Silje Endresen Reme

• Rosenblom, Maria; Jacobsen, Henrik Børsting & Reme, Silje Endresen (2026). Ready or Not? Applying the Transtheoretical Model of Change on Return-to-Work Following CBT for Chronic Low Back Pain. Journal of occupational rehabilitation. ISSN 1053-0487. doi: 10.1007/s10926-026-10432-5. Full text in Research Archive Show summary

  Purpose Chronic low back pain (CLBP) is a leading cause of work-related disability with limited benefit from biomedical treatments. Multidisciplinary approaches, including cognitive-behavioral therapy (CBT) show promise, but outcomes may depend on readiness to change. The Transtheoretical Model may help identify who benefits most, yet its relevance for return-to-work (RTW) outcomes in CLBP remains underexplored. This secondary analysis of a randomized controlled trial examined whether readiness to change, measured by the Pain Stages of Change Questionnaire (PSOCQ), was associated with back pain intensity and disability, and whether it predicted RTW 12 months after a multidisciplinary intervention for CLBP. Methods 414 participants on long-term sick leave due to CLBP were randomized to either: brief intervention (BI), BI + CBT, BI + seal oil, or BI + soy oil. Baseline measures included PSOCQ, pain intensity, and Oswestry Disability Index. RTW was assessed via registry data at 12 months. Results Hierarchal regression showed that higher precontemplation scores were significantly associated with greater baseline back pain and disability, while higher maintenance scores were linked to less back pain. In the CBT group, logistic regression revealed that higher precontemplation scores significantly predicted a 63% reduction in odds of RTW. Conclusion Readiness to change is associated with pain intensity and disability cross-sectionally, and RTW 12 months following CBT, with less ready individuals experiencing more pain and lower RTW. Assessing stage of change may help tailor rehabilitation and identify those less likely to benefit from CBT.

• Gjerdalen, Oda Skancke; Aas, Erlend Marius; Lystad, June Ullevoldsæter; Ueland, Torill; Arnevik, Espen Ajo & Falkum, Erik [Show all 12 contributors for this article] (2026). A comparison of characteristics of individuals with psychosis and substance use disorders seeking vocational rehabilitation. Nordic Journal of Psychiatry. ISSN 0803-9488. 80(3), p. 177–181. doi: 10.1080/08039488.2026.2625696. Full text in Research Archive
• Landmark, Live; Sunde, Hans Fredrik; Fors, Egil Andreas; Kennair, Leif Edward Ottesen & Reme, Silje Endresen (2026). Prevalence of Bodily Distress Syndrome and Prediction of Patient Outcomes: Cohort Study of 3762 Individuals With Persistent Pain. European Journal of Pain. ISSN 1090-3801. 30(2), p. 1–13. doi: 10.1002/ejp.70212. Full text in Research Archive Show summary

  ABSTRACT Background Persistent physical symptoms are common and often result in disability and high healthcare use. To capture how such symptoms co‐occur, Bodily Distress Syndrome (BDS, also called Functional Somatic Disorders) was developed as an empirically derived construct, in contrast to consensus‐based syndromes such as fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). BDS is distinct from ICD‐11 Bodily Distress Disorder and reflects the multisystem symptom pattern described in the Functional Somatic Disorder framework. However, its prevalence, symptom structure and prognostic relevance in pain populations have not been mapped. Methods This study included 3762 individuals referred to a tertiary pain clinic. At baseline, participants reported standardised measures of fatigue, insomnia, pain catastrophizing, psychological distress, perceived injustice, health‐related quality of life and disability. After 12 months, they reported disability and perceived change. BDS severity was classified from predefined symptom cluster criteria. We examined prevalence, clinical correlates and prognostic utility. Results 92.5% met the criteria for moderate or severe BDS. They reported more severe physical symptoms, elevated psychological distress and reduced functioning than those not meeting the criteria. Severe BDS was more common among women, those without higher education and individuals outside the workforce. After 12 months, individuals with BDS showed less improvement in functioning and reported lower perceived treatment benefit. Conclusion BDS was common in this outpatient hospital cohort and may offer a clinically useful lens for capturing multisystem complexity in specialised pain services. Incorporating BDS screening into routine assessment could help identify individuals with complex symptoms and support more mechanism‐oriented treatment approaches. Significance Statement Bodily Distress Syndrome (BDS) is highly prevalent in tertiary pain care and linked to more severe symptoms, psychosocial burden and poorer long‐term outcomes. The findings support BDS as a clinically useful framework for identifying patients with complex symptom profiles and for guiding interdisciplinary, mechanism‐oriented approaches to pain management.

• Ivanova, Anna; Amdal, Cecilie Delphin; Kvalem, Ingela Lundin & Reme, Silje Endresen (2026). Multidomain predictors of long-term work disability in late survivorship after head and neck cancer. Supportive Care in Cancer. ISSN 0941-4355. 34(3). doi: 10.1007/s00520-026-10524-1. Full text in Research Archive Show summary

  Abstract Purpose To estimate the prevalence of long-term work disability (LTD) among head and neck cancer (HNC) survivors more than five years posttreatment, compare profiles of employed, retired, and LTD groups, and identify independent predictors of LTD versus employment. Methods Late effects were assessed using the EORTC QLQ-C30, EORTC QLQ-H&N35, Chalder Fatigue Questionnaire, and Body Image Scale in a cross-sectional sample of 251 HNC survivors (mean 8.3 years posttreatment). Employment status was categorized as employed, retired, or LTD (> 12 months sick leave). Predictors of LTD were examined among working-age survivors (n = 145) using hierarchical logistic regression. Results LTD prevalence was 19% overall and 33% among working-age survivors. In multivariable models, better physical functioning (OR = 0.13, 95% CI 0.05–0.34) and better cognitive functioning (OR = 0.41, 95% CI 0.18–0.93) were associated with lower odds of LTD, while blue-collar occupation (OR = 6.70, 95% CI 1.18–38.05) and body image distress (OR = 13.34, 95% CI 1.25–142.07) were associated with higher odds. Treatment modality of chemoradiotherapy plus surgery vs radiotherapy was marginally associated with lower LTD odds (OR = 0.06, 95% CI 0.01–0.87), but this finding should be interpreted cautiously due to the small RT subgroup. Conclusions More than five years posttreatment, LTD remains common and is best explained by current physical and cognitive functioning, body image distress, and occupational context rather than historical clinical exposures or any single symptom.

• Parveen, Sana; Finne, Live Bakke; Reme, Silje Endresen & Nielsen, Morten Birkeland (2026). Client-Perpetrated Violence and Intent to Leave Among Child Welfare Workers: A Three-Wave Cross-Lagged Prospective Study of Causal Directions and the Role of Work-Related Worrying. Child & Family Social Work. ISSN 1356-7500. doi: 10.1111/cfs.70151. Full text in Research Archive Show summary

  Client-perpetrated violence and turnover intentions are widespread problems among child-welfare workers and are associated with both personal and organizational consequences. To elucidate their longitudinal association, the current study built on the cognitive activation theory of stress (CATS) and investigated (H1) whether client-perpetrated violence is associated with increased intention to leave, (H2) whether this forward relationship is mediated by work-related worrying and (H3) whether intention to leave is associated with subsequent reports of client-perpetrated violence. Utilizing a sample of 438 Norwegian public sector child welfare workers, a three-wave cross-lagged panel model was specified. Supporting H1 and H3, the cross-lagged panel model indicated a significant bidirectional relationship. The proposed indirect effect through work-related worrying (H2) was not supported. In conclusion, the current study provides support for client-perpetrated violence to predict increased intentions to leave among child welfare workers. The presence of a reverse causal effect highlights that conducting longitudinal studies alone offers little evidence of causality unless reverse causation is also explicitly tested. Although the study did not find work-related worrying to mediate the relationship between client-perpetrated violence and intentions to leave, it does support the idea of utilizing CATS as a theoretical framework also within organizational research.

• Rognli, Eline; Andersen, Kristoffer Andreas Aamodt; Aas, Erlend Marius; Reme, Silje Endresen; Lystad, June Ullevoldsæter & Stavseth, Marianne Riksheim [Show all 7 contributors for this article] (2025). The effectiveness of Individual Placement and Support on vocational outcomes for patients with substance use disorders: A pragmatic superiority randomized controlled trial of Individual Placement and Support versus enhanced self-help. Addiction. ISSN 0965-2140. 120(12), p. 2547–2558. doi: 10.1111/add.70155. Full text in Research Archive Show summary

  Background and aim Unemployment rates among individuals with substance use disorders (SUD) are high, and evidence-based vocational methods are lacking. Employment is important because it improves treatment outcomes and protects against relapse. Individual Placement and Support (IPS) has proven effective in helping patients with psychosis obtain competitive employment. We aimed to investigate the effectiveness of IPS on vocational outcomes for patients with SUD. Design Randomized controlled trial. Setting SUD treatment units at Oslo University Hospital, Norway. Participants Patients with SUD who wanted to obtain competitive employment. A total of 202 SUD patients were included in the trial, of which eight withdrew consent, five died and two were erroneously included, giving a modified intention to treat analysis set of 187 participants, of which 91 were randomized to IPS and 96 to the enhanced control group condition. Intervention and comparator Treatment as usual plus IPS for up to 13 months versus treatment as usual, a self-help guidebook, a workshop of three two-hour sessions and one session of individual counselling. Measurements Employment data were obtained from Statistics Norway and linked with study data. Primary outcome was at least one day of competitive employment during an 18-month period after inclusion in the trial. Secondary employment-related outcomes described job tenure, number of different jobs, hours worked and employment earnings during the same period. Findings There was no difference between the groups in the main outcome [39.6% vs. 34.4%; odds ratio (OR) = 1.28, 95% confidence interval (CI) = 0.70–2.35], but participants in the IPS group worked more hours (601 vs. 344; b = 330, 95% CI = 25–635) and had higher total salary in Norwegian krone (141 000 vs 73 000; b = 94 000, 95% CI = 17000–170 000) than control group participants. Control group participants were more likely to receive services from the Social and Welfare Services (53.1% vs. 27.5%; OR = 2.99, 95% CI = 1.64–5.57). Conclusion In this randomized controlled trial of Individual Placement and Support (IPS) versus enhanced self-help for individuals with substance use disorders in Norway, there was no difference between groups regarding job acquisition, defined as at least one day of competitive employment during an 18-month period; however, IPS participants worked more hours and earned a higher total salary than control group participants.

• Ustrimova, Ksenia Theodora Alexandra; Fait, Brian Randall; Reme, Silje Endresen; Rasmussen, Mari Storli & Hauger, Solveig Lægreid (2025). Existing evidence of self-management interventions in acquired brain injuries and traumatic injuries: a scoping review. Disability and Rehabilitation. ISSN 0963-8288. 15(1), p. 1–38. doi: 10.1080/09638288.2025.2530159. Full text in Research Archive
• Reme, Silje Endresen; Munk, Alice; Montgomery, Guy H.; Schnur, Julie B.; Falk, Ragnhild Sørum & Smits, Martijn Johannes Bernardus [Show all 7 contributors for this article] (2025). Preoperative Hypnosis versus Mindfulness for Reducing Postoperative symptoms in Breast Surgery: A Randomized Clinical Trial. Anesthesiology. ISSN 0003-3022. doi: 10.1097/ALN.0000000000005821. Full text in Research Archive
• Gjengedal, Ragne Gunnarsdatter Hole; Hannisdal, Marit; Osnes, Kåre; Reme, Silje Endresen; Wells, Adrian & Blonk, Roland [Show all 18 contributors for this article] (2025). Metacognitive therapy and work-focus for patients with depression, anxiety or comorbid depression and anxiety on sick leave: a single-centre, open-label randomised controlled trial. EClinicalMedicine. 89, p. 103613–103613. doi: 10.1016/j.eclinm.2025.103613. Full text in Research Archive
• Rosenblom, Maria; Reme, Silje Endresen & Jacobsen, Henrik Børsting (2025). The Role of Negative Affect and Experiential Avoidance in Postsurgical Pain and Fatigue Among Norwegian Women With Breast Cancer. European Journal of Pain. ISSN 1090-3801. 29(2). doi: 10.1002/ejp.4788. Full text in Research Archive
• Myrtveit-Stensrud, Linn; Ekholm, Elin; Flink, Ida; Kuile, Moniek Ter; Engman, Linnéa & Suvaal, Isabelle [Show all 8 contributors for this article] (2025). Partner responses to pain among male partners of women with provoked vestibulodynia - a cross-sectional study. Pain Reports. 10(2), p. e1265–e1265. doi: 10.1097/PR9.0000000000001265. Full text in Research Archive
• Engel, Sophia; Jacobsen, Henrik Børsting & Reme, Silje Endresen (2024). Cosmetic surgery and associated chronic postsurgical pain: A cross-sectional study from Norway. Scandinavian Journal of Pain. ISSN 1877-8860. 24(1). doi: 10.1515/sjpain-2023-0099. Full text in Research Archive
• Fostervold, Knut Inge; Reme, Silje Endresen; Strømsø, Helge Ivar & Ludvigsen, Sten Runar (2024). Relationships between study conditions, stress, and perceived health: Studying at university after the COVID-19 lockdown. In McCarthy, Christopher J.; Lynch, R. Jason & DiDonato, Stephen (Ed.), Research on College Stress and Coping Implications From the COVID-19 Pandemic and Beyond. Information Age Publishing. ISSN 9798887307329. p. 109–134. Full text in Research Archive
• Landmark, Live; Sunde, Hans Fredrik; Fors, Egil A.; Kennair, Leif Edward Ottesen; Sayadian, Annahita & Backelin, Caroline [Show all 7 contributors for this article] (2024). Associations between pain intensity, psychosocial factors, and pain-related disability in 4285 patients with chronic pain. Scientific Reports. 14(1), p. 1–12. doi: 10.1038/s41598-024-64059-8. Full text in Research Archive Show summary

