were linked to anxiety and depression, but metacognitive beliefs and strategies accounted for additional variance. Among the predictors, metacognitive strategies accounted for the most variance in symptoms. Furthermore, we evaluated two statistical models based on personality traits versus metacognitions and found that the latter provided the best fit. Thus, these findings indicate that emotional distress symptoms are maintained by metacognitive strategies that are better accounted for by metacognitions compared with personality traits. Theoretical and clinical implications of these findings are discussed.

• Ebrahimi, Omid Vakili (2022). Why scientific conferences must mitigate structural barriers. Nature Human Behaviour. 6(8), p. 1032–1033. doi: 10.1038/s41562-022-01417-4. Full text in Research Archive
• Johnson, Sverre Urnes; Amundsen, Ole Myklebust; Johnson, Miriam S.; Hoffart, Asle; Halsøy, Øyvind & Skjerdingstad, Nora [Show all 8 contributors for this article] (2022). Psychiatric symptoms in COVID-19-positive individuals in the general population: Trajectories of depression, anxiety, and insomnia. Psychiatry Research. ISSN 0165-1781. 317. doi: 10.1016/j.psychres.2022.114806. Full text in Research Archive Show summary

  The present study investigates differences in the trajectories of anxiety, depression, and sleep problems among infected versus non-infected case-controlled individuals. Patients who tested positive for COVID-19 were selected from a representative sample in Norway (N > 10,000). In total, 126 of these individuals were infected during the project period, and this group was analyzed at T5 (May 2021). Of these positive cases, those who had completed both PHQ-9 and GAD-7 at all three measurement points were selected for longitudinal analysis using multilevel modeling. There was a significant difference at T5 between those who had tested positive for COVID-19 and matched controls. Anxiety and depression were reduced among those who tested positive, but there were no differences in trajectory when compared to matched controls. Limitations include the use of self-report measures and the assessment of symptoms at a time when strict virus mitigation protocols were in place. The present findings indicate that individuals who test positive for COVID-19 exhibit higher levels of depressive symptoms after restrictions are lifted. However, comparison of anxiety and depression symptom trajectories with matched controls reveals that both groups exhibited stable or slightly decreased symptoms.

• Cheng, Cecilia; Ebrahimi, Omid Vakili & Luk, Jeremy W. (2022). Heterogeneity of Prevalence of Social Media Addiction Across Multiple Classification Schemes: Latent Profile Analysis. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 24(1). doi: 10.2196/27000. Full text in Research Archive Show summary

  Background As social media is a major channel of interpersonal communication in the digital age, social media addiction has emerged as a novel mental health issue that has raised considerable concerns among researchers, health professionals, policy makers, mass media, and the general public. Objective The aim of this study is to examine the prevalence of social media addiction derived from 4 major classification schemes (strict monothetic, strict polythetic, monothetic, and polythetic), with latent profiles embedded in the empirical data adopted as the benchmark for comparison. The extent of matching between the classification of each scheme and the actual data pattern was evaluated using sensitivity and specificity analyses. The associations between social media addiction and 2 comorbid mental health conditions—depression and anxiety—were investigated. Methods A cross-sectional web-based survey was conducted, and the replicability of findings was assessed in 2 independent samples comprising 573 adults from the United Kingdom (261/573, 45.6% men; mean age 43.62 years, SD 12.24 years) and 474 adults from the United States (224/474, 47.4% men; mean age 44.67 years, SD 12.99 years). The demographic characteristics of both samples were similar to those of their respective populations. Results The prevalence estimates of social media addiction varied across the classification schemes, ranging from 1% to 15% for the UK sample and 0% to 11% for the US sample. The latent profile analysis identified 3 latent groups for both samples: low-risk, at-risk, and high-risk. The sensitivity, specificity, and negative predictive values were high (83%-100%) for all classification schemes, except for the relatively lower sensitivity (73%-74%) for the polythetic scheme. However, the polythetic scheme had high positive predictive values (88%-94%), whereas such values were low (2%-43%) for the other 3 classification schemes. The group membership yielded by the polythetic scheme was largely consistent (95%-96%) with that of the benchmark. Conclusions Among the classification schemes, the polythetic scheme is more well-balanced across all 4 indices.

• Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2022). Mechanisms associated with the trajectory of depressive and anxiety symptoms: A linear mixed-effects model during the COVID-19 Pandemic. Current Psychology. ISSN 1046-1310. doi: 10.1007/s12144-022-02732-9. Full text in Research Archive Show summary

  Abstract With the fluctuations in anxious and depressive symptomatology accompanied by the pandemic crises, studies on the trajectories of these symptom domains are warranted to monitor the development of mental health problems in the population. This pre-registered longitudinal study examines stable factors and mechanistic processes covarying with the trajectory of anxiety and depressive symptoms using linear-mixed effects models in 4936 adults from the pandemic’s onset to four months into the COVID-19 pandemic in Norway. Prevalence estimates of moderate to severe levels of clinically impairing symptoms of anxiety and depression revealed high but reduced occurrence four months into the pandemic where social distancing protocols were substantially lightened in severity, revealing associations between symptoms and viral mitigation protocols after stringent control of plausible confounders. Subgroups at risk at the onset of the pandemic sustained their relative position compared to their counterparts four months into the pandemic, indicating prolonged suffering of these subgroups. Among mechanistic processes, key differences were identified regarding the trajectory of anxiety and depressive symptoms. Physical exercise was associated with long-term but not momentaneous alleviations in anxiety. In contrast, reductions in depressive symptoms were associated with both the simultaneous exertion as well as dose-increases in exercise over time. Increased knowledge about how to best cope with pandemic challenges was associated with greater improvement in depressive but not anxiety symptoms. Reductions in maladaptive coping strategies and negative metacognitive beliefs was substantially associated with greater improvement of both anxious and depressive symptomatology. Mechanistic processes divergently relate to the trajectory of depressive and anxious symptomatology, yielding domain-specific information of utility for preventive and interventive efforts aimed at impeding deleterious symptom levels.

