Harold Sexton - Academia.edu (original) (raw)
Papers by Harold Sexton
American Journal of Psychotherapy, Oct 1, 2002
We analyzed whether defense mechanisms changed and/or predicted outcome during brief dynamic psyc... more We analyzed whether defense mechanisms changed and/or predicted outcome during brief dynamic psychotherapy (N-43, max 40 sessions, Norwegian Multisite Study on Process and Outcome of Psychotherapy). Defenses were rated with the Defense Mechanism Rating Scales (DMRS, clinicianrated) and Defense Style Questionnaire (DSQ self-rated). Overall defensive functioning (ODF) as rated by DMRS changed significantly. We found that the initial ODF's neither predicted the quality of working alliance nor influenced the outcome. Symptoms improved most rapidly early in therapy, while defenses changed during the last half of therapy, consistent with the phase model of change.
Nordic Journal of Psychiatry, 2002
Several studies suggest that the patient&... more Several studies suggest that the patient's experience of being coerced, during the admission process to mental hospitals, does not necessarily correspond with their legal status. Rather, perceived coercion appears to be associated with having experienced force and/or threats (negative pressures), as well as feeling that their views were not taken into consideration in the admission process (process exclusion). We investigated perceived coercion, among patients admitted both voluntarily and involuntarily, to acute wards in Norway. We used a visual analogue scale (the Coercion Ladder, CL) and the MacArthur Perceived Coercion Scale (MPCS), a five-item questionnaire, to measure perceived coercion. Two hundred and twenty-three consecutively admitted patients to four acute wards were included and interviewed within 5 days of admission. Many patients reported high levels of perceived coercion in the admission process, with the involuntary group experiencing significantly higher levels than the voluntary group. However, 32% of voluntarily admitted patients perceived high levels, and 41% of involuntarily admitted patients perceived low levels of coercion. Legal status did not significantly predict perceived coercion on either the MPCS or the CL after taking negative pressures and process exclusion into account. Applying a visual analogue scale (CL) seems to provide a useful measure of patients' perception of coercion and one that largely parallels the MPCS.
Journal of Consulting and Clinical Psychology, 1993
Process was related to intermediate and posttreatment outcomes for 34 patients undergoing multimo... more Process was related to intermediate and posttreatment outcomes for 34 patients undergoing multimodal group therapy. Exploratory time series analysis suggested that process variable effects differed with the phase of the therapy. It appeared that an emotionally warm bond occurred between patient and therapist in the sessions prior to therapist-rated improvement. A patient rating of insight followed in subsequent sessions. A negative feedback loop between patient symptom levels and therapist negative patient-directed feelings was demonstrated. Patient dysphoria in later therapy sessions seemed to reflect an earlier therapeutic failure. Ego strength directly exerted its positive influence on outcome in later sessions. The relation between in-therapy process trends and overall outcome supported these findings.
International Journal of Biometeorology, Oct 17, 2013
The aim of this study was to examine the association between fibromyalgia pain and weather, and t... more The aim of this study was to examine the association between fibromyalgia pain and weather, and to investigate whether psychosocial factors influence this relationship. Women with chronic widespread pain/fibromyalgia (N = 50) enrolled in a larger study, were recruited from a 4-week inpatient rehabilitation program in Norway ( 2009-2010), and reported their pain and psychological factors up to three times per day (morning, afternoon, evening) for 5 weeks. These ratings were then related to the official local weather parameters. Barometric pressure recorded simultaneously impacted pain significantly while temperature, relative humidity, and solar flux did not. No psychological variables influenced the weather-pain interaction. No weather parameter predicted change in the subsequent pain measures. The magnitude of the inverse association between pain and barometric pressure was very small, and none of the psychological variables studied influenced the association between pain and barometric pressure. All in all, the evidence for a strong weather-pain association in fibromyalgia seems limited at best.