  Pain, a widespread challenge affecting daily life, is closely linked with psychological and social factors. While pain clearly influences daily function in those affected, the complete extent of its impact is not fully understood. Given the close connection between pain and psychosocial factors, a deeper exploration of these aspects is needed. In this study, we aim to examine the associations between psychosocial factors, pain intensity, and pain-related disability among patients with chronic pain. We used data on 4285 patients from the Oslo University Hospital Pain Registry, and investigated pain-related disability, pain intensity, pain catastrophizing, psychological distress, perceived injustice, insomnia, fatigue, and self-efficacy. We found significant associations between all psychosocial variables and pain-related disability, even after adjusting for demographic factors. In the multiple regression model, sleep problems and pain intensity were identified as primary contributors, alongside psychological distress, and fatigue. Combined, these factors accounted for 26.5% of the variability in pain-related disability, with insomnia and pain intensity exhibiting the strongest associations. While the direction of causation remains unclear, our findings emphasize the potential of interventions aimed at targeting psychosocial factors. Considering the strong link between psychosocial factors and pain-related disability, interventions targeting these factors—particularly insomnia—could reduce disability and enhance quality of life in those who suffer.

• Eide, Line Sophie; Rike, Per-Ola; Reme, Silje Endresen; Snekkevik, Hildegun; Rossner, Stephan Karl Otto & Rosen, Gunnar [Show all 8 contributors for this article] (2024). Using hypnotic suggestion in the rehabilitation of working memory capacity after acquired brain injury: study protocol for a randomized controlled trial. Trials. 25, p. 1–10. doi: 10.1186/s13063-023-07867-z. Full text in Research Archive Show summary

  Objectives Establishment of effective evidence-based interventions in rehabilitation of working memory (WM) deficits after acquired brain injury (ABI) is sorely needed. Despite robust evidence for the efficiency of clinical hypnosis in a wide range of clinical conditions, and improved understanding of mechanisms underlying its effects, the potential of clinical hypnosis in cognitive rehabilitation is underexplored. A recent study has shown large effects of hypnotic suggestion on WM capacity following ABI. This randomized controlled trial aims to evaluate and explore the replicability of these findings and examine the generalization of treatment effects. The study will also explore possible mechanisms of change. Methods Ninety patients will be recruited from the Sunnaas Rehabilitation Hospital. Inclusion criteria are nonprogressive ABI, minimum 12-month post-injury, ongoing WM deficits, and age between 18 and 67 years. Patients will be randomized to either (a) an intervention group receiving four weekly 1-h sessions with induction and hypnosis, (b) an active control group receiving four weekly 1-h sessions of induction and mindfulness, or (c) a passive control group without intervention. The targeted procedure consists of suggestions about enhancing WM functions, for example through the instantiation of preinjury WM capacity in the present using age regression or through visualizations of brain plasticity. The non-targeted suggestions contain no explicit mention of ABI- or WM-related abilities. Each participant will be assessed at baseline, immediately after intervention, and 6 months after baseline. The primary outcome is the WM index from WAIS-IV and self- and informant-reported WM subscale from BRIEF-A, a questionnaire exploring executive functioning in everyday life. Secondary outcomes include a cognitive composite score derived from tests measuring processing speed, executive functions, learning capacity and memory, and self-reported measures of emotional distress, quality of life, and community integration. Exploratory measures include self-rated ABI and WM-related self-efficacy. Discussion Rehabilitation of impaired WM after ABI has hitherto yielded limited transfer effects beyond the training material, i.e., improvement effects on everyday WM capacity, and clinical trials of new interventions are thus warranted. Long-standing empirical evidence demonstrates that hypnosis is an effective therapeutic technique in a wide range of conditions, and recent exploratory research has suggested a high efficacy of hypnosis in improving WM capacity in patients with ABI. However, these extraordinary findings need replication in studies applying scientifically rigorous designs. If successful, our ambition is to provide recommendations and materials to implement hypnotic suggestion as an adjunct treatment following ABI. Study findings may inform future studies exploring the use of clinical hypnosis in other areas of rehabilitation, such as mild TBI, and in other neurological conditions where WM deficit is prominent. Trial registration ClinicalTrials.gov NCT05287542. Registered on March 2022 Protocol version Protocol version 2.0, December 2023.

• Baumann-Larsen, Monica; Reme, Silje Endresen & Stensland, Synne Øien Blixt (2024). Barndomstraumer og langvarige smerter hos barn, ungdom og unge voksne. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. p. 829–842. doi: 10.52734/LSNU7172. Full text in Research Archive Show summary

  Bullying, physical violence, sexual abuse, loss of loved ones, accidents, disasters or other potentially traumatic events or situations in childhood are associated with a range of health problems and related functional impairment. New research findings suggest that such childhood trauma can lead to young people developing chronic pain with frequent use of painkillers already in childhood and adolescence. The high risk of adverse trajectories may indicate that young people who develop pain after childhood trauma lack access to early effective interventions. Trauma-exposed children and young people with long-term pain and other accompanying post-traumatic reactions may benefit little from established pain management. Knowledge of risk, resiliency and key pain mechanisms following childhood trauma can strengthen clinical management. This review article explores theoretical and empirical perspectives on how childhood trauma and related biological, psychological and social factors and reactions can contribute to the development of chronic pain and the use of painkillers among children and adolescents.

• Mandelkow, Lars & Reme, Silje Endresen (2024). Existential Needs in Mental Health – Who Cares? A Mixed Methods Study in Norway. Journal of Pastoral Care & Counseling. ISSN 1542-3050. p. 1–12. doi: 10.1177/15423050241274609. Full text in Research Archive
• Harel, Daphna; Wu, Yin; Levis, Brooke; Fan, Suiqiong; Sun, Ying & Xu, Mingyao [Show all 229 contributors for this article] (2024). Comparison of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale and Hospital Anxiety and Depression – Depression subscale scores by administration mode: An individual participant data differential item functioning meta-analysis. Journal of Affective Disorders. ISSN 0165-0327. 361, p. 674–683. doi: 10.1016/j.jad.2024.06.033. Full text in Research Archive
• Hammersmark, Ane T; Hjemdal, Odin; Hannisdal, Marit; Lending, Hilde D.; Reme, Silje Endresen & Hodne, Kjetil [Show all 9 contributors for this article] (2023). Metacognitive therapy for generalized anxiety disorders in group: A case study. Journal of Clinical Psychology. ISSN 0021-9762. p. 1–16. doi: 10.1002/jclp.23615. Full text in Research Archive Show summary

  Objectives In Metacognitive therapy (MCT), homework is used, for example, to increase awareness of thoughts and thought processes, to challenge metacognitive beliefs in real-life situations, and to practice new ways of processing thoughts, feelings, and symptoms. All MCT treatment manuals include homework assignments to be given between each session. Method The following study provides a detailed description of the implementation of homework in a group-based MCT treatment for generalized anxiety disorder (GAD) at an outpatient clinic in Norway. The treatment described in this case consisted of 10 weekly group sessions (7 patients) lasting two hours. Results This case study demonstrates that group-based MCT can be used to treat GAD and describes how the use of homework can facilitate therapeutic change. Conclusion Overall, the effectiveness of MCT was found to be high. Homework gives patients the opportunity to take charge of their therapy and develop a sense of responsibility for their own progress, both during and after treatment.

• Wu, Yin; Levis, Brooke; Daray, Federico M.; Ioannidis, John P. A.; Patten, Scott B. & Cuijpers, Pim [Show all 119 contributors for this article] (2023). Comparison of the Accuracy of the 7-Item HADS Depression Subscale and 14-Item Total HADS for Screening for Major Depression: A Systematic Review and Individual Participant Data Meta-Analysis. Psychological Assessment. ISSN 1040-3590. 35(2), p. 94–114. doi: 10.1037/pas0001181. Full text in Research Archive
• Alme, Tomas Nordheim; Andreasson, Anna; Asprusten, Tarjei Tørre; Bakken, Anne Karen; Beadsworth, Michael BJ & Boye, Birgitte [Show all 51 contributors for this article] (2023). Chronic fatigue syndromes: real illnesses that people can recover from. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), p. 372–376. doi: 10.1080/02813432.2023.2235609. Full text in Research Archive Show summary

  The ‘Oslo Chronic Fatigue Consortium’ consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.

• Abrahamsen, Cathrine; Reme, Silje Endresen; Wangen, Knut Reidar; Lindbæk, Morten & Werner, Erik Lønnmark (2023). The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trial. EClinicalMedicine. doi: 10.1016/j.eclinm.2023.102262. Full text in Research Archive Show summary

  Background Medically Unexplained Physical Symptoms (MUPS) are prevalent among primary care patients and frequently lead to diminished quality of life, increased healthcare costs, and decreased work participation. We aimed to examine the effects of a work-focused structured communication tool based on cognitive-behavioral therapy in patients with MUPS. Methods In a Norwegian two-arm cluster randomized trial, the effectiveness of the structured communication tool Individual Challenge Inventory Tool (ICIT) was compared to usual care for patients with MUPS using a two-arm cluster randomized design. Enrollment period was between March 7 and April 1, 2022. Ten groups (clusters) of 103 General Practitioners (GPs) were randomized to provide the ICIT or usual care for 11 weeks. Patients received two or more sessions with their GP, and outcomes were assessed individually. Primary outcome was patient-reported change in function, symptoms, and quality of life measured by the Patient Global Impression of Change (PGIC). Secondary outcomes included sick leave, work-related self-efficacy (RTW-SE), health-related quality of life (RAND-36), and patient experiences with consultants (PEQ). The trial was registered on ClinicalTrials.gov (NCT05128019). Findings A total of 541 patients with MUPS were enrolled in the study. In the intervention group 76% (n = 223) showed a significant overall improvement in function, symptoms, and quality of life as measured by the PGIC, compared to 38% (n = 236) in the usual care group (mean difference −0.8 ([95% CI −1.0 to −0.6]; p < 0.0001). At 11 weeks, the intervention group had a 27-percentage point decrease in sick leave (from 52.0 to 25.2), compared to 4-percentage point decrease (from 49.7 to 45.7) in the usual care group. Furthermore, compared to usual care, the intervention group reported significant improvements in work-related self-efficacy, health-related quality of life, and greater satisfaction with the communication during the consultations. No adverse events were reported. Interpretation The implementation of the structured communication tool ICIT in primary care significantly improved patient outcomes and reduced sick leave among patients with MUPS.

• Linnemørken, Lene Therese Bergerud; Stangeland, Helle; Reme, Silje Endresen & Stensland, Synne Øien Blixt (2023). Performance and acceptability of the Stressful Life Events Screening Questionnaire in a chronic pain population: A mixed-methods study. Pain Reports. 8(3). doi: 10.1097/PR9.0000000000001072. Full text in Research Archive Show summary

  Introduction: Pain-related fear, anxiety, and avoidance may play key roles in the chronification of pain and related disability. For practitioners, knowledge about the source or drivers of these fears, including patients' exposure to potentially traumatic events (PTEs) and related posttraumatic stress symptoms, could be particularly helpful in guiding their treatment approach. Objectives: We aimed to investigate whether the use of a brief screening for PTEs could help inform chronic pain treatment. Methods: The performance and acceptability of the Stressful Life Events Screening Questionnaire (SLESQ) was assessed among 567 adult patients (59% women, mean age 48.1 years) meeting at a hospital outpatient pain clinic. The sensitivity, specificity, and 20 months temporal stability of the SLESQ, assessing exposure to 14 specific trauma types followed by a 15th item capturing exposure to “other events,” were assessed through digital administration and follow-up interviews with 55 participants. The qualitative responses of 158 participants reporting exposure to “other events” were reviewed and assessed based on fulfillment of the A Criterion for traumatic events in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The acceptability of the SLESQ was assessed in clinical interviews with 12 participants. Results: The SLESQ demonstrated acceptable sensitivity (70.0%), high specificity (94.9%), and moderate temporal stability (κ = 0.66, P < 0.001). Participants' qualitative elaborations of “other events” were largely (76.3%) consistent with Criterion A events. The screening was well accepted and welcomed. Conclusion: The results indicate that the use of a brief screening for potential trauma may be helpful to guide clinical practice in chronic pain settings.