• Cheng, Cecilia & Ebrahimi, Omid Vakili (2022). A meta-analytic review of gamified interventions in mental health enhancement. Computers in Human Behavior. ISSN 0747-5632. doi: 10.1016/j.chb.2022.107621. Full text in Research Archive
• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2022). Metacognitive beliefs, maladaptive coping strategies, and depressive symptoms: A two-wave network study of the COVID-19 lockdown and reopening. Journal of Psychiatric Research. ISSN 0022-3956. 152, p. 70–78. doi: 10.1016/j.jpsychires.2022.06.008. Full text in Research Archive
• Karnbach, Katharina; Witkowski, Michal; Ebrahimi, Omid V. & Burger, Julian (2022). Back to life, back to reality: A multi-level dynamic network analysis of student mental health upon return to campus during the COVID-19 pandemic. Current Psychology. ISSN 1046-1310. doi: 10.1007/s12144-022-03196-7. Full text in Research Archive Show summary

  Lockdown measures during the COVID-19 pandemic resulted in drastic disruptions of university students' everyday life and study mode, such as marked reductions in face-to-face teaching activities. Previous research on student mental health during the pandemic found that prolonged campus relocation had negative effects on students' mental well-being. However, these studies focussed on the initial lockdown period, or periods of active lockdown measures. This longitudinal study collected 456 observations of 23 undergraduate students in the Netherlands using ecological momentary assessment data on mental health related items (anxiety, stress, social context) during the first two weeks of on-campus teaching after prolonged lock-down measures. Using multi-level dynamic network modelling, we anlysed the temporal and contemporaneous interplay of students' mental health factors following the return to campus in September 2021. On average, students reported low to medium scores on stress and anxiety both before and after the assessment period. Results of network analyses showed that students experienced social unease in relation to accumulating difficulties at univeristy and vice versa. Furthermore, there were clusters of different states of social unease next to clusters of stress, anger, loss of control, and feeling upset. Lastly, we found beneficial effects of self-efficacy on experiencing social comfort in university. We discuss implications and concrete examples of interventions in universities, such as the promotion of self-efficacy, providing guidance in structuring study load, as well as help with stress management.

• Ebrahimi, Omid Vakili; Hoffart, Asle; Bauer, Daniel J. & Johnson, Sverre Urnes (2022). A Critical Period for Pandemic Adaptation: The Evolution of Depressive Symptomatology in a Representative Sample of Adults Across a 17-Month Period During COVID-19. Journal of Psychopathology and Clinical Science. ISSN 2769-7541. doi: 10.1037/abn0000786. Full text in Research Archive
• Hoffart, Asle; Bauer, Daniel J.; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2022). Anxiety in the adult population from the onset to termination of social distancing protocols during the COVID-19: a 20-month longitudinal study. Scientific Reports. 12(1), p. 1–13. doi: 10.1038/s41598-022-22686-z. Full text in Research Archive Show summary

  The social distancing protocols (SDPs) implemented as a response to the COVID-19 pandemic may seriously influence people's mental health. We used a sample of 4361 Norwegian adults recruited online and stratified to be nationally representative to investigate the evolution of anxiety following each modification in national SDPs across a 20-month period from the onset of the pandemic to the reopening of society and discontinuation of SDPs. The mean anxiety level fluctuated throughout the observation period and these fluctuations were related to the stringency of the modified SDPs. Those with a high initial level almost in unison showed a substantial and lasting decrease of anxiety after the first lifting of SDPs. A sub-group of 9% had developed a persistent anxiety state during the first 3 months. Younger age, pre-existing psychiatric diagnosis, and use of unverified information platforms proved to predict marked higher anxiety in the long run. In conclusion, individuals with a high level of anxiety at the outbreak of the pandemic improved when the social distancing protocols were lifted. By contrast, a sizeable subgroup developed lasting clinical levels of anxiety during hte first 3 months of the pandemic and is vulnerable to prolonged anxiety beyond the pandemic period.

• Magnúsdóttir, Ingibjörg; Lovik, Anikó; Unnarsdóttir, Anna Bára; McCartney, Daniel L.; Ask, Helga & Kõiv, Kadri [Show all 23 contributors for this article] (2022). Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study. The Lancet Public Health. ISSN 2468-2667. 7(5), p. 406–416. doi: 10.1016/S2468-2667(22)00042-1. Full text in Research Archive Show summary

