Anxiety and Social Phobia in Norwegian Adolescents: Studies of risk factors, school absenteeism and treatment effects
Doctoral thesis
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Date
2014Metadata
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- Institutt for psykologi [3123]
Abstract
The background for the thesis is that research has shown that anxiety disorders are among the most prevalent disorders in adolescence. The effects of an anxiety disorder may be detrimental to the adolescents’ health and wellbeing, social life, and educational success. Many anxiety-disordered adolescents go undetected and untreated; this may lead to chronification and accumulation of problems. Excessive or problematic school absenteeism and school refusal has consistently been shown to be associated with anxiety disorders in adolescence.
The aims of the thesis were (1) to estimate characteristics of the distribution of anxiety symptoms in a community study of Norwegian adolescents (13-18) (paper IV). To investigate (2) whether or not excessive school absenteeism was an indicator for psychosocial problems and anxiety in high school students (paper I), and to establish the main risk factors for excessive school absenteeism. (3) To examine the differences in risk factors between anxious students attending and not attending school (paper II), and to (4) evaluate treatment effects for social phobia, the most common anxiety disorder in adolescents, closely linked to excessive school absenteeism (paper III).
The thesis consists of both cross sectional studies and a treatment study of Norwegian Adolescents aged 13-18. The main measures were SCARED and school absence in the cross sectional studies, and ADIS-IV-C and SPAI-C for the RCT.
Results showed that there was a general reduction in anxiety symptoms in Norwegian adolescents. Girls report higher symptom levels of anxiety compared to boys. Excessive school absenteeism is significantly associated with many psychosocial problems. The number of risk factors or balance between risk and protective factors seem to be as important as single factors in predicting school absenteeism. Compared to adolescents with high anxiety and low absenteeism, adolescents with high school absenteeism and high anxiety show more comorbid psychiatric problems, more psychosocial problems and lower resilience. They also show more symptoms of panic and social anxiety. Results from the RCT for adolescent social phobia indicate that Individual cognitive therapy show significant reductions in both symptoms and impairment, with significantly higher symptom reduction than group-CBT, after treatment and at 12 months follow up.
The thesis concludes that symptoms of anxiety seem to decline through adolescence, girls consistently reporting higher levels of symptomatology than boys. Further, anxious school absence is seen in adolescents with high degree of additional psychiatric and psychosocial problems. Adolescents with symptoms of social anxiety and panic seem to be at higher risk for absence than adolescents with other anxiety symptoms. High or excessive school absenteeism is a good indicator of psychosocial problems in high school students; absenteeism is predicted by externalizing problems, family work and health and school environment. The number of risk factors seems to play a larger role than the existence of individual factors. Finally, one of the most prevalent anxiety disorders in adolescence; social phobia, can be treated individually with good results and working with mechanisms hypothesized to maintain the problem seem to give long term effects. Dette forskningsprosjektet undersøker risikofaktorer for skolefravær, stabilitet i angstsymptomer hos ungdom og i hvilken grad ungdom med sosial fobi har effekt av behandling. Nesten 3000 ungdommer i Midt Norge deltatt i studiene i perioden 2005- 2010.
Avhandlingen en basert på 4 artikler fra forskningsprosjektet. Resultatene viser at ungdom har en generell reduksjon av angstsymptomatologi. Jenter rapporterer høyere angstnivå enn gutter og vi fant en stor kjønnsspesifikk økning i symptomatologi hos jenter i 14-15 års alder. Ungdom med høyt skolefravær og høy angst viser høyere forekomst av komorbide psykiatriske symptomer, særlig eksternaliserende vansker, de har flere psykososiale problemer og lavere resilience enn ungdom med høy angst og normalt skolefravær. Skolefravær synes å være en god indikator på psykososiale vansker hos elever i den videregående skole. Risikofaktorer for skolefravær viser seg å være både av personlig, familiær, skolemessige og nærmiljø baserte karakter. Eksternaliserende vansker og familiens arbeids og helse status er hoved risikofaktorer på et populasjonsnivå, mens internaliserende vansker ikke er like betydningsfulle på samme nivå. Avhandlingen viser, i en randomisert kontrollert studie at individuell kognitiv terapi basert på Clark og Wells sin modell, at ungdom med sosial fobi får signifikante reduksjoner på symptomatologi og funksjonsforstyrrelse like etter behandling og ved 12 mnd oppfølging. Sammenlignet med en gruppe behandling og en oppmerksomhetskontroll, viser opplegget signifikant bedre effekt.
Avhandlingen konkluderer med at ungdom med høyt skolefravær har store og mange psykososiale vansker, og indikerer at det heller er summen av disse, enn enkeltfaktorene, som bidrar til å skape et høyt skolefravær. Dette indikerer et behov for å anlegge intervensjoner bredt og koordinert. Videre viser resultatene at angst hos ungdom fluktuerer og at man i større grad bør ta hensyn til dette i klinisk praksis enn tilfellet er pr i dag. Resultatene viser også at ungdommer med sosial fobi viser god effekt på målrettet tidsavgrenset behandling som er rettet mot de opprettholdende faktorene i lidelsen.