• Meier, Isabell M.; Eikemo, Marie; Trøstheim, Martin Ostenfeldt; Buen, Kaja; Jensen, Eira Nordeng & Karlsen, Siri Gurandsrud [Show all 10 contributors for this article] (2023). Factors associated with use of opioid rescue medication after surgery. Regional anesthesia and pain medicine. ISSN 1098-7339. doi: 10.1136/rapm-2023-104412. Full text in Research Archive
• Myrtveit-Stensrud, Linn; Haugstad, Gro Killi; Reme, Silje Endresen; Schaller, Sidsel Louise & Groven, Karen Synne (2023). “It's all my fault”: a qualitative study of how heterosexual couples experience living with vulvodynia. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 102(10), p. 1378–1389. doi: 10.1111/aogs.14537. Full text in Research Archive
• Jacobsen, Henrik Børsting; Lyby, Peter Solvoll; Johansen, Thomas; Reme, Silje Endresen & Klungsøyr, Ole (2023). Can cognitive inflexibility reduce symptoms of anxiety and depression? Promoting the structural nested mean model in psychotherapy research. Psychotherapy Research. ISSN 1050-3307. 33(8), p. 1096–1116. doi: 10.1080/10503307.2023.2221808. Full text in Research Archive Show summary

  Objective To estimate the causal effect of executive functioning on the remission of depression and anxiety symptoms in an observational dataset from a vocational rehabilitation program. It is also an aim to promote a method from the causal inference literature and to illustrate its value in this setting. Method With longitudinal (four-time points over 13 months) data from four independent sites, we compiled a dataset with 390 participants. At each time point, participants were tested on executive function and self-reported symptoms of anxiety and depression. We used g-estimation to evaluate whether objectively tested cognitive flexibility affected depressive/anxious symptoms and tested for moderation. Multiple imputations were used to handle missing data. Results The g-estimation showed a strong causal effect of cognitive inflexibility reducing depression and anxiety and modified by education level. In a counterfactual framework, a hypothetical intervention that could lower cognitive flexibility seemed to cause improvement in mental distress at the subsequent time-point (negative sign) for low education. The less flexibility, the larger improvement. For high education, the same but weaker effect was found, with a change in sign, negative during the intervention and positive during follow-up. Discussion An unexpected and strong effect was found from cognitive inflexibility on symptom improvement. This study demonstrates how to estimate causal psychological effects with standard software in an observational dataset with substantial missing and shows the value of such methods.

• Munk, Alice; Jacobsen, Henrik Børsting; Schnur, Julie; Montgomery, Guy & Reme, Silje Endresen (2023). Acute and subacute postsurgical pain in women with breast cancer: Incidence and associations with biopsychosocial predictors - A secondary analysis of a randomized controlled trial. Pain Reports. 8(1), p. E1058–E1058. doi: 10.1097/PR9.0000000000001058. Full text in Research Archive
• Jacobsen, Henrik Børsting; Brun, Aurora; Stubhaug, Audun & Reme, Silje Endresen (2023). Stress specifically deteriorates working memory in peripheral neuropathic pain and fibromyalgia. Brain Communications. 5(4), p. S9–S15. doi: 10.1093/braincomms/fcad194. Full text in Research Archive
• Sandin, Kenneth; Shields, Gemma; Gjengedal, Ragne Gunnarsdatter Hole; Osnes, Kåre; Bjørndal, Marianne Tranberg & Reme, Silje Endresen [Show all 7 contributors for this article] (2023). Responsiveness to change in health status of the EQ-5D in patients treated for depression and anxiety. Health and Quality of Life Outcomes. 21(1). doi: 10.1186/s12955-023-02116-y. Full text in Research Archive Show summary

  Background The EQ-5D is a commonly used generic measure of health but evidence on its responsiveness to change in mental health is limited. This study aimed to explore the responsiveness of the five-level version of the instrument, the EQ-5D-5 L, in patients receiving treatment for depression and anxiety. Methods Patient data (N = 416) were collected at baseline and at end of treatment in an observational study in a Norwegian outpatient clinic. Patients were adults of working age (18–69 years) and received protocol-based metacognitive or cognitive therapy for depression or anxiety according to diagnosis. Responsiveness in the EQ-5D was compared to change in the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Effect sizes (Cohen’s d), Standardised response mean (SRM), and Pearson’s correlation were calculated. Patients were classified as “Recovered”, “Improved”, or “Unchanged” during treatment using the BDI-II and the BAI. ROC analyses determined whether the EQ-5D could correctly classify patient outcomes. Results Effect sizes were large for the BAI, the BDI-II, the EQ-5D value and the EQ VAS, ranging from d = 1.07 to d = 1.84. SRM were also large (0.93-1.67). Pearson’s correlation showed strong agreement between change scores of the EQ-5D value and the BDI-II (rs -0.54) and moderate between the EQ-5D value and the BAI (rs -0.43). The EQ-5D consistently identified “Recovered” patients versus “Improved” or “Unchanged” in the ROC analyses with AUROC ranging from 0.72 to 0.84. Conclusion The EQ-5D showed good agreement with self-reported symptom change in depression and anxiety, and correctly identified recovered patients. These findings indicate that the EQ-5D may be appropriately responsive to change in patients with depression and anxiety disorders, although replication in other clinical samples is needed.

• Engel, Sophia; Jacobsen, Henrik Børsting & Reme, Silje Endresen (2023). A cross-sectional study of fear of surgery in female breast cancer patients: Prevalence, severity, and sources, as well as relevant differences among patients experiencing high, moderate, and low fear of surgery. PLOS ONE. 18(6). doi: 10.1371/journal.pone.0287641. Full text in Research Archive
• Munk, Alice; Jacobsen, Henrik Børsting & Reme, Silje Endresen (2022). Coping expectancies and disability across the new ICD-11 chronic pain categories: A large-scale registry study. European Journal of Pain. ISSN 1090-3801. 26(7), p. 1510–1522. doi: 10.1002/ejp.1979. Full text in Research Archive
• Zetterberg, Hedvig; Owiredua, Christiana; Åsenlöf, Pernilla; Lennartsson, Rebecca; Jansen, Gunilla Brodda & Boersma, Katja [Show all 11 contributors for this article] (2022). Preventing Pain and Stress-Related Ill-Health in Employees: A 6-Months Follow-Up of a Psychosocial Program in a Cluster Randomized Controlled Trial. Journal of occupational rehabilitation. ISSN 1053-0487. doi: 10.1007/s10926-022-10074-3. Full text in Research Archive
• Sveinsdottir, Vigdis; Jacobsen, Henrik Børsting; Ljoså, Tone Marte; Linnemørken, Lene Therese Bergerud; Knutzen, Thomas & Ghiasvand, Reza [Show all 7 contributors for this article] (2022). The Individual Placement and Support (IPS) in Pain Trial: A Randomized Controlled Trial of IPS for Patients with Chronic Pain Conditions. Pain medicine (Malden, Mass.). ISSN 1526-2375. 23(10), p. 1757–1766. doi: 10.1093/pm/pnac032. Full text in Research Archive Show summary

  Objectives Although complex pain conditions require an interdisciplinary approach, employment services are rarely provided in pain centers. Individual Placement and Support (IPS) is an effective approach to increase work participation among patients with severe mental illness, and recent evidence suggests that this method can be successfully repurposed for new target groups. We aimed to investigate the effectiveness of IPS integrated with interdisciplinary treatment as usual (TAU) for patients with chronic pain in a tertiary pain center. Methods A randomized controlled trial comparing IPS integrated with TAU (n = 38) with TAU alone (n = 20) was conducted. Participants were patients with chronic pain who were 18–65 years of age and currently on long-term sick leave or disability benefits or unemployed. The primary outcome was employment within 12 months after enrollment, with additional long-term follow-up after 24 months. Secondary outcomes included health and quality of life, measured at baseline, 6 months, and 12 months. Results During 12-month follow-up, 52.8% in the IPS group and 38.9% in the TAU group had attained employment. The difference increased during 24-month follow-up but did not reach statistical significance. Findings on secondary outcomes were generally nonsignificant. Conclusions The IPS in Pain trial is the first study to evaluate the effect of IPS for patients with chronic pain conditions. It shows that IPS can be integrated into the daily practice of interdisciplinary pain treatment, with employment rates exceeding 50% in 1 year and a clear trend in favor of the IPS group. Results did not, however, reach significance. Larger randomized controlled trials are needed to draw clear conclusions about effectiveness.

• Wood, L.; Foster, Nadine; Lewis, M.; Bronfort, G; Groessl, E.J. & Hewitt, C. [Show all 9 contributors for this article] (2022). Matching the Outcomes to Treatment Targets of Exercise for Low Back Pain: Does it Make a Difference? Results of Secondary Analyses From Individual Patient Data of Randomised Controlled Trials and Pooling of Results Across Trials in Comparative Meta-analysis. Archives of Physical Medicine and Rehabilitation. ISSN 0003-9993. 104(2), p. 218–228. doi: 10.1016/j.apmr.2022.07.012. Full text in Research Archive
• Parveen, Sana; Nielsen, Morten Birkeland; Reme, Silje Endresen & Finne, Live Bakke (2022). Exposure to Client-Perpetrated Violence in the Child Welfare Service: Prevalence and Outcomes Using Two Different Measurement Methods. Journal of Interpersonal Violence. ISSN 0886-2605. doi: 10.1177/08862605221127216. Full text in Research Archive Show summary

  This study compared how two different measurement methods of client-perpetrated violence influence findings on prevalence rates and mental health outcomes in a probability sample of 660 Norwegian public sector child welfare workers. Using a single-item self-labeling approach, 15.4% reported exposure to physical violence, and 19.3% reported exposure to threats. Using a 15-item behavioral experience inventory, the prevalence rates ranged from 4.4% to 65.7%. A comparison of these methods uncovered a high number of false negatives when using the single-item approach as 62.2% of those who indicated that they had not experienced any workplace violence when answering the single-item questions reported being exposed 1 to 2 times when responding to the behavioral inventory. Results based on the behavioral inventory further revealed that the most frequently occurring actions in the child welfare service were direct and indirect forms of threats (24.5%–65.7%), while the least reported behaviors were threats and violence including objects (4.4.%–9.1%). Although client-perpetrated violence was significantly associated with mental health problems (e.g., symptoms of anxiety, depression, and post-traumatic stress [PTS]) for both assessment methods, the magnitude of the effect sizes differed from η2 = .000 to η2 = .121. These findings highlight that the use of different measurement methods for workplace violence has significant consequences for the assessment of prevalence rates, as well as on results of associated outcomes. Consequently, the decision on how to assess workplace violence has practical implications for uncovering how prominent the issue is, as well as the way in which this negative workplace exposure is subsequently addressed and counteracted. Therefore, both scholars and the child welfare service, and similar fields in which workplace violence frequently occurs, should take these findings into consideration for future assessments.

• Gjengedal, Ragne Gunnarsdatter Hole; Osnes, Kåre; Reme, Silje Endresen; Lagerveld, Suzanne E.; Johnson, Sverre Urnes & Lending, Hilde Dallavara [Show all 9 contributors for this article] (2022). Changes in depression domains as predictors of return to work in common mental disorders. Journal of Affective Disorders. ISSN 0165-0327. 308, p. 520–527. doi: 10.1016/j.jad.2022.04.080. Full text in Research Archive Show summary

  Background Depression highly impairs function and reduces quality of life. Therefore, both symptomatic and functional recovery are important treatment goals. Depression consists of several cognitive, somatic, and affective symptom factors that differently affect function. However, it is unclear whether changes in these domains predict return to work (RTW) after treatment. Methods Data were collected during treatment from patients on full or partial sick leave reporting depression symptoms (N = 300) at an out-patient clinic. Information on work status was assessed pre- and post-treatment and at 6 months follow-up. Multiple logistic regression was used to investigate if residualized changes in symptom factors predicted full RTW, controlling for gender, education level, and age. Results Changes (as symptom improvement) in the cognitive, somatic, and affective factor scores each significantly predicted full RTW post-treatment and at follow-up for patients on full and partial sick leave, even after controlling for gender, education level, and age. The change in the somatic factor explained the largest proportion of variance for full work post-treatment in patients on full sick-leave, while change in the cognitive factor explained most unique variance for patients on graded sick leave. Limitations The sample consisted of a majority of women with a relatively high level of education. This study should be replicated in more heterogeneous samples. Conclusion Changes in depression symptom domains are significant predictors for RTW work post-treatment. The change in the somatic factor explained the largest proportion of variance in patients on full sick leave and thus may particularly influence RTW after treatment.