  <p><b>Background</b> Long-term mental and physical health consequences of COVID-19 (long COVID) are a persistent public health concern. Little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities. Our aim was to assess the prevalence of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis. <p><b>Methods</b> This observational follow-up study included seven prospectively planned cohorts across six countries (Denmark, Estonia, Iceland, Norway, Sweden, and the UK). Participants were recruited from March 27, 2020, to Aug 13, 2021. Individuals aged 18 years or older were eligible to participate. In a cross-sectional analysis, we contrasted symptom prevalence of depression, anxiety, COVID-19-related distress, and poor sleep quality (screened with validated mental health instruments) among individuals with and without a diagnosis of COVID-19 at entry, 0–16 months from diagnosis. In a cohort analysis, we further used repeated measures to estimate the change in mental health symptoms before and after COVID-19 diagnosis. <p><b>Findings</b> The analytical cohort consisted of 247 249 individuals, 9979 (4·0%) of whom were diagnosed with COVID-19 during the study period. Mean follow-up was 5·65 months (SD 4·26). Participants diagnosed with COVID-19 presented overall with a higher prevalence of symptoms of depression (prevalence ratio [PR] 1·18 [95% CI 1·03–1·36]) and poorer sleep quality (1·13 [1·03–1·24]) but not symptoms of anxiety (0·97 [0·91–1·03]) or COVID-19-related distress (1·05 [0·93–1·20]) compared with individuals without a COVID-19 diagnosis. Although the prevalence of depression and COVID-19-related distress attenuated with time, individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risk of depression (PR 0·83 [95% CI 0·75–0·91]) and anxiety (0·77 [0·63–0·94]) than those not diagnosed with COVID-19, whereas patients who were bedridden for more than 7 days were persistently at higher risk of symptoms of depression (PR 1·61 [95% CI 1·27–2·05]) and anxiety (1·43 [1·26–1·63]) than those not diagnosed throughout the study period. <p><b>Interpretation</b> Severe acute COVID-19 illness—indicated by extended time bedridden—is associated with long-term mental morbidity among recovering individuals in the general population. These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19.<p><b>Funding</b> Nordforsk, Horizon2020, Wellcome Trust, and Estonian Research Council.

• Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2021). Viral mitigation and the COVID-19 pandemic: factors associated with adherence to social distancing protocols and hygienic behaviour. Psychology and Health. ISSN 0887-0446. doi: 10.1080/08870446.2021.1960987. Full text in Research Archive Show summary

  Objective To investigate the factors associated with adherence to viral mitigation protocols during the COVID-19 pandemic. Design This epidemiological cross-sectional study examines adherence to behaviour in 4158 adults and its relationship with sources of information. Main outcome measures Adherence to social distancing protocols (SDPs) and adherence to hygienic behaviour (HB) recommendations. Results Individuals aged 18–30 reported lowest adherence to SDPs and HB. Alcohol consumption was associated with lower adherence. Increased risk perception, fear of infection and altruistic attitude were associated with greater adherence. Males, single and childless individuals reported lower adherence. Extroverts and urban residents reported lower adherence to SDPs, but not HB. In contrast to earlier stages of the pandemic, voluntary social distancing was associated with greater adherence to SDPs as opposed to rule-enforced social distancing. Regarding information obtainment, increased time spent acquiring information from recognised newspapers had the strongest favourable association with adherence. Relying on information from friends and family was associated with decreased adherence to SDPs. Sensitivity analyses replicated the findings, supporting the stability and robustness of the proposed models. Conclusion This study identifies factors associated with favourable and detrimental adherence behaviour along with substantial dissemination routes, presenting strategies that may be of utility towards fostering adherence to contemporaneously implemented mitigation protocols.

• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2021). Loneliness during the COVID-19 pandemic: change and predictors of change from strict to discontinued social distancing protocols. Anxiety, Stress, & Coping. ISSN 1061-5806. doi: 10.1080/10615806.2021.1958790. Full text in Research Archive
• Solbakken, Ole Andre; Ebrahimi, Omid Vakili; Hoffart, Asle; Monsen, Jon Trygve & Johnson, Sverre Urnes (2021). Emotion regulation difficulties and interpersonal problems during the COVID-19 Pandemic: Predicting anxiety and depression. Psychological Medicine. ISSN 0033-2917. doi: 10.1017/S0033291721001987. Full text in Research Archive
• Johnson, Miriam Sinkerud; Skjerdingstad, Nora; Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2021). Parenting in a Pandemic: Parental Stress, Anxiety and Depression Among Parents During the Government-Initiated Physical Distancing Measures Following the First Wave of COVID-19. Stress and Health. ISSN 1532-3005. p. 1–16. doi: 10.1002/smi.3120. Full text in Research Archive Show summary

  Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk- and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2868; 79.5% mothers) with >1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents towards children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger towards their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents towards children explains 41% of the variation in parental stress. These findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID- 19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso- and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted.

• Cheng, Cecilia; Wang, Hsin-yi & Ebrahimi, Omid Vakili (2021). Adjustment to a “New Normal:” Coping Flexibility and Mental Health Issues During the COVID-19 Pandemic. Frontiers in Psychiatry. doi: 10.3389/fpsyt.2021.626197. Full text in Research Archive Show summary

  The Coronavirus Disease 2019 (COVID-19) pandemic is an unprecedented health crisis in terms of the scope of its impact on well-being. The sudden need to navigate this “new normal” has compromised the mental health of many people. Coping flexibility, defined as the astute deployment of coping strategies to meet specific situational demands, is proposed as an adaptive quality during this period of upheaval. The present study investigated the associations between coping flexibility and two common mental health problems: COVID-19 anxiety and depression. The respondents were 481 Hong Kong adults (41% men; mean age = 45.09) who took part in a population-based telephone survey conducted from April to May 2020. Self-report data were assessed with the Coping Flexibility Interview Schedule, COVID-19-Related Perception and Anxiety Scale, and Center for Epidemiological Studies Depression Scale. Slightly more than half (52%) of the sample met the criteria for probable depression. Four types of COVID-19 anxiety were identified: anxiety over personal health, others' reactions, societal health, and economic problems. The results consistently revealed coping flexibility to be inversely associated with depression and all four types of COVID-19 anxiety. More importantly, there was a significant interaction between perceived likelihood of COVID-19 infection and coping flexibility on COVID-19 anxiety over personal health. These findings shed light on the beneficial role of coping flexibility in adjusting to the “new normal” amid the COVID-19 pandemic.

