Eva Ørnbøl - Academia.edu (original) (raw)
Papers by Eva Ørnbøl
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Psychosomatic Research, Dec 1, 2022
Scandinavian Journal of Primary Health Care, Apr 3, 2019
Objective: This study aimed to assess the measurement properties of the Major Depression Inventor... more Objective: This study aimed to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients. Design: General practitioners (GPs) handed out the MDI to patients aged 18-65 years on clinical suspicion of depression. Setting: Thirty-seven general practices in the Central Denmark Region participated in the study. Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis. Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software. Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1-3) and after dichotomization of items according to diagnostic procedure. Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. KEY POINTS The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice. This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Minor problems with measurement structure should be addressed in future revisions of the MDI.
Psychological Medicine, Mar 3, 2014
Background. Somatoform disorders are costly for society in terms of increased healthcare expendit... more Background. Somatoform disorders are costly for society in terms of increased healthcare expenditure. Patients' illness perceptions have been found to play a role in somatoform disorders. However, it is unclear whether illness perceptions predict higher health costs in these patients. Method. A total of 1785 primary care patients presenting a new health complaint completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics after the consultation. In a stratified subsample, physician interviewers established diagnoses of DSM-IV somatization and undifferentiated somatoform disorders (n = 144) using the Schedules for Clinical Assessment in Neuropsychiatry. Healthcare expenditure was obtained from Danish health registers for a 2-year follow-up period. Results. Patients had more negative perceptions of their well-defined physical health problems when they had a comorbid somatoform disorder. A strong illness identity [β = 0.120, 95% confidence interval (CI) 0.029-0.212, p = 0.012], perceived negative consequences (β = 0.010, 95% CI 0.001-0.019, p = 0.024), a long timeline perspective (β = 0.013, 95% CI 0.005-0.021, p = 0.001), low personal control (β = − 0.009, 95% CI-0.015 to −0.002, p = 0.011) and negative emotional representations (β = 0.009, 95% CI 0.002-0.017, p = 0.020) predicted healthcare expenditure in somatoform disorders. Conclusions. The results suggest that illness perceptions play a role in the perpetuation of symptoms in somatoform disorders and predict higher future healthcare expenditure among a subgroup of these patients.
Children (Basel), Jun 22, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Psychosomatic Research, Jun 1, 2023
Frontiers in pain research, Jun 15, 2022
Posttraumatic stress symptoms (PTSS) are common after whiplash injury and are associated with poo... more Posttraumatic stress symptoms (PTSS) are common after whiplash injury and are associated with poor recovery. The acute stress response may lead to pain sensitization and widespread pain, thereby compromising recovery. To our knowledge, no longitudinal study has assessed the associations between early PTSS and pain sensitization over time using quantitative sensory testing (QST). The aim of this study was to compare participants with different levels of PTSS, as measured by the impact of event scale (IES; subclinical 0-8, mild 9-25, and clinical ≥ 26) at baseline (<10-day post-injury) and at a follow-up of 1, 3, 6, and 12-month post-injury on pain sensitivity, neck mobility, pain distribution, and pain intensity. In total, 740 participants were recruited from emergency units or general practitioners with acute neck pain after a whiplash injury. The clinical PTSS group showed increased pain sensitivity on all QSTs at all time points compared to the subclinical PTSS group. Also, the clinical PTSS group showed significantly lower neck mobility at all time points except for a 3-month follow-up compared to the subclinical PTSS group. Moreover, the clinical PTSS group showed more widespread pain and self-reported headache and neck pain intensity at all time points compared to the subclinical PTSS group. This study emphasizes that participants with clinical levels of PTSS constitute a high-risk group that is sensitized to pain early after the injury. Hence, screening for PTSS within the 1st week after whiplash injury for those who experience high levels of pain intensity and distress may be an important clinical procedure in the assessment and treatment of whiplash-associated disorders (WAD).