• Lalouni, Maria; Olén, Ola; Bjureberg, Johan; Bonnert, Marianne; Chalder, Trudie & Hedman-Lagerlöf, Erik [Show all 9 contributors for this article] (2022). Validation of child-adapted short scales for measuring gastrointestinal-specific avoidance and anxiety. Acta Paediatrica. ISSN 0803-5253. 111(8), p. 1621–1627. doi: 10.1111/apa.16403. Full text in Research Archive
• Reme, Silje Endresen; Ljoså, Tone Marte; Stubhaug, Audun; Granan, Lars-Petter Ness; Falk, Ragnhild Sørum & Jacobsen, Henrik Børsting (2022). Perceived Injustice in Patients With Chronic Pain: Prevalence, Relevance, and Associations With Long-Term Recovery and Deterioration. Journal of Pain. ISSN 1526-5900. 23(7), p. 1196–1207. doi: 10.1016/j.jpain.2022.01.007. Full text in Research Archive Show summary

  The Injustice Experience Questionnaire (IEQ) assesses the degree to which chronic pain sufferers perceive injustice in relation to their pain. The aim of the current study was to assess the prevalence and relevance of the IEQ and its association to perceived recovery and deterioration in a naturalistic pain clinic population. Data was obtained from the Oslo University Hospital's Pain Registry. Among 2,950 patients, the prevalence of low (<19), medium (19-29) and high (30+) IEQ was 39%, 32% and 29% respectively. High levels of injustice were positively associated with a wide range of adverse health outcomes. Differences between those with high vs low levels of IEQ were clinically significant for most health outcomes. A Venn diagram analysis showed considerable, but not complete, overlap between IEQ, pain catastrophizing, psychological distress and severe pain intensity. High IEQ was associated with reduced clinical recovery (OR 0.6, 95% CI 0.4-0.9) and deterioration (OR 3.6, 95% CI 2.1-6.2) at 12-months follow-up, however, not when controlling for pain-related disability and pain intensity. We conclude that perceived injustice is a prevalent and clinically relevant phenomenon in a chronic pain clinic population, and that more knowledge is needed regarding its role as indicator of poor prognosis and target for tailored treatment.

• Ekeberg, Ole Marius; Pedersen, Stein Jarle; Natvig, Bård; Brox, Jens Ivar; Biringer, Eva Aaker & Reme, Silje Endresen [Show all 10 contributors for this article] (2022). Making should erpa in simple in general practice: Implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study). BMJ Open. 12(1). doi: 10.1136/bmjopen-2021-051656. Full text in Research Archive
• Aarestad, Sarah Helene; Harris, Anette; Hjemdal, Odin; Gjengedal, Ragne Gunnarsdatter Hole; Osnes, Kåre & Sandin, Kenneth [Show all 9 contributors for this article] (2022). Healing the wounds of workplace bullying: Evaluating mental health and workplace participation among victims seeking treatment for common mental disorders. WORK: A Journal of Prevention, Assessment & Rehabilitation. ISSN 1051-9815. 73(4), p. 1379–1391. doi: 10.3233/WOR-210920. Full text in Research Archive Show summary

  Background: Victims of workplace bullying represent a group characterised by severe negative health complaints at risk of losing their foothold in working life. To date, very few studies have investigated the effect of psychological treatment of the health-related problems often facing victims of bullying. Objective: The aim was to investigate if victims of workplace bullying suffering from common mental disorders (CMD) benefit from clinical treatment for their mental health problems at an outpatient clinic treating patients using Metacognitive or Cognitive Behavioural Therapy with work-focus. Criteria were symptom reduction and change in workplace participation. Comparisons were made between the victims of workplace bullying with CMD, a wait-list control group consisting of patients who had also been exposed to bullying yet now awaiting treatment, and other patients not exposed to bullying. Methods: The sample comprised of 405 patients from an outpatient clinic in Norway. The study used a naturalistic observational design and data was collected pre-treatment and post-treatment. Results: The results showed the treatment to be effective in symptom reduction for victims of bullying to a similar degree as patients otherwise not exposed to bullying. Even more, victims receiving treatment had a larger improvement compared to the wait-list control group (p < 0.001). Yet, among patients on sick leave pre-treatment, fewer victims of bullying were fully working by the end of treatment compared to the patients not exposed to workplace bullying. Conclusion: The findings provide ground for optimism for this treatment as an efficient way of dealing with the aftermath of workplace bullying.

• Mandelkow, Lars & Reme, Silje Endresen (2022). Religious sensitivity at secular universities: A cross-sectional replication study among Norwegian psychology students. Nordic Journal of Religion and Society. ISSN 0809-7291. 35(1), p. 4–19. doi: 10.18261/njrs.35.1.1. Full text in Research Archive
• Mandelkow, Lars; Frick, Eckhard; Büsing, Arndt & Reme, Silje Endresen (2021). Norwegian psychotherapy: religiosity gap and spiritual care competence. The Journal of Spirituality in Mental Health. ISSN 1934-9637. p. 1–22. doi: 10.1080/19349637.2021.1938343. Full text in Research Archive
• Lind, Sofie Bulling; Jacobsen, Henrik Børsting; Solbakken, Ole Andre & Reme, Silje Endresen (2021). Clinical Hypnosis in Medical Care: A Mixed-Method Feasibility Study. Integrative Cancer Therapies. ISSN 1534-7354. 20, p. 1–11. doi: 10.1177/15347354211058678. Full text in Research Archive
• Fyhn, Tonje; Sveinsdottir, Vigdis; Reme, Silje Endresen & Sandal, Gro Mjeldheim (2021). A mixed methods study of employers' and employees' evaluations of job seekers with a mental illness, disability, or of a cultural minority. WORK: A Journal of Prevention, Assessment & Rehabilitation. ISSN 1051-9815. 70(1), p. 235–245. doi: 10.3233/WOR-213568. Full text in Research Archive Show summary

  BACKGROUND: Groups in society that are under-represented in the workforce encounter various barriers in the job-seeking process. Some of these barriers are found on the employer’s side of the table. OBJECTIVE: This study investigates supervisors’ and employees’ assessments of job seekers with different forms of disabilities, health issues, or with a minority background. It also investigates respondents’ previous experience with such colleagues, and whether supervisor status affects their assessments. METHODS: A survey was distributed among supervisors (n = 305) and employees (n = 925) using a vignette design with ten characters, inquiring about willingness to include such an employee in their work group. The vignettes described job seekers with either a mental illness, a physical disability or a cultural minority. Risk ratio (RR) was calculated for being assessed positively, using a vignette character describing a single mother as reference. RESULTS: Vignette characters describing mental health issues and physical disabilities were less likely to be assessed positively than the reference case, except for the vignette describing audio impairment. Cultural minorities were assessed as positive, or more positively than the reference case. Supervisors and employees generally agreed in their assessments of vignette characters, and previous experience was consistently associated with a more positive assessment of the character in question. Various barriers to include the least favoured vignette characters were identified. CONCLUSIONS: Although some findings are promising with regard to increasing work participation for underrepresented groups, barriers pertaining to some of the vignette characters should be addressed in vocational rehabilitation efforts, as well as in organizations seeking to enhance equal opportunities and diversity.

• Holmås, Tor Helge; Monstad, Karin & Reme, Silje Endresen (2021). Regular employment for people with mental illness – An evaluation of the individual placement and support programme. Social Science and Medicine. ISSN 0277-9536. 270, p. 1–10. doi: 10.1016/j.socscimed.2021.113691. Full text in Research Archive Show summary

  Highlights • Individual placement and support (IPS) investigated in moderate/severe mental illness. • We document the long-term effects of IPS in Norway using an RCT and registry data. • Effects were particularly large for younger individuals with low education. • IPS proves to increase regular employment during a 43 months follow-up period. • IPS is cost-effective compared to treatment-as-usual.

• Jacobsen, Henrik Børsting; Stubhaug, Audun; Holmøy, Bjørn; Kvam, Tor-Morten & Reme, Silje Endresen (2021). Have Norwegians tried psilocybin, and do they accept it as a medicine? Journal of Psychedelic Studies. 5(1), p. 33–36. doi: 10.1556/2054.2021.00167. Full text in Research Archive
• Løvvik, Camilla Margrethe Sigvaldsen; Øverland, Simon Nygaard; Nielsen, Morten Birkeland; Jacobsen, Henrik Børsting & Reme, Silje Endresen (2021). Associations between workplace bullying and later benefit recipiency among workers with common mental disorders. International Archives of Occupational and Environmental Health. ISSN 0340-0131. 95, p. 791–798. doi: 10.1007/s00420-021-01764-1. Full text in Research Archive Show summary

  Objective In this study, we examined exposure to workplace bullying as a predictor of registry-based benefit recipiency among workers struggling with work participation due to common mental disorders. Further, we examined if the experience of receiving social support moderated the association between workplace bullying and benefit recipiency. Design Secondary analyses of a randomized controlled trial. Patients People struggling with work participation due to common mental disorders (CMD). Methods Study participants (n = 1193) were from a randomized controlled trial (The At Work and Coping trial (AWaC), trial registration http://www.clinicaltrials.gov NCT01146730), and self-reported CMD as a main obstacle for work participation. Participants were at risk of sickness absence, currently on sickness absence or on long-term benefits. Benefit recipiency indicated sickness absence and/or long-term benefits (i.e., disability pension) at 6-month follow-up. Results Of the 1193 participants, 36% reported exposure to workplace bullying. Workplace bullying was significantly associated with benefit recipiency at 6-month follow-up (OR 1.41, CI 1.11–1.79). Social support did not moderate the association between bullying and benefit recipiency. Conclusions The finding that workplace bullying increases the risk of later benefit recipiency suggest that bullying is a significant obstacle for work participation.

• Gjengedal, Ragne Gunnarsdatter Hole; Lagerfeld, Suzanne E.; Reme, Silje Endresen; Osnes, Kåre; Sandin, Kenneth & Hjemdal, Odin (2021). The Return-to-Work Self-Efficacy Questionnaire (RTW-SE): A validation study of predictive abilities and cut-off values for patients on sick leave due to anxiety or depression. WORK: A Journal of Prevention, Assessment & Rehabilitation. ISSN 1051-9815. 31(3), p. 664–673. doi: 10.1007/s10926-021-09957-8. Full text in Research Archive Show summary

  Purpose This study aimed to evaluate the validity of the Return-to-Work Self-efficacy Questionnaire (RTW-SE) in a Norwegian sample of patients with common mental disorders. The secondary aim was to provide validated cut-off scores for the RTW-SE. Methods Among patients receiving work-focused therapy (N = 626), the RTW-SE was measured pre-and post-treatment, and work status was assessed up to one-year post-treatment. The factor structure, internal consistency and construct validity were assessed. Furthermore, post-treatment cut-off scores were calculated using receiver operating characteristic (ROC) analysis for patients on sick leave at baseline (n = 314) and at the end of treatment (n = 145). The predictive ability of the suggested RTW-SE cut-off scores were investigated longitudinally. Results Exploratory principal component analysis identified a one-factor solution with high internal consistency (0.91). RTW-SE exhibited small to moderate negative correlations with measures of depression and anxiety, and was significantly different between subgroups of patients with different work status, supporting construct validity. Pre- and post-treatment RTW-SE scores significantly predicted full return to work at 3, 6 and 12 months post-treatment. ROC analysis suggested an upper cut-off score of 4.6, associated with full RTW, and lower cut-off score of 3.7, associated with partial RTW. These cut-offs showed acceptable discriminative ability and significant longitudinal predictive ability. Conclusion The RTW-SE possesses good psychometric properties and the suggested cut-off scores have significant predictive ability in a clinical setting.

• Fauske, Lena; Bruland, Øyvind; Dahl, Alv A; Myklebostad, Åse & Reme, Silje Endresen (2021). Does the lightning process training programme reduce chronic fatigue in adolescent and young adult cancer survivors? A mixed-methods pilot study. Cancers. 13(16), p. 1–13. doi: 10.3390/cancers13164076. Full text in Research Archive Show summary

  Chronic fatigue is a common late adverse effect following oncological therapies. No effective treatments exist, although cognitive behaviour therapy has been reported to offer some benefits. The Lightning Process® is a three-day educational training programme with a six-month follow-up comprising elements derived from cognitive behaviour therapy, neurolinguistic programming, and stress theory, which are presented in a condensed form. This pilot intervention study represents the first systematic account of the experience and perceived efficacy of the LP training programme in 13 adolescent and young adult cancer survivors treated for sarcoma or Hodgkin lymphoma. Statistically significant improvements were documented for all the patient-reported outcome measure (PROM) questionnaires comparing the pre- and post-intervention periods. The qualitative findings of the interviews corresponded well with the PROMs findings, as participants emphasised that they now experienced both less fatigue and explicit improvement in their energy level.