• Halsøy, Øyvind; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2021). Insomnia Symptoms in the General Population During the COVID-19 Pandemic. Frontiers in Psychiatry. 12. doi: 10.3389/fpsyt.2021.762799. Full text in Research Archive Show summary

  This empirical study aims to investigate factors associated with insomnia symptoms during the COVID-19 pandemic in 4,921 Norwegian adults. Participants were queried across two time-points, between March 31 st and April the 7th 2020, and between June 22nd and July 13th, 2020. Relevant risk factors and psychological correlates at the first time-point and insomnia symptoms were measured 3 months later, allowing for the investigation of concurrent associations as well as associations across time. Insomnia symptoms were measured with the Bergen Insomnia Scale. The results revealed that individuals reported higher mean levels of insomnia symptoms during the COVID-19 lockdown, compared to pre-pandemic surveys from 2008 ( p &amp;lt; 0.0001, Cohen's d = 0.29). Individuals who predominantly socially distanced reported higher mean levels of insomnia symptoms than those who did not predominantly distance. Females, individuals with lower education levels, individuals who had lost their job, and individuals who declared having been diagnosed with an unspecified pre-existing psychiatric disorder reported the most symptoms. The regression model (R 2 = 0.44) showed that physical exercise, was associated with less symptoms of insomnia. Symptoms of health Anxiety, symptoms of depression, unhelpful coping strategies, worry about job and economy, and older age were all associated with higher levels of insomnia symptoms. These findings highlight particularly vulnerable subgroups, as well as providing clinicians with key areas of intervention to help individuals suffering from insomnia symptoms.

• Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2021). Physical Distancing and Mental Health During the COVID-19 Pandemic: Factors Associated With Psychological Symptoms and Adherence to Pandemic Mitigation Strategies. Clinical Psychological Science. ISSN 2167-7026. 9(3), p. 489–506. doi: 10.1177/2167702621994545. Full text in Research Archive Show summary

  In this epidemiological investigation, we assessed the prevalence of depression and anxiety symptoms during the COVID-19 pandemic. A total of 10,061 adults participated in the study. Symptoms of depression and anxiety were 2 to 3 times higher compared with prepandemic samples. Participants who predominantly socially distanced themselves revealed substantially higher symptoms than their counterparts. Females, ethnic and sexual-orientation minorities, younger adults, unemployed individuals, and participants with a psychiatric diagnosis reported higher prevalence of psychological symptoms. Worry about prolonged duration of physical-distancing protocols and frustration of autonomy was associated with elevation in symptoms of depression and anxiety. Increased competence to deal with the pandemic crisis was associated with fewer adverse symptoms. Physical exercise, experiencing nature, and distraction with activities were associated with reduced depressive symptoms but not anxiety. The extent of information access about the pandemic was associated with reduced anxiety symptoms. Furthermore, adherence to mitigation protocols was investigated. Younger adults and males reported lowest adherence. Altruistic attitudes, in addition to mandatory as opposed to voluntary adherence, were associated with higher adherence rates. Worrying about the health of significant others was associated with higher adherence rates, whereas worry about duration of pandemic protocols was associated with lower adherence rates.

• Skjerdingstad, Nora; Johnson, Miriam Sinkerud; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2021). Parental burnout during the COVID-19 pandemic. Family Process. ISSN 0014-7370. p. 1–15. doi: 10.1111/famp.12740. Full text in Research Archive Show summary

  Increased and long-term parental stress related to one's parental role can lead to parental burnout. In the early phase of the COVID-19 pandemic, families experienced intensified pressure due to the government-initiated contact restrictions applied to prevent the spread of the virus in the population. This study investigates the risk factors and predictors of parental burnout in a large sample of parents (N = 1488) during the COVID-19 pandemic in Norway. Demographic and psychosocial factors were assessed at two timepoints: at the beginning of the pandemic outbreak in March 2020 (T1) and at 3 months follow-up (T2). A hierarchical regression analysis was applied to identify the factors that contribute to parental burnout at T2. Parental burnout was additionally explored across subgroups. Findings revealed that younger age was associated with more parental burnout. Concurrent (T2) use of unhelpful coping strategies, insomnia symptoms, parental stress, and less parental satisfaction was significantly associated with the presence of greater parental burnout (T2). Additionally, parental stress and satisfaction measured in the earliest phase of the pandemic (T1) were associated with parental burnout 3 months later (T2) over and above concurrent parental stress/satisfaction. Unemployed parents and individuals with a mental health condition were identified as subgroups with substantially heightened levels of parental burnout.