International Journal of Law and Psychiatry, Nov 1, 2007
Legal-, perceived-and objective coercion were examined both separately and together as a measure ... more Legal-, perceived-and objective coercion were examined both separately and together as a measure of accumulated coercion, to determine how coercion affected patient satisfaction in patients admitted for acute psychiatric care. Accumulated coercive events significantly reduced both overall satisfaction, and satisfaction in four of five subscales evaluating different aspects of treatment. Neither legal status nor perceived coercion affected patient satisfaction, while objective coercion had a significant negative effect on overall satisfaction when these measures were analysed separately. Overall patient satisfaction reported at discharge was low, while satisfaction with different aspects of treatment showed considerable variation. The observation that perceived coercion in the admission process did not affect satisfaction significantly underlines the need to further explore the interaction between subjective and objective measures for coercion. It appears that multiple measures for coercion should be used in future studies.
Journal of Psychiatric Research, May 1, 2002
Objective: The effectiveness of an attention distracting and an attention focusing guided imagery... more Objective: The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively. Methods: Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized, controlled clinical trial. One group received relaxation training and guided instruction in ''pleasant imagery'' (PI) in order to distract from the pain experience (n=17). Another group received relaxation training and attention imagery upon the ''active workings of the internal pain control systems'', ''attention imagery'' (AI) (n=21). The control group (CG) received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures. Results: We found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery (P< 0.005), but not the attention imagery group's slope, declined significantly when compared with the control group (P> 0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects, P=0.98) nor a significant amitriptyline  psychological interaction (P=0.76). Conclusion: Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.
Social Psychiatry and Psychiatric Epidemiology, Dec 1, 2001
Acta Psychiatrica Scandinavica, Sep 1, 1989
The psychological benefits of walking and jogging were compared in 52 symptomatic neurotics over ... more The psychological benefits of walking and jogging were compared in 52 symptomatic neurotics over an 8-week training period and subsequent 6-month follow-up. Both groups showed marked reduction of anxiety, depression and global symptoms. Joggers had greater aerobic gain, but no greater psychologic benefit. Significantly larger numbers of joggers dropped out of the study. There was no relationship between aerobic gain and reduction of symptoms at the end of the program. However, at 6 months' follow-up, those with greater aerobic fitness had much lower anxiety levels. Changes in exercise frequency and aerobic capacity were also maintained at follow-up. Depression levels were not associated with aerobic fitness at follow-up. High initial exercise intensity appears to inhibit the forming of new exercise habits.
Acta Psychiatrica Scandinavica, Nov 1, 1990
ABSTRACTA comparative outcome study of 2 contrasting activity‐based groups with 80 hospitalized n... more ABSTRACTA comparative outcome study of 2 contrasting activity‐based groups with 80 hospitalized nonpsychotic patients is described. One group focused on activities designed to evoke emotional or interpersonal reactions followed by a subsequent reflection. The other focused on handicrafts and non‐emotionally challenging activities. Ego strength was also measured with an instrument developed in conjunction with the study. The 2 groups were demonstrated to be consistent with the preconditions and significantly different by independent scoring of videotaped sessions. There was a greater rated threrapeutic gain in the interactional group at discharge, but patient ratings did not differ between groups. There were no differences at follow‐up between the groups. Measured ego strength strongly predicted outcome after correcting for the initial symptom levels. Ego strength did not interact with activity type. Clinical diagnosis did not predict differential outcome. The groups had no differential effects on specific symptom clusters or social functioning.