• Ljoså, Tone Marte; Berg, Hanne Svardal; Jacobsen, Henrik Børsting; Granan, Lars-Petter & Reme, Silje Endresen (2021). Translation and validation of the Norwegian version of the Injustice Experience Questionnaire. Scandinavian Journal of Pain. ISSN 1877-8860. doi: 10.1515/sjpain-2021-0177. Full text in Research Archive
• Sveinsdottir, Vigdis; Johnsen, Tone Langjordet; Fyhn, Tonje; Opsahl, Jon; Tveito, Torill Helene & Indahl, Aage [Show all 8 contributors for this article] (2021). Development of the Workplace Inclusion Questionnaire (WIQ). Scandinavian Journal of Public Health. ISSN 1403-4948. 50(3), p. 371–380. doi: 10.1177/1403494821990241. Full text in Research Archive Show summary

  Aims: To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market. Methods: A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens (N=485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case. Results: Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories. Conclusions: The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion.

• Hellström, Lone; Pedersen, Pernille; Christensen, Thomas Nordahl; Wallstroem, Iben Gammelgaard; Bojesen, Anders Bo & Stenager, Elsebeth [Show all 13 contributors for this article] (2021). Vocational Outcomes of the Individual Placement and Support Model in Subgroups of Diagnoses, Substance Abuse, and Forensic Conditions: A Systematic Review and Analysis of Pooled Original Data. Journal of occupational rehabilitation. ISSN 1053-0487. doi: 10.1007/s10926-021-09960-z. Full text in Research Archive
• Sandin, Kenneth; Anyan, Frederick; Osnes, Kåre; Gjengedal, Ragne Gunnarsdatter Hole; Leversen, Jonas Sigurd Risberg & Reme, Silje Endresen [Show all 7 contributors for this article] (2021). Sick leave and return to work for patients with anxiety and depression: A longitudinal study of trajectories before, during and after work-focused treatment. BMJ Open. 11(9), p. 1–9. doi: 10.1136/bmjopen-2020-046336. Full text in Research Archive Show summary

  Objectives Sick leave due to anxiety and depression is a heterogeneous process constituting a pressing public health issue. This longitudinal study aimed to identify sick leave trajectories among patients before, during and after work-focused treatment, in all 29.5 months. We then aimed to determine the background and clinical characteristics of these trajectory groups. Methods Background and clinical data were collected by patient self-report (N=619) in an observational study in a specialised mental healthcare clinic. Sick leave was recorded from national registry data. A latent growth mixture model identified trajectories. Multinomial logistic regression determined differences in background characteristics while a one-way analysis of variance (ANOVA) identified clinical differences. Results We identified three trajectories: The ‘Resilient’ group (47.7%) had low sick leave throughout the period. The two other groups (‘Recovery’, 31.8% and ‘High risk’, 20.5%) had similar pretreatment trajectories: lower sick leave one year prior which increased to high sick leave at the start of treatment. After treatment, the ‘Recovery’ group made an almost full return to work while the ‘High risk’ group remained at high sick leave. The two groups with high sick leave had more women and higher age compared with the ‘Resilient’ group. All groups had similar clinical scores at the start of treatment, but the ‘High risk’ groups had residual depressive symptoms at the end of treatment. Effect sizes for anxiety and depression were moderate or large for all groups, (Cohen’s d=0.74–1.81), and 87.2% of the total sample were fully working one year after treatment. Conclusion We found three subgroups with distinctly different trajectories. Female gender and higher age were associated with high sick leave at the start of treatment, while residual depressive symptoms at the end of treatment predicted continued sick leave. The study points to the possibility of improving patient outcomes in the future by stratifying and tailoring treatment to patient characteristics.

• Munk, Alice; Reme, Silje Endresen & Jacobsen, Henrik Børsting (2021). What does CATS have to do with cancer? The cognitive activation theory of stress (CATS) forms the SURGE model of chronic post-surgical pain in women with breast cancer. Frontiers in Psychology. 12:630422, p. 1–14. doi: 10.3389/fpsyg.2021.630422. Full text in Research Archive
• Fyhn, Tonje; Øverland, Simon Nygaard & Reme, Silje Endresen (2020). Predictors of employment in people with moderate to severe mental illness participating in a randomized controlled trial of Individual Placement and Support (IPS). International Journal of Social Psychiatry. ISSN 0020-7640. doi: 10.1177/0020764020934841. Full text in Research Archive Show summary

  Background: Many people with moderate to severe mental illness have a desire to obtain ordinary employment. To aid further development of health and social services for this group, the aim of this study was to examine candidate modifiable and prognostic markers of employment, and moderating effects of group allocation in a clinical trial. Method: The sample consists of 327 patients in treatment for mental illness, randomized to Individual Placement and Support (IPS) or treatment as usual (TAU) as part of a clinical trial. Psychosocial and demographic baseline characteristics were included as predictors in log binary regression analyses with employment 18 months after inclusion as the outcome, and group allocation as the moderator (IPS or TAU). Results: Directive emotional support and non-directive instrumental support seemed to positively predict employment, but effects were small. Involuntary hospitalization seemed to be a strong negative predictor of employment. Group allocation did not moderate any main effects. Conclusion: Interpretation of the findings suggest that attention should be given to certain aspects of health and social services provided to this target group, and in particular the effect of receiving appropriate types of social support. The findings are novel because social support and involuntary hospitalization do not seem to have been included in previous predictor studies. The results from this study identify new topics for research on employment outcomes for this population.

• Gjengedal, Ragne Gunnarsdatter Hole; Reme, Silje Endresen; Osnes, Kåre; Lagerfeld, Suzanne E.; Blonk, Roland W. B. & Sandin, Kenneth [Show all 8 contributors for this article] (2020). Work-focused therapy for common mental disorders: A naturalistic study comparing an intervention group with a waitlist control group. WORK: A Journal of Prevention, Assessment & Rehabilitation. ISSN 1051-9815. 66(3), p. 657–667. doi: 10.3233/WOR-203208. Full text in Research Archive Show summary

  BACKGROUND: Common mental disorders (CMD) are leading causes of sickness absence. Treatments for CMD that both reduce symptoms and support work participation urgently need to be developed. OBJECTIVE: Determine the potential effects of work-focused therapy combining work interventions with either meta cognitive therapy or cognitive behavioural therapy (W-MCT/CBT) for patients with CMD on sick leave. METHODS: Naturalistic study with a quasi-experimental approach. Pre- and post-scores (return to work, symptoms, return-to-work self-efficacy, clinical recovery from depression and anxiety) were compared between the intervention group (n = 87) who received immediate treatment over an average of 10.40 sessions (SD = 3.09) and the non-randomized waitlist control group (n = 95) that had waited an average of 11.18 weeks (SD = 2.29). RESULTS: Significantly more patients returned fully to work in the intervention group (41.4%) than the control group (26.3%). Effect sizes for self-efficacy scores, depression and anxiety were large in the intervention group (d = 1.28, 1.01, 1.58), and significantly lower in the control group (d = 0.60, 0.14, 0.45). Significantly more patients in the treatment group than control group recovered from depression (54.1% vs. 12.8%) and anxiety (50.0% vs.10.6%). CONCLUSIONS: W-MCT/CBT may be an effective intervention for patients on sick leave due to CMD.

• Rosseland, Leiv Arne; Reme, Silje Endresen; Simonsen, Tone Breines; Thoresen, Magne; Nielsen, Christopher Sivert & Eberhard-Gran, Malin (2020). Are labor pain and birth experience associated with persistent pain and postpartum depression? A prospective cohort study. Scandinavian Journal of Pain. ISSN 1877-8860. 20(3), p. 591–602. doi: 10.1515/sjpain-2020-0025. Full text in Research Archive Show summary

  <i>Background and aims</i> - A considerable research-literature focuses on pain during labor and associations with postpartum persistent pain and depression, with findings pointing in various directions. The aim of this study was to examine the role of labor pain and overall birth experience in the development of pain and depression 8 weeks after delivery.<p><p> <i>Methods</i> - The study sample was drawn from the Akershus Birth Cohort. Data from multiple sources were used, including the hospital’s birth record (n = 4,391), questionnaire data from gestational week 17 of pregnancy (n = 3,752), 8 weeks postpartum (n = 2,217), and two questions about pain and birth experience asked within 48 h after delivery (n = 1,221). The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain 8 weeks postpartum, while pain and birth experience were measured by numeric rating scales. A history of pre-pregnant depression and chronic pain were measured through self-report questions in gestational week 17. A total of 645 women had complete data from all sources. We applied multiple imputation techniques to handle missing responses on the two questions about pain and birth experience.<p><p> <i>Results</i> - The results showed that neither labor pain nor birth experience were associated with persistent pain 8 weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71–5.04) and a history of depression (OR 2.31; 95% CI 1.85–2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04–1.29) associated with postpartum depression, whereas labor pain intensity was not. A history of depression (OR 3.95; 95% CI 2.92–5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37–3.01) were important predictors of postpartum depression 8 weeks after delivery.<p><p> <i>Conclusions and implications</i> - Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.

• Flink, Ida K.; Reme, Silje Endresen; Jacobsen, Henrik Børsting; Glombiewski, Julia; Vlaeyen, Johan W.S. & Nicholas, Michael K. [Show all 12 contributors for this article] (2020). Pain psychology in the 21st century: Lessons learned and moving forward. Scandinavian Journal of Pain. ISSN 1877-8860. p. 1–10. doi: 10.1515/sjpain-2019-0180. Full text in Research Archive
• Wu, Yin; Levis, Brooke; Ioannidis, John P.A.; Benedetti, Andrea; Thombs, Brett D. & Sun, Ying [Show all 239 contributors for this article] (2020). Probability of major depression classification based on the SCID, CIDI, and MINI diagnostic interviews: A synthesis of three individual participant data meta-analyses. Psychotherapy and Psychosomatics. ISSN 0033-3190. 90(1), p. 28–40. doi: 10.1159/000509283. Full text in Research Archive
• Linnemørken, Lene Therese Bergerud; Granan, Lars-Petter & Reme, Silje Endresen (2020). Prevalence of posttraumatic stress symptoms and associated characteristics among patients with chronic pain conditions in a Norwegian university hospital outpatient pain clinic. Frontiers in Psychology. 11:749, p. 1–14. doi: 10.3389/fpsyg.2020.00749. Full text in Research Archive Show summary

  Introduction: Comorbid posttraumatic stress disorder (PTSD) in patients with chronic pain may have a negative effect on the course and outcome of both disorders. Nevertheless, the co-occurrence of the two conditions is often overlooked in clinical settings. Further, little is known about how PTSD is associated with biopsychosocial characteristics in this patient group. The first objective was to assess the prevalence of posttraumatic stress symptoms (PTSS) in patients with chronic pain in a Norwegian university hospital outpatient pain clinic. The second objective was to investigate possible associations between PTSS and adverse outcomes such as pain intensity, disability, and distress. The third objective was to compare the PTSS prevalence rates between primary versus secondary pain conditions. Materials and methods: Six hundred and ninety-two patients meeting for pain assessment completed self-report questionnaires about PTSS and possibly associated factors. The Life Events Checklist and the Stressful Life Events Screening Questionnaire were used to screen for potentially traumatic life events. The Impact of Events Scale – Revised and the PTSD Checklist for DSM-5 were used to assess PTSS. Differences between patients with and without severe PTSS on the possibly associated variables were analyzed by chi-squared-, and t-tests. Results: 20.7% of the participants reported a level of PTSS qualifying for a PTSD diagnosis. These patients reported higher levels of pain intensity, pain bothersomeness, disability, and psychological distress, as well as lower levels of self-efficacy. They also reported higher levels of pain catastrophizing, perceived injustice, fatigue, and sleep difficulties. Finally, there was not a significant difference in prevalence rates between primary and secondary pain conditions. Discussion: PTSS are frequent in patients with chronic pain, and a range of psychological characteristics is associated with a high level of such symptoms in this patient group. Patients with both conditions report a significantly higher symptom load, and the potential impact on the individual’s life is major. In terms of pain condition, there were no differences in PTSS between primary pain conditions and secondary pain conditions in this pain population. This study emphasizes the importance of increased attention on PTSS when seeing patients with chronic pain conditions in clinical practice.