• Skjerdingstad, Nora; Johnson, Miriam Sinkerud; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2021). Feelings of Worthlessness Links Depressive Symptoms and Parental Stress: A Network Analysis during the COVID-19 Pandemic. European psychiatry. ISSN 0924-9338. 64(1), p. 1–10. doi: 10.1192/j.eurpsy.2021.2223. Full text in Research Archive Show summary

  Background. The prevalent co-occurrence between parental stress and depression has been established prior to and during the COVID-19 pandemic outbreak. However, no studies to date have identified the connections through which these symptom domains interact with each other to emerge into a complex and detrimental mental health state, along with the plausible mechanistic variables that may play key roles in maintaining parental stress and depression. The aim of this research is to uncover these interactions in a period where parents experience heightened demands and stress because of the strict social distancing protocols. Methods: Network analysis is utilized to examine parental stress and depressive symptoms during the COVID-19 pandemic in a large cross-sectional study (N = 2,868) of parents. Two graphical Gaussian graphical network models were estimated, one in which only parental stress and depression symptoms were included, and another in which several mechanistic variables were added. Results: Expected influence and bridge expected influence revealed that feeling worthless was the most influential node in the symptoms network and bridged the two psychological states. Among the mechanistic variables, worry and rumination was specifically relevant in the depressive cluster of symptoms, and self-criticism was connected to both constructs. Conclusion: The study displays that the co-occurrence of parental stress and depression has specific pathways, was manifested through feelings of worthlessness, and has specific patterns of connection to important mechanisms of psychopathology. The results are of utility when aiming to avoid the constellation of co-occurring parental stress and depressive symptoms during the pandemic.

• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2021). The network of stress-related states and depression and anxiety symptoms during the COVID-19 lockdown. Journal of Affective Disorders. ISSN 0165-0327. doi: 10.1016/j.jad.2021.07.019. Full text in Research Archive
• Amundsen, Ole Myklebust; Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid V. (2021). Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study. JMIR Formative Research. 5(12). doi: 10.2196/28239. Full text in Research Archive Show summary

  Background: The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals. Objective: This study aimed to investigate whether and to what extent higher levels of COVID-19–related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19–related information is associated with the aforementioned symptoms. Methods: In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19–related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01. Results: The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19–related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007). Conclusions: This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19–related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment.

• Ebrahimi, Omid Vakili; Burger, Julian; Hoffart, Asle & Johnson, Sverre Urnes (2021). Within- and across-day patterns of interplay between depressive symptoms and related psychopathological processes: a dynamic network approach during the COVID-19 pandemic. BMC Medicine. 19(1), p. 1–17. doi: 10.1186/s12916-021-02179-y. Full text in Research Archive Show summary

  Background In order to understand the intricate patterns of interplay connected to the formation and maintenance of depressive symptomatology, repeated measures investigations focusing on within-person relationships between psychopathological mechanisms and depressive components are required. Methods This large-scale preregistered intensive longitudinal study conducted 68,240 observations of 1706 individuals in the general adult population across a 40-day period during the COVID-19 pandemic to identify the detrimental processes involved in depressive states. Daily responses were modeled using multi-level dynamic network analysis to investigate the temporal associations across days, in addition to contemporaneous relationships between depressive components within a daily window. Results Among the investigated psychopathological mechanisms, helplessness predicted the strongest across-day influence on depressive symptoms, while emotion regulation difficulties displayed more proximal interactions with symptomatology. Helplessness was further involved in the amplification of other theorized psychopathological mechanisms including rumination, the latter of which to a greater extent was susceptible toward being influenced rather than temporally influencing other components of depressive states. Distinctive symptoms of depression behaved differently, with depressed mood and anhedonia most prone to being impacted, while lethargy and worthlessness were more strongly associated with outgoing activity in the network. Conclusions The main mechanism predicting the amplifications of detrimental symptomatology was helplessness. Lethargy and worthlessness revealed greater within-person carry-over effects across days, providing preliminary indications that these symptoms may be more strongly associated with pushing individuals toward prolonged depressive state experiences. The psychopathological processes of rumination, helplessness, and emotion regulation only exhibited interactions with the depressed mood and worthlessness component of depression, being unrelated to lethargy and anhedonia. The findings have implications for the impediment of depressive symptomatology during and beyond the pandemic period. They further outline the gaps in the literature concerning the identification of psychopathological processes intertwined with lethargy and anhedonia on the within-person level.

• Johnson, Miriam Sinkerud; Skjerdingstad, Nora; Ebrahimi, Omid V.; Hoffart, Asle & Johnson, Sverre Urnes (2021). Mechanisms of parental distress during and after the first COVID-19 lockdown phase: A two-wave longitudinal study. PLOS ONE. 16(6), p. 1–17. doi: 10.1371/journal.pone.0253087. Full text in Research Archive Show summary

  Background: In these unpredictable times of the global coronavirus disease 2019 (COVID-19) pandemic, parents worldwide are affected by the stress and strain caused by the physical distancing protocols that have been put in place. Objective: In a two-wave longitudinal survey, we investigated the levels of parental stress and symptoms of anxiety and depression in a sample of parents at two time points; during the implementation of the strictest physical distancing protocols following the onset of the COVID-19 pandemic (T1, N = 2,868) and three months after the discontinuation of the protocols (T2, N = 1,489). Further, we investigated the relationships between parental stress and anxiety and depression relative to relationship quality and anger toward their children at the two aforementioned time points, including subgroups based on age, parental role, cultural background, relationship status, education level, number of children, employment status and pre-existing psychiatric diagnosis. Methods and findings: Parents were asked to fill out a set of validated questionnaires on the two measurement points. Parental stress significantly decreased from T1 to T2, indicating that the cumulative stress that parents experienced during the implementation of the distancing protocols declined when the protocols were phased out. The decrease of perceived parental stress was accompanied by a significant decrease in the symptoms of both depression and anxiety among the participating parents. Symptoms meeting the clinical cut-offs for depression (23.0%) and generalized anxiety disorder (23.3%) were reported among participating parents at T1, compared to 16.8% and 13.8% at T2, respectively. The reduction in depression and anger toward their child(ren) from T1 to T2 was associated with a reduction of parental stress. Relationship quality and anger toward their child(ren) at T1 further predicted a change in the level of parental stress from T1 to T2. Conclusions: The study underlines the negative psychological impacts of the implementation of the distancing protocols on parents’ health and well-being. Uncovering the nature of how these constructs are associated with parents and families facing a social crisis such as the ongoing pandemic may contribute to the design of relevant interventions to reduce parental distress and strengthen parental coping and resilience.