Advances in Health Sciences Education, Jul 18, 2006
The study describes the learning process in psychiatry of medical students through their clerkshi... more The study describes the learning process in psychiatry of medical students through their clerkship and internship, It focused upon the development of studentsÕ attitudes to psychiatry, subjective psychiatric competence and self-confidence. The relationships between the participantsÕ background, aspects of the learning environment, their attitudes to psychiatry, psychiatric competence and psychiatric self-confidence were explored in order to develop an empirical model of the learning process. The participants were medical students at the University of Tromsoe, Norway. The study was prospective and based on studentsÕ self-reports, Structural panel modelling and growth curve analyses were used to explore the complex interactions between the variables over time and to create a model of the learning processes. The medical students significantly increased their subjective competence and psychiatric self-confidence during their clerkship in psychiatry and maintained them during their internship. Previous psychiatric experience, attitudes towards psychiatry and current psychiatric experience contributed to subjective psychiatric competence, Competence in turn had a positive effect on selfconfidence. Interestingly, those with greater subjective competence also appeared to have more psychiatric experience during their internship. An empirical model of the important aspects of the learning process was developed.
Nordic Journal of Psychiatry, 2002
Social Psychiatry and Psychiatric Epidemiology, Nov 11, 1999
Earlier studies on the direct effect of social support and social network upon mental health have... more Earlier studies on the direct effect of social support and social network upon mental health have mostly been done in cross-sectional studies and the results have been conflicting. The direct effect of social network and social support upon mental distress was tested in population-based health surveys conducted in 1987, 1990 and 1993. The population consisted of all persons aged 40-62 years and a random sample of persons aged between 20 and 39 years living in five small municipalities in Finnmark, the northernmost county in Norway. The attendance rates were 77%, 74% and 70% for the three health surveys, respectively. All those who had attended the health surveys more than once and answered the key questions about mental distress, social support and social network were selected for analyses (966 persons who attended both the two first health surveys and 1425 persons attending both the two last surveys). A theoretical full cross-lagged panel model was used to search for the predictive effects of time 1 variables (mental distress, social network and social support) upon corresponding subsequent variables. Mental distress, social support and social network at time 1 strongly predicted the corresponding variable at the next time point. Emotional support at time 1 exerted a weak positive effect upon mental distress on the next time point, explaining approximately 1% of the variance. Neither the social network nor instrumental support at time 1 predicted degree of mental distress at the subsequent time point. We conclude that social network and social support have very little direct predictive effect upon mental distress 3 years later in this population.
Tidsskrift for Den Norske Laegeforening, Mar 29, 1998
Medical Education, Apr 1, 2004
SETTING The clinical experience and the subjective learning of pre-registration house officers wh... more SETTING The clinical experience and the subjective learning of pre-registration house officers who completed 4 months' psychiatric rotation are described. METHOD The study was cross-sectional and based on self-report. The participants had responded to an anonymous questionnaire at the completion of their 4 months' psychiatric rotation in the period 1999-2001. Of those eligible (n ¼ 137), 85 (61%) completed the questionnaire. The relationships between individual background variables, different factors of the learning environment, and good learning outcome were explored. CONCLUSIONS The subjective learning benefit and positive learning environment were most related to the amount of practical experience, the degree of tailoring of the tasks to the house officers' competence, and to the formal intramural teaching programme. Supervision, gender, previous experience, and prior interest in psychiatry did not have significant impact on subjective learning. The findings are discussed in terms of the learning model that was developed.
Tidsskrift for Den Norske Laegeforening, 2005
Avdeling for hjerte, lunge og karkirurgi B A KG R U N N. Vi ønsket å undersøke hvilke sykdomsrela... more Avdeling for hjerte, lunge og karkirurgi B A KG R U N N. Vi ønsket å undersøke hvilke sykdomsrelaterte, psykososiale og behandlingsrelaterte faktorer det er som spår pasien ilfredshet e er kirurgisk opphold i kirurgisk avdeling.
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 30, 1998
Over 70% of the adult population of five rural communities in Northern Norway participated in a t... more Over 70% of the adult population of five rural communities in Northern Norway participated in a three-part epidemiological study that included identical questions on mental health. Data were collected in 1987/88, 1990 and 1993. Both repeated cross-sectional analyses and individual growth curve analyses on the 2,486 individuals who participated in either two or three surveys were carried out in order to reveal the changes in mental health over time. The proportion of the population using sleeping pills or psychotropic drugs decreased significantly as time progressed. There were also a significant decrease in the proportion of people who reported being depressed or dissatisfied with life, or who had insomnia or problems in coping. A similar improvement in mental health was noted for both sexes and it remained statistically significant even after adjusting for age and level of education. There was no decrease in the proportion of individuals who reported loneliness. The time effect rem...