• Fjeld, Sara Skilbred; Reme, Silje Endresen & Mossige, Svein (2020). Cyberbullying involvement and mental health problems among late adolescents. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. 14:5(1), p. 1–16. doi: 10.5817/CP2020-1-5. Full text in Research Archive Show summary

  Exposure to cyberbullying is associated with psychological distress like depressive symptoms, self-injurious behavior and suicidal thoughts. Cyberbullying is thus a major challenge for public health. This study examines the prevalence of cyberbullying and explores the psychological characteristics of adolescents who have experienced cyberbullying. The sample consisted of 4531 Norwegian graduates in high school, age 18–21. The following psychological characteristics were investigated: self-harm, suicide attempts, antisocial behavior, anxiety and depression. Three mutually exclusive groups of cyberbullying were compared: 1) cybervictims, 2) cyberbullies and 3) cyberbully-victims. Participants involved in cyberbullying were further compared to those not involved. The prevalence of cyberbullying in this study was 5 %. There were no significant differences between cyberbullies, cybervictims and cyberbully-victims on any of the psychological variables, except for fewer reported suicide attempts in cyberbullies compared to cybervictims and cyberbully-victims. Late adolescents involved in cyberbullying did however report significantly more anxiety, depression, self-harm, suicide attempts and antisocial behavior, compared to those not involved. Thus, late adolescents involved in cyberbullying struggle more with psychological problems than non-involved adolescents. Increased knowledge about the characteristics of cyberbullies, cybervictims and cyberbully-victims could contribute to better detection and earlier identification of those involved in cyberbullying. This knowledge can further help understand more of the potential psychological vulnerability factors and consequences of cyberbullying, which could be used to optimize preventive measures and treatment.

• Fyhn, Tonje; Ludvigsen, Kari; Reme, Silje Endresen & Schaafsma, Frederieke (2020). A structured mixed method process evaluation of a randomized controlled trial of Individual Placement and Support (IPS). Implementation Science Communications. 1(1). doi: 10.1186/s43058-020-00083-9. Full text in Research Archive Show summary

  Background Individual Placement and Support (IPS) is an evidence-based work rehabilitation program helping people with moderate to severe mental illness to obtain ordinary employment. Although IPS has proven superior to other work rehabilitation programs, in many studies, the majority of the participants remain unemployed. Structured process evaluations of IPS that use mixed methods are scarce, although they could identify implementation aspects that may enhance its effect. The aim of the current study is to assess reach, fidelity, and identify barriers and facilitators to implement IPS. Methods The process evaluation was conducted alongside a randomized controlled trial including six IPS centers, comparing IPS with treatment as usual in a population of patients in treatment for moderate to severe mental illness. Mixed methods were used in the process evaluation, including focus group interviews with service providers, individual interviews and survey data from participants, and fidelity reviews using the validated IPS Fidelity Scale. Results The intervention reached the intended target group. All centers reached fair to good fidelity according to the IPS Fidelity Scale within the project period (range 97–109, SD 8.1) (see Table 5). Certain fidelity items indicated implementation issues related to employer contact, community-based services, and integration with health services. Survey data showed that less than half of the participants regarded their illness as a barrier for participating in IPS and that freedom of disclosure was important. Participant interviews gave further insight into the role of the IPS specialist, emphasizing their availability and consistent job focus. Conclusions Indications of implementation challenges across centers during the first year suggest special attention should be given to these aspects in an early phase to ensure higher fidelity from the start and thus enhance the effectiveness of IPS. The IPS specialist played an important role for participants and was described as positive, pushing in a positive way, and encouraging. More knowledge on the characteristics of successful IPS specialists could further enhance the effectiveness of the intervention. Trial registration The study was registered on clinicaltrials.gov prior to the inclusion period (reg.no: NCT01964092 , registered 17/07/2013).

• Wu, Yin; Levis, Brooke; Sun, Ying; Krishnan, Ankur; He, Chen & Riehm, Kira E [Show all 52 contributors for this article] (2019). Probability of major depression diagnostic classification based on the SCID, CIDI and MINI diagnostic interviews controlling for Hospital Anxiety and Depression Scale - Depression subscale scores: An individual participant data meta-analysis of 73 primary studies. Journal of Psychosomatic Research. ISSN 0022-3999. 129. doi: 10.1016/j.jpsychores.2019.109892. Full text in Research Archive
• Sveinsdottir, Vigdis; Bull, Helen; Evensen, Stig; Reme, Silje Endresen; Knutzen, Thomas & Lystad, June Ullevoldsæter (2019). A Short History of Individual Placement and Support in Norway. Psychiatric rehabilitation journal. ISSN 1095-158X. doi: 10.1037/prj0000366. Full text in Research Archive Show summary

  bjective: Norway is a high-income and high-cost society with a generous welfare system, and it has the largest mental health–related unemployment gap of the OECD countries. The aim of the current article was to present a short history of Individual Placement and Support (IPS) services to increase work participation in Norway. Method: We provide a narrative overview of the developments and research on IPS in Norway, from the introduction of supported employment to recent and ongoing randomized controlled trials (RCTs) investigating the effectiveness of IPS for various target groups. Findings: While vocational rehabilitation services in Norway have traditionally followed a train-then-place approach, the introduction of supported employment in the early 1990s led to a range of new initiatives to increase work participation. Early implementations were inspired by supported employment but did not follow the evidence-based IPS methodology. More recent developments include a shift toward evidence-based IPS, and the first Norwegian RCT of IPS showed effectiveness on both work- and health-related outcomes among people with moderate to severe mental illness. Several ongoing trials are currently investigating IPS for new target groups, including chronic pain patients and refugees. Conclusions and Implications for Practice: The results suggest that IPS is more effective than traditional approaches to increase work participation, even in the Norwegian context of a high-cost welfare society. IPS has shown effectiveness in severe as well as more common types of mental illness in Norway, and results from ongoing trials will further reveal whether IPS may be expanded to various new target groups.

• Reme, Silje Endresen; Monstad, Karin; Fyhn, Tonje; Sveinsdottir, Vigdis; Løvvik, Camilla & Lie, Stein Atle [Show all 7 contributors for this article] (2019). A randomized controlled multicenter trial of individual placement and support for patients with moderate-to-severe mental illness. Scandinavian Journal of Work, Environment and Health. ISSN 0355-3140. 45(1), p. 33–41. doi: 10.5271/sjweh.3753. Full text in Research Archive Show summary

  Objectives: The aim of this study was to evaluate the effectiveness of individual placement and support (IPS) for people struggling with work participation due to moderate-to-severe mental illness. The study was conducted in Norway, a setting characterized by a comprehensive welfare system and strong employment protection legislation. Methods: A randomized controlled multicenter trial including 410 participants was conducted. The intervention group received IPS according to the IPS manual. The control group received high-quality usual care. The main outcome was competitive employment at 12- and 18-months follow-up, based on objective registry data. Changes in mental health and health-related quality of life were secondary outcomes. Results: At 12-months follow-up, 36.6% of participants in the IPS group and 27.1% of participants in the control group were in competitive employment, while the difference was slightly higher (37.4% versus 27.1%) at 18-months follow-up. Furthermore, IPS yielded positive effects on all the secondary outcomes compared to the control group (all P<0.05). Conclusions: The IPS model of supported employment was superior to high-quality usual care on both vocational and non-vocational outcomes for people with moderate-to-severe mental illness, even in a policy context characterized by high job security and a comprehensive welfare system.

• Sveinsdottir, Vigdis; Lie, Stein Atle; Bond, Gary R.; Eriksen, Hege Randi; Tveito, Torill Helene & Grasdal, Astrid [Show all 7 contributors for this article] (2019). Individual placement and support for young adults at risk of early work disability (the SEED trial). A randomized controlled trial. Scandinavian Journal of Work, Environment and Health. ISSN 0355-3140. 46(1), p. 50–59. doi: 10.5271/sjweh.3837. Full text in Research Archive Show summary

  Objectives Individual placement and support (IPS) is an effective approach for helping people with severe mental illness gain employment. This study aimed to investigate if IPS can be effectively repurposed to support young adults at risk of early work disability due to various social and health related problems. Methods A randomized controlled trial including 96 young adults (18‒29 years; 68% men) was conducted in Norway. Participants were not in employment, education, or training, received temporary benefits due to social or health-related problems, and were eligible for traditional vocational rehabilitation (TVR). Participants were randomized to IPS (N=50) or TVR (N=46). Self-reported data were collected at baseline and at 6- and 12-months follow-up. The primary outcome was obtaining any paid employment in the competitive labor market during follow-up. Secondary outcomes were physical and mental health, well-being, coping, alcohol consumption, and drug use. Results Significantly more IPS participants obtained competitive employment compared to TVR participants during 12-months follow-up (48% versus 8%; odds ratio 10.39, 95% confidence interval 2.79‒38.68). The IPS group reported significantly better outcomes than the TVR group in subjective health complaints, helplessness, and hopelessness. In post hoc analyses adjusted for baseline and missing data, the IPS group reported significantly better outcomes on these measures in addition to level of disability, optimism about future well-being, and drug use. Conclusions IPS is effective for young adults at risk of early work disability. IPS was superior to TVR in increasing competitive employment and promoted improvements in some non-vocational outcomes. IPS services should be offered to improve employment rates in this vulnerable group.

• Nøttingnes, Cathrine; Fersum, Kjartan; Reme, Silje Endresen; Moe-Nilssen, Rolf & Morken, Tone (2019). Jobbrelatert mestringstro ved muskel og skjelettplager - et spørreskjema. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(11). doi: 10.4045/tidsskr.18.0571. Full text in Research Archive
• Granan, Lars-Petter; Reme, Silje Endresen; Jacobsen, Henrik Børsting; Stubhaug, Audun & Ljoså, Tone Marte (2019). The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients. Scandinavian Journal of Pain. ISSN 1877-8860. 19(2), p. 365–373. doi: 10.1515/sjpain-2017-0160. Full text in Research Archive Show summary

  Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0–10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient’s perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients’ self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.

• Øverland, Simon Nygaard; Grasdal, Astrid & Reme, Silje Endresen (2018). Long-term effects on income and sickness benefits after work-focused cognitive-behavioural therapy and individual job support: a pragmatic, multicentre, randomised controlled trial. Occupational and Environmental Medicine. ISSN 1351-0711. 75(10), p. 703–708. doi: 10.1136/oemed-2018-105137. Full text in Research Archive
• Sveinsdottir, Vigdis; Eriksen, Hege Randi; Baste, Valborg; Hetland, Jørn & Reme, Silje Endresen (2018). Young adults at risk of early work disability: who are they? BMC Public Health. 18:1176(1176), p. 1–12. doi: 10.1186/s12889-018-6095-0. Full text in Research Archive Show summary

  Background: Young adults that are not in education, training or employment represent a problem across European countries. While some are cases of temporary transitions or short-term inactivity, others represent a more vulnerable group at risk of early work disability. Early exclusion from the labor market represents long lives exposed to detrimental effects of unemployment on health and well-being, and constitutes an economic burden for society. There is need for more knowledge about young adults who are at risk of early work disability but have not yet reached the point of more permanent exclusion. This study aims to investigate social and health-related problems in a Norwegian sample of young adults at risk of early work disability, and their self-perceived causes of illness. Methods: Baseline data from participants in the SEED-trial (N = 96), a randomized controlled trial comparing individual placement and support to traditional vocational rehabilitation in young adults at risk of early work disability, were analyzed. Background, health behaviors, adverse social experiences, disability level, physical and mental health, social support, coping, and self-perceived causal attributions of illness were measured. Gender differences were analyzed using chi-square and t-tests. Results: Mean age was 24, and 68% were men. One third reported reading and writing difficulties, and 40% had less than high-school education. The majority had experienced bullying (66%) or violence (39%), and 53% reported hazardous alcohol use. Psychological distress was the most prevalent health problem (52%), and women generally had more physical and mental health problems than men. Self-perceived causal attributions of illness were mainly related to relational problems, followed by health behaviors, heredity/genetics, and external environmental factors. Conclusions: The study provides a deeper insight into a vulnerable group with substantial challenges related to adverse social experiences, psychological distress, and alcohol use, who emphasized relational problems as the main causal factor for their illness. Findings suggest a need for broader focus on psychological and social factors in vocational rehabilitation efforts targeting young adults at risk of early work disability. Furthermore, gender-specific approaches may be warranted and should be followed up in future studies.

• Linnemørken, Lene Therese Bergerud; Sveinsdottir, Vigdis; Knutzen, Thomas; Rødevand, Linn Nilsen; Hernæs, Kjersti Helene & Reme, Silje Endresen (2018). Protocol for the Individual Placement and Support (IPS) in Pain Trial: A randomized controlled trial investigating the effectiveness of IPS for patients with chronic pain. BMC Musculoskeletal Disorders. 19(47). doi: 10.1186/s12891-018-1962-5. Full text in Research Archive Show summary

  Background Work disability involves large costs to the society as well as to the individual. Work disability is common among people with chronic pain conditions, yet few effective interventions exist. Individual Placement and Support (IPS) is an evidence-based work rehabilitation model originally developed to help people with severe mental illness obtain and maintain employment. The effectiveness of IPS for patients with severe mental illness is well documented, but the model has never before been tested for patients with chronic pain. Methods/design The aim of the IPS in Pain trial is to investigate the effectiveness of IPS as an integrated part of the interdisciplinary treatment for patients with chronic pain in a hospital outpatient clinic. The study is a randomized controlled trial comparing pain treatment with integrated IPS to treatment as usual in unemployed patients suffering from various chronic pain conditions. The primary outcome of the study is labor market participation during 12 months after enrollment, and secondary outcomes include physical and mental health and well-being, collected at baseline, 6, and 12 months. Finally, there will be an additional long-term follow-up for the primary outcome, which will be collected through a brief phone interview at 24 months. Discussion The IPS in Pain trial will be the first report of the effectiveness of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. It will thus provide important information about the effectiveness of repurposing IPS to a new patient group in great need of job support. Trial registration Clinicaltrials.gov: NCT02697656 . Registered January 15th, 2016.