• Ebrahimi, Omid Vakili; Johnson, Miriam Sinkerud; Ebling, Sara; Amundsen, Ole Myklebust; Halsøy, Øyvind & Hoffart, Asle [Show all 8 contributors for this article] (2021). Risk, Trust, and Flawed Assumptions: Vaccine Hesitancy During the COVID-19 Pandemic. Frontiers in Public Health. 9. doi: 10.3389/fpubh.2021.700213. Full text in Research Archive Show summary

  Background: The pace at which the present pandemic and future public health crises involving viral infections are eradicated heavily depends on the availability and routine implementation of vaccines. This process is further affected by a willingness to vaccinate, embedded in the phenomenon of vaccine hesitancy. The World Health Organization has listed vaccine hesitancy among the greatest threats to global health, calling for research to identify the factors associated with this phenomenon. Methods: The present cross-sectional study seeks to investigate the psychological, contextual, and sociodemographic factors associated with vaccination hesitancy in a large sample of the adult population. 4,571 Norwegian adults were recruited through an online survey between January 23 to February 2, 2021. Subgroup analyzes and multiple logistic regression was utilized to identify the covariates of vaccine hesitancy. Results: Several subgroups hesitant toward vaccination were identified, including males, rural residents, and parents with children below 18 years of age. No differences were found between natives and non-natives, across education or age groups. Individuals preferring unmonitored media platforms (e.g., information from peers, social media, online forums, and blogs) more frequently reported hesitance toward vaccination than those relying on information obtainment from source-verified platforms. Perceived risk of vaccination, belief in the superiority of natural immunity, fear concerning significant others being infected by the virus, and trust in health officials' dissemination of vaccine-related information were identified as key variables related to vaccine hesitancy. Conclusion: Given the heterogeneous range of variables associated with vaccine hesitancy, additional strategies to eradicate vaccination fears are called for aside from campaigns targeting the spread of false information. Responding to affective reactions in addition to involving other community leaders besides government and health officials present promising approaches that may aid in combating vaccination hesitation.

• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid V. (2020). Loneliness and social distancing during the COVID-19 pandemic: Risk factors and associations with psychopathology. Frontiers in Psychiatry. 11:589127, p. 1–9. doi: 10.3389/fpsyt.2020.589127. Full text in Research Archive Show summary

  Background: The mitigation strategies employed against the COVID-19 pandemic have severe mental health consequences. In particular, as a result of the social distancing protocols, loneliness is likely to increase. This study investigates (a) potential risk and resilience factors for loneliness in the Norwegian population during the strict social distancing non-pharmacological interventions (NPIs) implemented against the pandemic and (b) the associations between loneliness and psychopathology symptoms. Methods: A survey was disseminated online to the adult Norwegian population when strict social distancing measures had been implemented for 2 weeks. The resulting sample of 10,061 respondents was unproportionate in terms of gender and educational level and thus sensitivity analyses were conducted. The levels of loneliness were compared across demographic sub-groups, and regression analyses were conducted to identify potential risk and resilience factors for loneliness and associations between loneliness and psychopathology symptoms. Results: Among the stable factors, being single and having a psychiatric diagnosis were related to more loneliness with small effect sizes. Among the state risk factors, more rumination and worry in general were associated with stronger loneliness, showing a medium effect size. Among the coping behaviors examined, doing new things at home not done otherwise was negatively related to loneliness, with a small effect size. Loneliness was associated with both depression and anxiety with small effect sizes when all potential confounders and psychiatric diagnosis were controlled for. The relationship to depression was more marked than the relationship to anxiety. Conclusions: The findings suggest that singles and those with a psychiatric diagnosis were most affected by loneliness during the implementation of social distancing measures to impede the coronavirus. The results support the link between loneliness and depression and anxiety symptoms. The results of the analysis of potential risk and resilience factors point to intervention targets for reducing loneliness during pandemic crises.

• Johnson, Sverre Urnes; Ebrahimi, Omid V. & Hoffart, Asle (2020). PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLOS ONE. doi: 10.1371/journal.pone.0241032. Full text in Research Archive Show summary

  In the frontline of the pandemic stand healthcare workers and public service providers, occupations which have proven to be associated with increased mental health problems during pandemic crises. This cross-sectional, survey-based study collected data from 1773 healthcare workers and public service providers throughout Norway between March 31, 2020 and April 7, 2020, which encompasses a timeframe where all non-pharmacological interventions (NPIs) were held constant. Post-traumatic stress disorder (PTSD), anxiety and depression were assessed by the Norwegian version of the PTSD checklist (PCL-5), General Anxiety Disorder –7, and Patient Health Questionnaire-9 (PHQ-9), respectively. Health anxiety and specific predictors were assessed with specific items. Multiple regression analysis was used for predictor analysis. A total of 28.9% of the sample had clinical or subclinical symptoms of PTSD, and 21.2% and 20.5% were above the established cut-offs for anxiety and depression. Those working directly in contrast to indirectly with COVID-19 patients had significantly higher PTSD symptoms. Worries about job and economy, negative metacognitions, burnout, health anxiety and emotional support were significantly associated with PTSD symptoms, after controlling for demographic variables and psychological symptoms. Health workers and public service providers are experiencing high levels of PTSD symptoms, anxiety and depression during the COVID-19 pandemic. Health workers working directly with COVID-19 patients have significantly higher levels of PTSD symptoms and depression compared to those working indirectly. Appropriate action to monitor and reduce PTSD, anxiety, and depression among these groups of individuals working in the frontline of pandemic with crucial societal roles should be taken immediately.