American Journal of Psychotherapy, Oct 1, 2002
We analyzed whether defense mechanisms changed and/or predicted outcome during brief dynamic psyc... more We analyzed whether defense mechanisms changed and/or predicted outcome during brief dynamic psychotherapy (N-43, max 40 sessions, Norwegian Multisite Study on Process and Outcome of Psychotherapy). Defenses were rated with the Defense Mechanism Rating Scales (DMRS, clinicianrated) and Defense Style Questionnaire (DSQ self-rated). Overall defensive functioning (ODF) as rated by DMRS changed significantly. We found that the initial ODF's neither predicted the quality of working alliance nor influenced the outcome. Symptoms improved most rapidly early in therapy, while defenses changed during the last half of therapy, consistent with the phase model of change.
Nordic Journal of Psychiatry, 2002
Several studies suggest that the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more Several studies suggest that the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s experience of being coerced, during the admission process to mental hospitals, does not necessarily correspond with their legal status. Rather, perceived coercion appears to be associated with having experienced force and/or threats (negative pressures), as well as feeling that their views were not taken into consideration in the admission process (process exclusion). We investigated perceived coercion, among patients admitted both voluntarily and involuntarily, to acute wards in Norway. We used a visual analogue scale (the Coercion Ladder, CL) and the MacArthur Perceived Coercion Scale (MPCS), a five-item questionnaire, to measure perceived coercion. Two hundred and twenty-three consecutively admitted patients to four acute wards were included and interviewed within 5 days of admission. Many patients reported high levels of perceived coercion in the admission process, with the involuntary group experiencing significantly higher levels than the voluntary group. However, 32% of voluntarily admitted patients perceived high levels, and 41% of involuntarily admitted patients perceived low levels of coercion. Legal status did not significantly predict perceived coercion on either the MPCS or the CL after taking negative pressures and process exclusion into account. Applying a visual analogue scale (CL) seems to provide a useful measure of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perception of coercion and one that largely parallels the MPCS.
Journal of Consulting and Clinical Psychology, 1993
Process was related to intermediate and posttreatment outcomes for 34 patients undergoing multimo... more Process was related to intermediate and posttreatment outcomes for 34 patients undergoing multimodal group therapy. Exploratory time series analysis suggested that process variable effects differed with the phase of the therapy. It appeared that an emotionally warm bond occurred between patient and therapist in the sessions prior to therapist-rated improvement. A patient rating of insight followed in subsequent sessions. A negative feedback loop between patient symptom levels and therapist negative patient-directed feelings was demonstrated. Patient dysphoria in later therapy sessions seemed to reflect an earlier therapeutic failure. Ego strength directly exerted its positive influence on outcome in later sessions. The relation between in-therapy process trends and overall outcome supported these findings.
International Journal of Biometeorology, Oct 17, 2013
The aim of this study was to examine the association between fibromyalgia pain and weather, and t... more The aim of this study was to examine the association between fibromyalgia pain and weather, and to investigate whether psychosocial factors influence this relationship. Women with chronic widespread pain/fibromyalgia (N = 50) enrolled in a larger study, were recruited from a 4-week inpatient rehabilitation program in Norway ( 2009-2010), and reported their pain and psychological factors up to three times per day (morning, afternoon, evening) for 5 weeks. These ratings were then related to the official local weather parameters. Barometric pressure recorded simultaneously impacted pain significantly while temperature, relative humidity, and solar flux did not. No psychological variables influenced the weather-pain interaction. No weather parameter predicted change in the subsequent pain measures. The magnitude of the inverse association between pain and barometric pressure was very small, and none of the psychological variables studied influenced the association between pain and barometric pressure. All in all, the evidence for a strong weather-pain association in fibromyalgia seems limited at best.