• Øverland, Simon Nygaard; Grasdal, Astrid & Reme, Silje Endresen (2018). Long-term outcomes of an integrated approach to help people with mental illness return to work. European Journal of Public Health. ISSN 1101-1262. 28. doi: 10.1093/eurpub/cky213.083. Full text in Research Archive
• Reme, Silje Endresen (2018). Body image concerns and distortions in people with persistent pain. Scandinavian Journal of Pain. ISSN 1877-8860. doi: 10.1515/sjpain-2018-0086. Full text in Research Archive

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• Reme, Silje Endresen; Landmark, Live; Asprusten, Tarjei Tørre; Suvatne, Christer; Herner, Linn Breen & Drivenes, Elin [Show all 63 contributors for this article] (2026). Gi pasientene livet tilbake. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146. doi: 10.4045/tidsskr.26.0480. Full text in Research Archive Show summary

  Vi vet nok til å kunne hjelpe langt flere pasienter med langvarige symptomer. Likevel holder vi tilbake håpet, av frykt for å skuffe. Det kan koste pasientene store deler av livet. Denne kronikken er et faglig opprop fra 63 klinikere, forskere og fagpersoner fra hele landet. Vi har klinisk og forskningsmessig erfaring med vedvarende fysiske symptomer, som smerter, utmattelse, «hjernetåke», svimmelhet og mageplager og har samlet oss om et felles budskap: Ny kunnskap om hvordan slike symptomer oppstår og opprettholdes gir grunn til langt større håp om bedring enn mange pasienter får formidlet i dag.

• Kristiansen, Hege; Reme, Silje Endresen; Pedersen, Maria & Sagabråten, Ståle Onsgård (2026). Arendalsuka | Arrangement: Hjernen skaper smerte – men systemet…. doi: https:/www.arendalsuka.no/program/hjernen-skaper-smerte---men-systemet-skaper-ko-hvordan-loser-vi-det. Full text in Research Archive Show summary

  Langvarige smerter, utmattelse og funksjonelle plager er blant de største årsakene til sykefravær og uførhet i Norge. Likevel møter mange pasienter et…

• Engel, Sophia; Solberg, Lene Bergendal; Reme, Silje Endresen & Jacobsen, Henrik Børsting (2025). Pasientens udekkede behov i akutt ortopedisk traumebehandling – Hvordan kan disse møtes? Full text in Research Archive Show summary

  Abstract presentation

• Parveen, Sana; Nielsen, Morten Birkeland; Reme, Silje Endresen & Finne, Live Bakke (2024). Intent to Leave Among Child Welfare Workers: A three- way interaction between client-perpetrated violence, violence prevention behavior and violence management climate. Full text in Research Archive
• Parveen, Sana; Nielsen, Morten Birkeland; Reme, Silje Endresen & Finne, Live Bakke (2024). Intent to Leave Among Child Welfare Workers: A three-way interaction between client-perpetrated violence, violence prevention behavior and violence management climate. Full text in Research Archive
• Parveen, Sana; Finne, Live Bakke; Reme, Silje Endresen & Nielsen, Morten Birkeland (2023). Client-Perpetrated Violence and Intent to Leave Among Child Welfare Workers: A Three-Wave Cross-Lagged Prospective Study of Causal Directions and The Role of Work-Related Rumination. Full text in Research Archive
• Bekkenes, Maria Egeland; Stubhaug, Audun; Reme, Silje Endresen; Fagerland, Morten Wang; Michelsen, Trond Melbye & Rosseland, Leiv Arne (2022). Effects of 2.5 IU oxytocin or 100 μg carbetocin on pain intensity and opioid consumption after planned cesarean delivery; a randomized controlled trial. Full text in Research Archive
• Stensrud, Linn Myrtveit; Haugstad, Gro Killi; Reme, Silje Endresen & Groven, Karen Synne (2022). How do heterosexual couples experience living with vulvodynia? Full text in Research Archive Show summary

  Background and aims Vulvodynia is a chronic genital pain disorder with a high lifetime prevalence among women. It has a significant negative impact on both the women and their partners, often increasing psychological distress. While there is a growing body of literature on the experiences of women with vulvodynia, there is scarce research on the effects it has on partners and romantic relationships. The following study aims at exploring the experiences of both patients and partners, in particular how it affects and is dealt with by heterosexual couples. Methods Eight Norwegian women diagnosed with vulvodynia by gynecologists were recruited with their partners (couples aged 19-32 years). Data was collected with individual semi-structured interviews and analyzed with inductive thematic analysis. Results Both relationship and pain duration ranged from one to more than ten years. The results of the data material were structured into three main themes: 1) Mysterious disorder, 2) Social exclusion, and 3) Sexual expectations. The results show that the couples struggle with understanding the pain, as well as navigating their social and sexual lives. Conclusions Lack of understanding of vulvodynia in the health care system and in the general public, makes it difficult for couples to communicate openly with each other, with health care workers, and with their social network. Communication difficulties increases feelings of helplessness and loneliness, while social expectations of male and female sexuality give rise to guilt and shame for both men and women when they face sexual problems due to vulvodynia.

• Reme, Silje Endresen (2022). Can chronic pain be prevented? Psychological interventions to prevent pain after surgery and its clinical applications. Full text in Research Archive
• Reme, Silje Endresen; Munk, Alice; Holter, Marianne Therese Smogeli; Falk, Ragnhild Sørum & Jacobsen, Henrik Børsting (2022). Pre- and post-operative psychological interventions to prevent pain and fatigue after breast cancer surgery (PREVENT): Protocol for a randomized controlled trial. PLOS ONE. 17(7). doi: 10.1371/journal.pone.0268606. Full text in Research Archive Show summary

  Background Breast cancer is the most common cancer type among women worldwide with over a million new cases each year. More than 40% of these women will struggle with chronic pain and fatigue after surgery, regardless of surgical procedure. These consequences are detrimental and result in distress and disability, including work disability. Few attempts have been made to prevent chronic pain and fatigue after surgery by applying a psychological approach, despite psychological risk factors being crucial in the development of both chronic pain and fatigue. In this study, we aim to develop and test an easily implementable strategy of preventing chronic pain and fatigue after breast cancer surgery. The intervention strategy involves a pre-operative hypnosis session and a web-based post-operative Acceptance and Commitment Therapy (ACT). The hypnosis has previously been found effective in alleviating acute post-operative pain and fatigue in breast cancer patients, while ACT is well suited to cancer populations as it offers a model of healthy adaptation to difficult circumstances. Together they form an intervention strategy with both a preventive and a rehabilitative focus. Methods/Design This randomized controlled trial aims to estimate the effects of the pre- and post- operative interventions compared to attentional control and treatment as usual (TAU) and will also include a qualitative process evaluation. Participants will be randomized to receive either a pre-operative brief hypnosis session and a post-operative web-based psychological intervention (iACT) or a pre-operative one-session mindfulness through an audio file and post-operative TAU. Self-reported questionnaire data and biomarker data will be assessed pre-surgery, post-surgery and 3 and 12 months after surgery. In addition, we will assess registry data on sick leave and prescriptions until 2-year follow-up. In the qualitative process evaluation, data will be collected from participants from both study arms (through interviews and a diary) and two different analyses performed (socio-narrative and Grounded Theory) with the objective to describe the development of chronic post-surgical pain and fatigue and the potential influence of the interventions on these processes. The study is set-up to demonstrate a minimum difference in pain of 1 point on NRS (0–10) and 3 points on FACIT-F (0–52) between the groups at 3-months follow-up by including 200 breast cancer patients in total. Discussion This trial will be the first study to estimate the effect of a combined pre-operative hypnosis with a post-operative iACT to prevent pain and fatigue after breast cancer surgery. The results from our study might i) help the large group of women affected by chronic pain and fatigue after breast cancer surgery, ii) shed light on the mechanisms involved in chronic pain and fatigue development, and iii) serve as a model for other surgical procedures. Trial registration Clinicaltrials.gov, registration number NCT04518085. Registered on January 29th, 2020. https://clinicaltrials.gov/ct2/show/NCT04518085.

• Reme, Silje Endresen (2022). «Er sykmelding god behandling? Hvordan kan fastlegen hjelpe pasienter (tilbake) i jobb»? Full text in Research Archive
• Rognli, Eline B.; Aas, Erlend Marius; Drake, Robert; Marsden, John; Anders, Paul & Bond, Gary R. [Show all 9 contributors for this article] (2021). The effect evaluation of Individual Placement and Support (IPS) for patients with substance use disorders: study protocol for a randomized controlled trial of IPS versus enhanced self-help. Trials. 22(1), p. 1–9. doi: 10.1186/s13063-021-05673-z. Full text in Research Archive Show summary

  Background Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population. Methods/design The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (1:1) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% difference in the main outcome of employment with 90% power. We will make assessments at inclusion and at 6- and 12-month follow-ups and obtain outcome data on employment from national mandatory registries. The primary outcome will be at least 1 day of competitive employment during the 18-month follow-up period. Secondary employment outcomes will capture the pattern and extent of employment in terms of total time worked (days/hours), time to first employment, number of different jobs, duration of the longest employment, and sustained employment. Secondary non-employment outcomes will be substance use, mental distress, and quality of life measured by validated instruments at 6, 12, and 18 months follow-up assessments. To be eligible, participants must be between 18 and 65 years, currently unemployed and in treatment for SUD. Discussion The IPS-SUD trial will provide evidence for the use of IPS in a SUD population. Findings from the study will have implications for service delivery. Trial registration ClinicalTrials.gov NCT04289415. Registered on February 28, 2020

• Sandin, Kenneth; Gjengedal, Ragne Gunnarsdatter Hole; Osnes, Kåre; Hannisdal, Marit; Berge, Torkil & Leversen, Jonas Sigurd Risberg [Show all 14 contributors for this article] (2021). Correction to: Metacognitive therapy and work-focused interventions for patients on sick leave due to anxiety and depression: study protocol for a randomised controlled wait-list trial (Trials, (2021), 22, 1, (854), 10.1186/s13063-021-05822-4). Trials. 22(1). doi: 10.1186/s13063-021-05933-y. Full text in Research Archive
• Sandin, Kenneth; Gjengedal, Ragne Gunnarsdatter Hole; Osnes, Kåre; Hannisdal, Marit; Berge, Torkil & Leversen, Jonas Sigurd Risberg [Show all 14 contributors for this article] (2021). Metacognitive therapy and work-focused interventions for patients on sick leave due to anxiety and depression: study protocol for a randomised controlled wait-list trial. Trials. 22(1). doi: 10.1186/s13063-021-05822-4. Full text in Research Archive Show summary

  Background Common mental disorders such as depression and anxiety are major contributors to the global burden of disease. Affected individuals suffer reduced quality of life, impaired functioning and reduced capacity to work. Maintaining employment is an important determinant for health and wellbeing, and the economic impact of depression and anxiety is a significant societal expense. Treatments providing effective symptom reduction and helping patients return to work (RTW) would thus have substantial public health benefits. The present study will explore the effectiveness of metacognitive therapy (MCT) and work-focused interventions on reducing symptoms and increasing RTW rates for patients on sick leave due to depression and anxiety. Methods The study is a randomised controlled wait-list trial (RCT; N = 240). The intervention group will receive protocol-based MCT and work-focused interventions immediately after inclusion. The control condition is a wait-list control group. All patients will receive up to 12 weekly sessions. The study context is a Norwegian outpatient clinic part of a national programme aimed at reducing sick leave. The co-primary outcomes are change in RTW and symptoms of depression and anxiety at the end of treatment. In addition to self-report, sick leave will also be collected from national registries from 2 years prior to intervention to 4 years after intervention. Symptoms of scores will be collected by self-report at pre- and post-treatment and at 6 and 12 months follow-up after treatment. A cost-effectiveness analysis will use total cost and quality-adjusted life-years as the secondary outcomes. Discussion There is broad consensus on the importance of identifying treatment that effectively reduces depression and anxiety symptoms and aids RTW. This study is an important contribution to the field as it is the first RCT on MCT and work-focused interventions for patients on sick leave due to anxiety and depression. Trial registration ClinicalTrials.gov NCT03301922. Registered on October 4, 2017.