Psychiatry Research-neuroimaging, May 1, 2022
This study retrospectively compares two previous parallel running, randomized, controlled trials ... more This study retrospectively compares two previous parallel running, randomized, controlled trials of pharmacotherapy (imipramine) and psychotherapy (acceptance and commitment therapy) for multi-organ functional somatic disorder (FSD). Differences in demographics, psychiatric comorbidity, illness severity, and illness duration associated with eligibility for the two trials and patients' willingness to participate are explored using linear or binary regression models. 418 patients with multi-organ FSD was included. We found that 377 (95%) were eligible for psychotherapy and 257 patients (61%) for pharmacotherapy. Patients eligible for pharmacotherapy were less severely impaired, less often received disability pension, reported shorter illness duration and experienced less psychological distress than patients eligible for psychotherapy. Whilst exclusion criteria for both trials differed markedly, it was not possible to clearly identify patient or illness characteristics associated with patients' willingness to participate. The study showed that trial-specific exclusion criteria led to the selection of less complex and less severely impaired patients in the pharmacological trial in this sample of multi-organ FSD. Our findings have important implications for the interpretation and comparability of RCT results of different treatments in multi-organ FSD and may point to some common flaws in study design and interpretation of pharmacological vs. psychotherapeutic intervention trials in psychiatry.
International Journal of Behavioral Medicine, 2016
, Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual ca... more , Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual care for functional somatic syndromes. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Psr(2017),
Journal of Psychosomatic Research, Jun 1, 2016
Background: To assess the ten-year outcome as to sick leave and work disability in primary care p... more Background: To assess the ten-year outcome as to sick leave and work disability in primary care patients with BDS compared with patients with a well-defined physical disease and to study the persistence of BDS over time. Method: 1785 consecutive patients consulting their family physician (FP) were screened by questionnaires for symptoms and mental illness. FPs rated patients' main reason for consultation. A stratified subsample was examined with a standardized diagnostic interview. Patients with BDS single-organ type (n=124) and BDS multi-organ type (n=35) and a reference group having a medical condition according to their FP (n=880) were included. Patients completed questionnaires at three, 12-and 24-month follow-up. Register data on health care costs and work were obtained for 2-and 10-year follow-up. Results: Patient with BDS displayed poorer self-rated health and higher illness worry at index and throughout follow-up compared to the medical condition group (p≤0.001). Annual total health care costs were higher in the BDS groups compared with the medical condition group (2,270 USD and 4,066 USD vs 1,392 USD, ASL≤0.001). Both BDS groups had higher risk of sick leave during the first two years of follow-up (RR BDS single-organ =3.0, 95%CI: 1.8;5.0, RR BDS multi-organ =3.4, 95%CI:1.5;7.5), and they had substantially higher ten-year risk of new disability pension awards compared with the reference group (HR BDS single-organ = 4.9, 95%CI: 2.8;8.4, HR BDS multi-organ =8.7, 95%CI:3.7;20.7). Conclusions This long-term follow-up study of primary care patients with BDS showed that the disorder has severe long-term consequences for the patients including poor physical and mental health, high health care costs and high risk of permanent work disability. This stresses the need for adequate recognition and management of BDS.
Journal of Psychosomatic Research, Jun 1, 2015
Clinical Epidemiology
Several psychological factors have been proposed to be associated with functional somatic disorde... more Several psychological factors have been proposed to be associated with functional somatic disorders (FSD) including functional somatic syndromes, such as irritable bowel, chronic widespread pain, and chronic fatigue. However, large randomly selected population-based studies of this association are sparse. This study aimed to investigate the association between FSD and perceived stress and self-efficacy, respectively, and to investigate if FSD differed from severe physical diseases on these aspects. Methods: This cross-sectional study included a random sample of the adult Danish population (n = 9656). FSD were established using self-reported questionnaires and diagnostic interviews. Perceived stress was measured with Cohen's Perceived Stress Scale and self-efficacy with the General Self-Efficacy Scale. Data were analysed with generalized linear models and linear regression models. Results: FSD were associated with higher perceived stress and lower self-efficacy, especially for the multi-organ and the general symptoms/fatigue FSD types and for chronic fatigue. However, controlling for the personality trait neuroticism altered the associations with self-efficacy so it became insignificant. The analysis did not support an important interaction between perceived stress and selfefficacy on the likelihood of having FSD. Individuals with FSD presented levels of perceived stress that were not equal, ie higher, to those in individuals with severe physical diseases. Conclusion: FSD were positively associated with perceived stress and negatively associated with self-efficacy. Our study may point to stress being part of the symptomatology of FSD. This underlines the severity of having FSD and stresses the relevance of the resilience theory in the understanding of the condition.