• Cheng, Cecilia; Ebrahimi, Omid V. & Lau, Yan-ching (2020). Maladaptive coping with the infodemic and sleep disturbance in the COVID‐19 pandemic. Journal of Sleep Research. ISSN 0962-1105. doi: 10.1111/jsr.13235. Full text in Research Archive
• Ebrahimi, Omid V.; Pallesen, Ståle; Kenter, Robin Maria Francisca & Nordgreen, Tine (2019). Psychological interventions for the Fear of Public Speaking: A Meta-analysis. Frontiers in Psychology. 10:488, p. 1–27. doi: 10.3389/fpsyg.2019.00488. Full text in Research Archive Show summary

  Background: Fear of Public Speaking (FoPS) or public speaking anxiety is a type of social anxiety and the single most commonly feared situation in the population. FoPS is disabling with negative occupational, academic, and social consequences, reported by up to one third of the population. FoPS in adolescence and adulthood is associated with an increased risk of developing generalized social anxiety disorder with further impairments. Since the last review on FoPS, a significant number of randomized controlled trials (RCTs) have been conducted assessing the effects of novel interventions with innovative modes of delivery. Objectives: The objectives of the present meta-analysis are to (1) examine the short and long-term effects of psychological interventions aimed at FoPS on FoPS and generalized social anxiety; (2) assess whether differences exist between technology-assisted modes of delivery (e.g., Internet-delivered therapies) and more traditional modes of delivering treatment (e.g., face-to-face therapies); (3) investigate whether differences in effect exist between theoretical frameworks; (4) inspect the differences in effect size between self-report measures and other measures (i.e., physiological and behavioral); (5) examine the effects of psychological interventions aimed at FoPS on secondary outcome measures (e.g., depression); and (6) investigate whether a “sleeper effect” is present for psychological interventions for FoPS and generalized social anxiety. Methods: The study investigates the effects of psychological interventions for FoPS through a quantitative meta-analysis of RCTs, using a random-effects model. Results: A total of 30 RCTs with 1,355 participants were included through systematic searches of PsycINFO, MEDLINE, Web of Science, and Cochrane Library. The majority of the studies investigated the effects of cognitive or behavioral interventions. Nearly half of the studies used active control groups (e.g., attention placebo), whereas the other half used passive (e.g., waitlist) controls. The overall effect of psychological interventions for FoPS across 62 interventions was 0.74 (Hedges g; 95% CI: 0.61–0.87) with low to moderate heterogeneity. No difference in effect was found across theoretical frameworks. The effects based on self-report measures were larger compared to physiological and behavioral outcomes. Effects were robust against both active and passive control groups. Furthermore, psychological interventions for FoPS had a small to moderate effect on generalized social anxiety disorder (g = 0.35; 95% CI: 0.22–0.48). The effect of psychological interventions aimed at FoPS at follow-up was large (g = 1.11, 95% CI: 0.90–1.31) and moderate to large for generalized social anxiety (g = 0.70, 95% CI: 0.59–0.80). A sleeper effect was found for cognitive and behavioral interventions, indicating that patients continued to improve after treatment termination. There were some indications of publication bias. Conclusions: Psychological interventions are effective in reducing FoPS. Interventions using technology-assisted modes of delivery are equally effective as traditional face-to-face interventions in reducing FoPS. This finding highlights an opportunity to increase access to evidence-based treatments through technology-delivered interventions, which can be implemented at schools, in primary care and specialist mental health care. Moreover, psychological interventions aimed at FoPS have an effect on generalized social anxiety. Further implications are discussed.

View all works in NVA

• Bjørndal, Ludvig Daae; Nes, Ragnhild Bang; Ebrahimi, Omid V. & Røysamb, Espen (2024). Multiple social factors are associated with wellbeing measured cross-sectionally and six years later when accounting for shared genetic and environmental confounding. Full text in Research Archive
• Curreri, Andrew J.; Ebrahimi, Omid V.; Rosellini, Anthony Joseph; J., Farchione Todd & Barlow, David H. (2020). Convergent validity of the Multidimensional Emotional Disorder Inventory across Cognitive Behavior Therapy. Full text in Research Archive
• Ebrahimi, Omid V. (2024). The COVID-19 Pandemic as a Critical Incident and its Impact on Depression. Universitetet i Oslo. Full text in Research Archive Show summary