• Ljoså, Tone Marte & Reme, Silje Endresen (2020). Hvordan måle opplevd urettferdighet. Full text in Research Archive
• Rosseland, Leiv Arne; Reme, Silje Endresen & Eberhard-Gran, Malin (2020). Jordmødre og fødselsleger bør gi korrekt og saklig informasjon ikke synse. Aftenposten Viten. ISSN 2464-3033. Full text in Research Archive
• Rosseland, Leiv Arne; Reme, Silje Endresen; Simonsen, Tone Breines; Thoresen, Magne; Nielsen, Christopher Sivert & Eberhard-Gran, Malin (2020). Corrigendum to: Are labor pain and birth experience associated with persistent pain and postpartum depression? A prospective cohort study. Scandinavian Journal of Pain. ISSN 1877-8860. 20(4), p. 865–865. doi: 10.1515/sjpain-2020-2023. Full text in Research Archive
• Rosseland, Leiv Arne; Reme, Silje Endresen; Simonsen, Tone Breines; Thoresen, Magne; Nielsen, Christopher Sivert & Eberhard-Gran, Malin Marie Cecilia (2020). Reply: Response to letter to the editor "Labor pain, birth experience and postpartum depression". Scandinavian Journal of Pain. ISSN 1877-8860. 20(4), p. 861–863. doi: 10.1515/sjpain-2020-0130. Full text in Research Archive
• Juel, Niels Gunnar; Pedersen, Stein Jarle; Engebretsen, Kaia Beck; Brurberg, Kjetil Gundro; Ekeberg, Ole Marius & Reme, Silje Endresen [Show all 8 contributors for this article] (2019). Atraumatiske skuldersmerter i prim?rhelsetjenesten. 139(7). doi: 10.4045/tidsskr.19.0116. Full text in Research Archive
• Granan, Lars-Petter; Reme, Silje Endresen; Jacobsen, Henrik Børsting; Stubhaug, Audun & Ljoså, Tone Marte (2019). Reply to Letter to the Editor "Clinical registries are essential tools for ensuring quality and improving outcomes in pain medicine" by Baciarello et al. Scandinavian Journal of Pain. ISSN 1877-8860. 19(3), p. 635–635. doi: 10.1515/sjpain-2019-2010. Full text in Research Archive
• Juel, Niels Gunnar; Brox, Jens Ivar; Ekeberg, Ole Marius; Brurberg, Kjetil Gundro; Engebretsen, Kaia Beck & Reme, Silje Endresen [Show all 8 contributors for this article] (2018). Norwegian guidelines for shoulder pain in primary care. Full text in Research Archive
• Pedersen, Stein Jarle; Juel, Niels Gunnar; Brox, Jens Ivar; Engebretsen, Kaia Beck; Ekeberg, Ole Marius & Reme, Silje Endresen [Show all 7 contributors for this article] (2018). Shoulder pain in primary care. Presentation of a simple net-based educational program for the general practitioner. Full text in Research Archive
• Reme, Silje Endresen (2018). De 20 kritiske prosentene :. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 55(7), p. 611–613. Full text in Research Archive
• Mæland, Silje; Reme, Silje & Sveinsdottir, Vigdis (2017). Har virkelig ikke arbeid noe med helse å gjøre? Full text in Research Archive
• Landmark, Live; Kennair, Leif Edward Ottesen; Bendixen, Mons; Fors, Egil Andreas; Wyller, Vegard Bruun Bratholm & Reme, Silje Endresen [Show all 7 contributors for this article] (2026). Towards an integrative model of persistent physical symptoms: Studies in a specialised pain setting. Norges teknisk-naturvitenskapelige universitet. ISSN 9788235300089. Full text in Research Archive Show summary

  Persistent physical symptoms such as pain, sleep problems, and fatigue are common and among the leading causes of functional impairment. Patients referred to specialised pain care often present with symptom profiles that extend far beyond pain alone, raising fundamental questions about whether pain-focused classifications adequately capture the full extent of these presentations. This thesis addresses these questions in a large clinical cohort of approximately 4,000 patients referred to specialised pain services, examining overall symptom burden, psychosocial mechanisms, and prognostic factors within a transdiagnostic framework. Study I showed that insomnia symptoms showed associations with functioning that were comparable to or stronger than pain intensity, while fatigue and psychological distress contributed independently but with smaller effects. Study II demonstrated that insomnia symptoms were pronounced across all ICD-11 chronic pain categories, and that baseline levels of insomnia symptoms predicted both pain intensity and pain bothersomeness at 12-month follow-up, independent of baseline pain and psychosocial factors. Study III found that more than 90% of the cohort met criteria for moderate or severe Bodily Distress Syndrome (BDS), and that greater extent of multisystem symptoms at baseline predicted poorer function and lower perceived improvement at 12-month follow-up. Taken together, the findings indicate that this specialised pain population is characterised by high overall symptom burden in addition to pain. The findings support a transdiagnostic and integrated approach that moves beyond both organ-based classifications and a narrow focus on pain alone, and instead targets factors associated with functional impairment.

• Fyhn, Tonje; Reme, Silje Endresen & Sandal, Gro Mjeldheim (2021). Barriers and facilitators to increasing work participation among people with moderate to severe mental illness. Universitetet i Bergen. ISSN 9788230842195. Full text in Research Archive Show summary

  This thesis seeks to identify facilitators and barriers to obtaining employment for people in treatment for moderate to severe mental illness. Many people with mental illness wish to pursue life goals such as ordinary employment, and several studies have demonstrated the positive association between employment and physical and mental health. Even so, obtaining ordinary employment can be a challenge, which is demonstrated by high unemployment rates among people with moderate to severe mental illness. The current thesis bases most of its work on an effect evaluation of the vocational rehabilitation program Individual Placement and Support (IPS). IPS provides long-term, individualized follow-up through an IPS specialist, with the goal of obtaining competitive employment. Alhthough numerous international studies have proven IPS to be more effective than traditional forms of vocational rehabilitation, the trial described in this thesis was the first to investigate the effect of IPS in a Norwegian context. This context is characterized by a generous welfare system, which has many advantages, but may also create incentives to remain outside the workforce. It was therefore not given that IPS would be more effective than ordinary vocational services in this context. The effect evaluation did, however, prove it to be effective also in Norway. The work presented in the current thesis seeks to understand how the intervention works, and which factors influence employment for its target group. Paper 1 investigates the IPS implementation through a process evaluation, utilizing data from IPS service providers, fidelity reports, and participants. The study uses mixed methods, with an emphasis on the quantitative material. Results from paper 1 show that IPS was implemented successfully across the six pilot centers, as demonstrated by satisfactory fidelity scores during the project period. Fidelity scores did indicate implementation challenges related to employment contact, providing community-based services, and integration with health services, which was further elaborated on in interviews with IPS specialists. Participants were overall very satisfied with the intervention, and emphasized the important role of the IPS specialist. Moreover, participants found freedom of disclosure to be important for participation. Less than half of the participants regarded their illness as a barrier to participation in the intervention. Paper 2 investigates baseline-measured predictors for employment after 18 months, and whether group allocation (IPS vs TAU) moderates this effect. The study population consists of 327 participants from the IPS trial, and log binary regression analyses were conducted to investigate the research questions. Results indicate that while involuntary hospitalization is a strong negative predictor for employment at 18 months’ follow-up, directive emotional support and non-directive instrumental support positively predict employment. Self-reported measures of anxiety and depression, directive instrumental and non-directive emotional support, age, and education did not predict employment at 18 months in this study, supporting an inclusive approach to providing vocational rehabilitation to the target group. Paper 3 investigates the perspective of Norwegian workplaces and their assessment of fictive job candidates who either had a mental illness, a physical disability, or a cultural minority background. Results show that supervisors and employees in Norwegian workplaces were generally reluctant towards vignette characters with a mental illness in terms of hireability. However, respondents who reported to have previous work experience with a colleague resembling the vignette character in question, generally assessed this character more positively than those who did not have this experience. Main concerns regarding the characters with a mental illness were social interaction and increased workload for colleagues. The paper concludes that job candidates with some kind of health issue are still likely to be underestimated in the labor market. In conclusion, the findings of the PhD thesis highlight specific barriers and facilitators operating on different levels, to work participation for people with moderate to severe mental illness. It provides avenues for further research on these factors, and provides insights which may enhance vocational services for people in treatment for moderate to severe mental illness. Finally, findings on the workplace perspective should be addressed in the practical job development efforts conducted by IPS specialists, as well as in the governmental efforts to create a more inclusive work life.

• Sveinsdottir, Vigdis; Reme, Silje Endresen; Hetland, Jørn; Eriksen, Hege Randi & Bond, Gary R. (2019). Supported Employment and preventing Early Disability (SEED). Universitetet i Bergen. ISSN 9788230855843. Full text in Research Archive Show summary

  Young adults who are not in education, training or employment (NEET) represent an international challenge that causes worry due to the potentially harmful health-effects of unemployment, and the economic costs for society. The NEET population includes those who are temporarily unemployed or inactive, as well as more marginalized groups at high risk of prolonged or lifelong disengagement. Being excluded from the labor market in early adulthood can have severe consequences for later work participation, and the diversity of the NEET population implies a need to focus on specific subgroups. In Norway, the share of young adults receiving permanent disability benefits has increased considerably during the last years. The main reason for early disability benefits in Norway are mental and behavioral disorders, and risk factors include socioeconomic factors such as low educational attainment. There is however little knowledge about the individuals who are at high risk, but have not yet reached the point of more permanent exclusion from the labor market. This thesis focuses on young adults with impaired work capability who are at risk of early work disability due to various social and health-related challenges. Studies of vocational rehabilitation of NEETs are scarce, and existing knowledge is insufficient to guide policy-makers and other stakeholders in efforts for this group. Furthermore, policies aimed at NEETs in general may be more appropriate for those who are ready to work, while failing to reach the most vulnerable groups. Individual Placement and Support (IPS) is a high-contact approach that is effective for patients with severe mental illness. It is based on clearly defined principles with a main focus on ordinary paid employment in the competitive labor market. IPS is effective across a range of demographic and clinical subgroups with severe mental illness, but there is limited evidence about the effectiveness of IPS in non-psychiatric populations. The aim of the thesis was to generate knowledge about young adults at risk of early work disability in Norway, and to investigate whether the Individual Placement and Support (IPS) model of supported employment may help this group enter the labor market. The aim of paper I was to plan and design a randomized controlled trial to evaluate the effectiveness of repurposing IPS to young adults at risk of early work disability due to various social or health-related problems. The trial was named Supported Employment and preventing Early Disability (the SEED-trial), and compared IPS to a control group that received traditional vocational rehabilitation using traineeships in sheltered businesses. Participants were NEETs, aged 18-29 years old, receiving temporary benefits, and had been considered eligible for traineeships in sheltered businesses. The primary outcome was competitive employment, defined as any paid employment in the competitive labor market during the first year after enrollment. Secondary outcomes included physical and mental health, health behaviors, and wellbeing. Survey data were collected at baseline, 6, and 12 months. The trial design also included long-term follow-up using register data for benefit recipiency, income, and education for five years after inclusion in the study, and a cost-benefit analysis. The aim of paper II was to investigate social and health-related characteristics in young adults at risk of early work disability in Norway, and what they believe may have caused their illness. The paper used baseline data from the 96 participants who were included in the SEED-trial. The majority were male, single, childless, and nearly half were living with their parent(s). Participants had relatively low educational attainment, and more than half reported hazardous drinking or active alcohol use disorders. The prevalence of psychological distress was high, which coincides with previous knowledge about the major reasons for early work disability in Norway. The most noteworthy findings with important implications for efforts targeting this group were however related to psychosocial stressors, including a high prevalence of bullying and exposure to violence. When participants who considered themselves to have an illness were asked about the reasons for their illness, the most common responses were also related to non-medical causes, especially relational problems such as loneliness and isolation. The aim of paper III was to evaluate the effectiveness of IPS versus traditional vocational rehabilitation for young adults at risk of early work disability, on outcomes of competitive employment, and physical and mental health and well-being. Findings showed that significantly more participants in the IPS group (48%) obtained competitive employment compared to participants in the control group (8%) during 12-month follow-up. The groups did generally not differ on health-related outcomes in unadjusted analyses, with a few exceptions. However, when adjusted for baseline and missing observations in post hoc analyses, the IPS group reported significantly better outcomes in anxiety, subjective health complaints, pseudoneurology, helplessness, hopelessness, and drug use at 6-month follow-up, and in level of disability, subjective health complaints, optimism about future well-being, helplessness, hopelessness, and drug use at 12-month follow-up. The findings of this thesis have several implications. In addition to underlining the importance of preventive measures to reduce social exclusion by bullying and early dropout, the findings suggest that there is need for a broader focus on psychosocial aspects in vocational rehabilitation of young adults at risk of early work disability. The findings that IPS was superior to the control condition in increasing competitive employment among this group of NEETs, and that IPS may also have beneficial effect on health, furthermore indicate that vocational rehabilitation for this group should be redirected from traditional sheltered approaches to individualized support in competitive work settings. The SEED-trial is also the first to show that IPS can be successfully repurposed to this new and vulnerable target group at risk of being excluded from working life before having established themselves on the labor market.

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