Contemporary Clinical Trials Communications
Journal of Psychosomatic Research
Scientific Reports
Several psychological factors have been proposed to be associated with functional somatic disorde... more Several psychological factors have been proposed to be associated with functional somatic disorders (FSD). However, large population-based studies investigating the importance of both personality and adverse life events (ALE) are sparse. This study aimed to investigate the association between FSD and neuroticism and the accumulated number of ALE, respectively. This cross-sectional study included a random sample of the adult Danish population (N = 7493). FSD were established by means of self-reported questionnaires and diagnostic interviews. Neuroticism was measured with the Danish version of the short-form NEO Personality Inventory. ALE were measured with the Danish version of the Cumulative Lifetime Adversity Measure. Strong positive associations were found between neuroticism and FSD, and ALE and questionnaire-based FSD. For interview-based FSD, strong positive associations were found for FSD, multi-organ type, and for the subtype of the general symptoms. The level of self-efficac...
International Journal of Environmental Research and Public Health
Background: Adverse experiences in childhood are a major public health concern, promoting social ... more Background: Adverse experiences in childhood are a major public health concern, promoting social inequality in health through biopsychosocial mechanisms. So far, no known measures comprehend the complexity and variations of severity of adverse events. This study aims to develop and validate a new index: the Weighted Index for Childhood Adverse Conditions (WICAC). Methods: The population consists of 7493 randomly invited men and women aged 18–72 years. Data were collected in 2012–2015 as part of the Danish Study of Functional Disorders (DanFunD). Content and construct validation of the WICAC was performed with the hypothesis testing of multiple biopsychosocial outcomes: cardiovascular disease, cancer, poor health, back pain, BMI, obesity, anxiety, depression, low vitality, subjective social status, lower education, smoking, and alcohol consumption. Data were analysed with binominal and linear regression models with risk ratios (RR) and mean differences (MD). Results: Content validati...
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Psychosomatic Research, Dec 1, 2022
Scandinavian Journal of Primary Health Care, Apr 3, 2019
Objective: This study aimed to assess the measurement properties of the Major Depression Inventor... more Objective: This study aimed to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients. Design: General practitioners (GPs) handed out the MDI to patients aged 18-65 years on clinical suspicion of depression. Setting: Thirty-seven general practices in the Central Denmark Region participated in the study. Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis. Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software. Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1-3) and after dichotomization of items according to diagnostic procedure. Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. KEY POINTS The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice. This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Minor problems with measurement structure should be addressed in future revisions of the MDI.
Psychological Medicine, Mar 3, 2014
Background. Somatoform disorders are costly for society in terms of increased healthcare expendit... more Background. Somatoform disorders are costly for society in terms of increased healthcare expenditure. Patients' illness perceptions have been found to play a role in somatoform disorders. However, it is unclear whether illness perceptions predict higher health costs in these patients. Method. A total of 1785 primary care patients presenting a new health complaint completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics after the consultation. In a stratified subsample, physician interviewers established diagnoses of DSM-IV somatization and undifferentiated somatoform disorders (n = 144) using the Schedules for Clinical Assessment in Neuropsychiatry. Healthcare expenditure was obtained from Danish health registers for a 2-year follow-up period. Results. Patients had more negative perceptions of their well-defined physical health problems when they had a comorbid somatoform disorder. A strong illness identity [β = 0.120, 95% confidence interval (CI) 0.029-0.212, p = 0.012], perceived negative consequences (β = 0.010, 95% CI 0.001-0.019, p = 0.024), a long timeline perspective (β = 0.013, 95% CI 0.005-0.021, p = 0.001), low personal control (β = − 0.009, 95% CI-0.015 to −0.002, p = 0.011) and negative emotional representations (β = 0.009, 95% CI 0.002-0.017, p = 0.020) predicted healthcare expenditure in somatoform disorders. Conclusions. The results suggest that illness perceptions play a role in the perpetuation of symptoms in somatoform disorders and predict higher future healthcare expenditure among a subgroup of these patients.
