Anxiety and depression in individuals with somatic health problems. The Nord-Trøndelag Health Study (HUNT)

There is a high occurrence of depressive symptoms in patients with somatic health problems. About one-third of individuals with somatic health problems have anxiety disorders and/or depression. Comorbid anxiety disorder and depression are found to be more strongly associated with somatic health problems than pure anxiety disorder and pure depression. Objective - To examine the relationship between anxiety disorders and depression and various somatic health problems in the general population. Design - Cross-sectional study with survey methods and clinical examinations. Setting - The Health Study of Nord-Trøndelag, Norway (the HUNT study). Participants - 60 &#116 869 individuals aged 20-89 years. Main outcome measures - Anxiety disorder, depression and their comorbidity are categorized based on scores on the Hospital Anxiety and Depression Scale. All somatic health variables are self-reported, while blood pressure, height and weight are measured. Multivariate nominal logistic regression analyses are used to investigate the relationship between somatic variables and the anxiety/depression categories. Results - Most somatic health variables show a stronger association with comorbid anxiety disorder/depression than with anxiety disorder or depression alone. About one-third of individuals reporting somatic health problems also have anxiety disorder and/or depression. Conclusion - Somatic health problems carry a high risk of both anxiety disorder and depression. Active identification and treatment of these co-occurring mental disorders are of practical importance.     

Enabling overweight children to improve their food and exercise habits - school nurses' counselling in multilingual settings

Aims and objectives. The study aimed at analysing school nurses' counselling of overweight and obese children in settings with many immigrants, focusing on content concerning food and physical activity and how this was communicated. Background. For people with a predisposition for overweight, the weight control process requires cognitive skills. School nurses' counselling of overweight children has the potential to support this process by enabling personal resources in the children and their families. However, there is uncertainty among nurses about how to conduct supportive counselling. Design. An explorative design was used when collecting and analysing data. Method. Twenty-two counselling sessions between eight school nurses and 20 overweight children were audio-recorded and analysed using qualitative content analysis. Most of the participating schools represented areas with low socioeconomic status and a high proportion of immigrants and refugees. Results. Less adequate skills in enabling resources in the children and their parents were observed. Concurrently, school nurses provided inadequate explanations about food and physical activity. Topics related to general nutrition models were frequently communicated as general advice instead of individually tailored counselling. Counselling families with other languages and food cultures than the traditional Swedish created additional difficulties. Conclusions. Improved nutritional knowledge for nurses may enhance their skills in enabling children's and families' resources. School nurses should be provided with opportunities to cooperate with other professions in counteracting overweight. Relevance to clinical practice. Our findings demonstrate a relationship between content skills and person-centeredness in the counselling. This highlights the importance of inter-professional collaboration to ensure a high quality of lifestyle counselling. School health authorities should give high priority to facilitating school nurses' evidence-based continuing education.