  The COVID-19 pandemic is a critical incident that has been accompanied by drastic and sudden changes in individuals’ daily lives and societal functioning. Beyond the mental distress tied to the uncertainty and fear of an unknown virus, the pandemic’s concomitant social distancing protocols have been suggested to pose a significant burden on individuals. The abrupt changes in individuals’ everyday lives resulting from these measures prompted early concerns about mental health and depressive symptoms in the population. This doctoral thesis examines the impact of the COVID-19 pandemic and its accompanying distancing protocols in connection with depressive symptoms in the general adult population in Norway over a two-year period. The project spans from March 2020, ensuing the initial implementation of social distancing protocols in Norway, to March 2022, where these protocols were discontinued. The thesis encompasses three longitudinal studies that investigate depressive symptomatology during the pandemic across different levels of granularity. Study 1 followed 4,361 adults (≥ 18 years) over the first 1.5 years of the pandemic across six longitudinal assessment waves, forming 26,166 observations. The participants were measured upon each modification of national social distancing protocols, enabling investigation of the association between these protocols and changes in depressive symptomatology over time in the same group of individuals. Societal SARS-CoV-2 infection rates were further measured to investigate how this stressor was linked to depressive symptoms. Employing a non-linear longitudinal model (Latent Change Score Model), Study 1 identified that depressive symptom levels in the adult population were associated with social distancing protocols, but unrelated to infection rates. This contrasted with observed changes in anxious symptomatology, which were more closely related to societal SARS-CoV-2 infection rates. Longer periods of sustained social distancing protocols were related to prolonged periods of heightened depressive symptoms. Increasing the stringency of social distancing protocols was associated with higher levels of depressive symptoms, while reducing the stringency and discontinuation of these protocols was associated with subsequent reductions in depressive symptomatology. This demonstrated that, on the population level, the observed increases in depressive symptoms were temporary and decreased after the termination of these protocols. When examining depressive symptom change patterns on the individual level however, Study 1 identified a smaller subgroup of adults whose mental health had deteriorated during the pandemic. These findings indicated the presence of heterogeneous responses to the pandemic across adults. Study 2 investigated whether these individual differences could reveal subgroups of adults displaying distinct and prototypical depressive symptom change patterns during the pandemic. A Latent Change Score Mixture Model was applied to model change over time in 4,361 adults. Through the investigation of depressive symptom levels across nine assessment waves (39,259 observations) from March 2020 to March 2022, five distinct depressive symptom change profiles were identified. The majority of adults displayed either resilience to depressive symptoms (42.5%), or a temporary heightening (i.e. initial shock) in depressive symptomatology during the onset of the pandemic (13.2%). A third subgroup of individuals, predominantly with previous mental health difficulties, reported high levels of depressive symptoms that lasted from the onset throughout the pandemic period (8.5%). A fourth group of adults exhibited mild deterioration in depressive symptom levels during the pandemic (29.0%). A final subgroup of approximately 6.8% of adults displayed strong deterioration and clinically severe levels of gained symptoms occurring during the initial months of the pandemic, which was sustained over the two-year assessment period of this study. The two deteriorating subgroups of individuals did not report any signs of pre-existing psychiatric conditions and reported low levels of depressive symptoms at the beginning of the pandemic. These individuals reported a high probability of seeking psychiatric treatment by the end of the two-year study period. This indicates the potential emergence of a new subgroup of adults with severe depressive symptoms during the pandemic. Both resilient and adverse types of change patterns in depressive symptoms occurred during the first three months of the pandemic. The risk factors related to increases in depressive symptoms levels identified across Study 1 and 2 were increased alcohol consumption during the pandemic, lower education, living alone, and belonging to an ethnic minority. The initial shock that was observed in depressive symptoms in a subgroup of adults was predicted by frequent information acquisition about the pandemic, in addition to financial and occupational concerns tied to the pandemic’s economic repercussions. An additive dose-response relationship was identified between quarantine exposure and depressive symptoms. Protective factors related to resilient response patterns during the pandemic were being in a relationship, older age, and long-term engagement in physical activity. Study 3 aimed to extend beyond risk factors to identify psychological mechanisms that were related to increases in specific symptoms of depression during the pandemic. This study followed 1,706 Norwegian adults, each person measured daily over a 40-day period, accumulating into a total of 68,240 observations across adults. A dynamic network model (i.e. multi-level graphical vector autoregressive model) was implemented to examine the relationship between psychological mechanisms and specific symptoms of depression. The study found helplessness to be the key psychological mechanism predicting increases in depressive symptoms over time during the pandemic. Loneliness was identified as a predictor of depressed mood. The study further corroborated how depressive symptoms can amplify each other on an across-day basis during the pandemic. Lethargy and worthlessness were identified as the symptoms with the strongest impact on additional symptoms of depression (i.e. anhedonia and depressed mood, respectively), highlighting the key role of these symptoms in pushing individuals toward prolonged depressive states during the pandemic. Overall, this doctoral thesis identified that most adults over time displayed resilience to the abrupt societal changes that accompanied the COVID-19 pandemic. Temporary fluctuations in depressive symptoms on the population level were associated with the pandemic’s social distancing protocols. However, a minority subgroup of adults exhibited severe levels of depressive symptoms which emerged during pandemic, without any signs of recovery over a two-year period. Many adults in this subgroup reported seeking psychiatric treatment. Should these trends persist, this underscores a need for careful planning and resource allocation to facilitate preparedness and avoid the potential overburdening of mental healthcare systems. The link between financial concerns and depressive symptoms suggests that the implementation of socioeconomic policies may be warranted during pandemics. Disseminating information about physical activity as a protective factor and frequent information acquisition behaviour as a risk factor could present a useful public health strategy to protect against depressive symptoms during pandemics. The first three months of the pandemic were revealed as a critical period for pandemic adaptation, representing a key time window for implementing preventive measures in future pandemics and similar periods of infectious disease. This thesis further highlights the need for a balanced approach to social distancing, considering their association with depressive symptoms in several subgroups in the population. Such a cautious approach could entail the early implementation of social bubbles and similar interventions, both permitting some degree of social interaction while mitigating infectious spread, thereby having the potential to safeguard psychological as well as physical health.

View all works in NVA