Children (Basel), Jun 22, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Journal of Psychosomatic Research, Jun 1, 2023
Frontiers in pain research, Jun 15, 2022
Posttraumatic stress symptoms (PTSS) are common after whiplash injury and are associated with poo... more Posttraumatic stress symptoms (PTSS) are common after whiplash injury and are associated with poor recovery. The acute stress response may lead to pain sensitization and widespread pain, thereby compromising recovery. To our knowledge, no longitudinal study has assessed the associations between early PTSS and pain sensitization over time using quantitative sensory testing (QST). The aim of this study was to compare participants with different levels of PTSS, as measured by the impact of event scale (IES; subclinical 0-8, mild 9-25, and clinical ≥ 26) at baseline (<10-day post-injury) and at a follow-up of 1, 3, 6, and 12-month post-injury on pain sensitivity, neck mobility, pain distribution, and pain intensity. In total, 740 participants were recruited from emergency units or general practitioners with acute neck pain after a whiplash injury. The clinical PTSS group showed increased pain sensitivity on all QSTs at all time points compared to the subclinical PTSS group. Also, the clinical PTSS group showed significantly lower neck mobility at all time points except for a 3-month follow-up compared to the subclinical PTSS group. Moreover, the clinical PTSS group showed more widespread pain and self-reported headache and neck pain intensity at all time points compared to the subclinical PTSS group. This study emphasizes that participants with clinical levels of PTSS constitute a high-risk group that is sensitized to pain early after the injury. Hence, screening for PTSS within the 1st week after whiplash injury for those who experience high levels of pain intensity and distress may be an important clinical procedure in the assessment and treatment of whiplash-associated disorders (WAD).
Psychiatry Research-neuroimaging, May 1, 2022
This study retrospectively compares two previous parallel running, randomized, controlled trials ... more This study retrospectively compares two previous parallel running, randomized, controlled trials of pharmacotherapy (imipramine) and psychotherapy (acceptance and commitment therapy) for multi-organ functional somatic disorder (FSD). Differences in demographics, psychiatric comorbidity, illness severity, and illness duration associated with eligibility for the two trials and patients' willingness to participate are explored using linear or binary regression models. 418 patients with multi-organ FSD was included. We found that 377 (95%) were eligible for psychotherapy and 257 patients (61%) for pharmacotherapy. Patients eligible for pharmacotherapy were less severely impaired, less often received disability pension, reported shorter illness duration and experienced less psychological distress than patients eligible for psychotherapy. Whilst exclusion criteria for both trials differed markedly, it was not possible to clearly identify patient or illness characteristics associated with patients' willingness to participate. The study showed that trial-specific exclusion criteria led to the selection of less complex and less severely impaired patients in the pharmacological trial in this sample of multi-organ FSD. Our findings have important implications for the interpretation and comparability of RCT results of different treatments in multi-organ FSD and may point to some common flaws in study design and interpretation of pharmacological vs. psychotherapeutic intervention trials in psychiatry.
International Journal of Behavioral Medicine, 2016
, Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual ca... more , Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual care for functional somatic syndromes. The address for the corresponding author was captured as affiliation for all authors. Please check if appropriate. Psr(2017),
Journal of Psychosomatic Research, Jun 1, 2016
Background: To assess the ten-year outcome as to sick leave and work disability in primary care p... more Background: To assess the ten-year outcome as to sick leave and work disability in primary care patients with BDS compared with patients with a well-defined physical disease and to study the persistence of BDS over time. Method: 1785 consecutive patients consulting their family physician (FP) were screened by questionnaires for symptoms and mental illness. FPs rated patients' main reason for consultation. A stratified subsample was examined with a standardized diagnostic interview. Patients with BDS single-organ type (n=124) and BDS multi-organ type (n=35) and a reference group having a medical condition according to their FP (n=880) were included. Patients completed questionnaires at three, 12-and 24-month follow-up. Register data on health care costs and work were obtained for 2-and 10-year follow-up. Results: Patient with BDS displayed poorer self-rated health and higher illness worry at index and throughout follow-up compared to the medical condition group (p≤0.001). Annual total health care costs were higher in the BDS groups compared with the medical condition group (2,270 USD and 4,066 USD vs 1,392 USD, ASL≤0.001). Both BDS groups had higher risk of sick leave during the first two years of follow-up (RR BDS single-organ =3.0, 95%CI: 1.8;5.0, RR BDS multi-organ =3.4, 95%CI:1.5;7.5), and they had substantially higher ten-year risk of new disability pension awards compared with the reference group (HR BDS single-organ = 4.9, 95%CI: 2.8;8.4, HR BDS multi-organ =8.7, 95%CI:3.7;20.7). Conclusions This long-term follow-up study of primary care patients with BDS showed that the disorder has severe long-term consequences for the patients including poor physical and mental health, high health care costs and high risk of permanent work disability. This stresses the need for adequate recognition and management of BDS.
Journal of Psychosomatic Research, Jun 1, 2015
Clinical Epidemiology
Several psychological factors have been proposed to be associated with functional somatic disorde... more Several psychological factors have been proposed to be associated with functional somatic disorders (FSD) including functional somatic syndromes, such as irritable bowel, chronic widespread pain, and chronic fatigue. However, large randomly selected population-based studies of this association are sparse. This study aimed to investigate the association between FSD and perceived stress and self-efficacy, respectively, and to investigate if FSD differed from severe physical diseases on these aspects. Methods: This cross-sectional study included a random sample of the adult Danish population (n = 9656). FSD were established using self-reported questionnaires and diagnostic interviews. Perceived stress was measured with Cohen's Perceived Stress Scale and self-efficacy with the General Self-Efficacy Scale. Data were analysed with generalized linear models and linear regression models. Results: FSD were associated with higher perceived stress and lower self-efficacy, especially for the multi-organ and the general symptoms/fatigue FSD types and for chronic fatigue. However, controlling for the personality trait neuroticism altered the associations with self-efficacy so it became insignificant. The analysis did not support an important interaction between perceived stress and selfefficacy on the likelihood of having FSD. Individuals with FSD presented levels of perceived stress that were not equal, ie higher, to those in individuals with severe physical diseases. Conclusion: FSD were positively associated with perceived stress and negatively associated with self-efficacy. Our study may point to stress being part of the symptomatology of FSD. This underlines the severity of having FSD and stresses the relevance of the resilience theory in the understanding of the condition.
Contemporary Clinical Trials Communications
Journal of Psychosomatic Research
Scientific Reports
Several psychological factors have been proposed to be associated with functional somatic disorde... more Several psychological factors have been proposed to be associated with functional somatic disorders (FSD). However, large population-based studies investigating the importance of both personality and adverse life events (ALE) are sparse. This study aimed to investigate the association between FSD and neuroticism and the accumulated number of ALE, respectively. This cross-sectional study included a random sample of the adult Danish population (N = 7493). FSD were established by means of self-reported questionnaires and diagnostic interviews. Neuroticism was measured with the Danish version of the short-form NEO Personality Inventory. ALE were measured with the Danish version of the Cumulative Lifetime Adversity Measure. Strong positive associations were found between neuroticism and FSD, and ALE and questionnaire-based FSD. For interview-based FSD, strong positive associations were found for FSD, multi-organ type, and for the subtype of the general symptoms. The level of self-efficac...
International Journal of Environmental Research and Public Health
Background: Adverse experiences in childhood are a major public health concern, promoting social ... more Background: Adverse experiences in childhood are a major public health concern, promoting social inequality in health through biopsychosocial mechanisms. So far, no known measures comprehend the complexity and variations of severity of adverse events. This study aims to develop and validate a new index: the Weighted Index for Childhood Adverse Conditions (WICAC). Methods: The population consists of 7493 randomly invited men and women aged 18–72 years. Data were collected in 2012–2015 as part of the Danish Study of Functional Disorders (DanFunD). Content and construct validation of the WICAC was performed with the hypothesis testing of multiple biopsychosocial outcomes: cardiovascular disease, cancer, poor health, back pain, BMI, obesity, anxiety, depression, low vitality, subjective social status, lower education, smoking, and alcohol consumption. Data were analysed with binominal and linear regression models with risk ratios (RR) and mean differences (MD). Results: Content validati...