International Journal of Law and Psychiatry, Nov 1, 2007
Legal-, perceived-and objective coercion were examined both separately and together as a measure ... more Legal-, perceived-and objective coercion were examined both separately and together as a measure of accumulated coercion, to determine how coercion affected patient satisfaction in patients admitted for acute psychiatric care. Accumulated coercive events significantly reduced both overall satisfaction, and satisfaction in four of five subscales evaluating different aspects of treatment. Neither legal status nor perceived coercion affected patient satisfaction, while objective coercion had a significant negative effect on overall satisfaction when these measures were analysed separately. Overall patient satisfaction reported at discharge was low, while satisfaction with different aspects of treatment showed considerable variation. The observation that perceived coercion in the admission process did not affect satisfaction significantly underlines the need to further explore the interaction between subjective and objective measures for coercion. It appears that multiple measures for coercion should be used in future studies.
Journal of Psychiatric Research, May 1, 2002
Objective: The effectiveness of an attention distracting and an attention focusing guided imagery... more Objective: The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively. Methods: Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized, controlled clinical trial. One group received relaxation training and guided instruction in ''pleasant imagery'' (PI) in order to distract from the pain experience (n=17). Another group received relaxation training and attention imagery upon the ''active workings of the internal pain control systems'', ''attention imagery'' (AI) (n=21). The control group (CG) received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures. Results: We found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery (P< 0.005), but not the attention imagery group's slope, declined significantly when compared with the control group (P> 0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects, P=0.98) nor a significant amitriptyline  psychological interaction (P=0.76). Conclusion: Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.
Social Psychiatry and Psychiatric Epidemiology, Dec 1, 2001
Acta Psychiatrica Scandinavica, Sep 1, 1989
The psychological benefits of walking and jogging were compared in 52 symptomatic neurotics over ... more The psychological benefits of walking and jogging were compared in 52 symptomatic neurotics over an 8-week training period and subsequent 6-month follow-up. Both groups showed marked reduction of anxiety, depression and global symptoms. Joggers had greater aerobic gain, but no greater psychologic benefit. Significantly larger numbers of joggers dropped out of the study. There was no relationship between aerobic gain and reduction of symptoms at the end of the program. However, at 6 months' follow-up, those with greater aerobic fitness had much lower anxiety levels. Changes in exercise frequency and aerobic capacity were also maintained at follow-up. Depression levels were not associated with aerobic fitness at follow-up. High initial exercise intensity appears to inhibit the forming of new exercise habits.
Acta Psychiatrica Scandinavica, Nov 1, 1990
ABSTRACTA comparative outcome study of 2 contrasting activity‐based groups with 80 hospitalized n... more ABSTRACTA comparative outcome study of 2 contrasting activity‐based groups with 80 hospitalized nonpsychotic patients is described. One group focused on activities designed to evoke emotional or interpersonal reactions followed by a subsequent reflection. The other focused on handicrafts and non‐emotionally challenging activities. Ego strength was also measured with an instrument developed in conjunction with the study. The 2 groups were demonstrated to be consistent with the preconditions and significantly different by independent scoring of videotaped sessions. There was a greater rated threrapeutic gain in the interactional group at discharge, but patient ratings did not differ between groups. There were no differences at follow‐up between the groups. Measured ego strength strongly predicted outcome after correcting for the initial symptom levels. Ego strength did not interact with activity type. Clinical diagnosis did not predict differential outcome. The groups had no differential effects on specific symptom clusters or social functioning.
Advances in Health Sciences Education, Jul 18, 2006
The study describes the learning process in psychiatry of medical students through their clerkshi... more The study describes the learning process in psychiatry of medical students through their clerkship and internship, It focused upon the development of studentsÕ attitudes to psychiatry, subjective psychiatric competence and self-confidence. The relationships between the participantsÕ background, aspects of the learning environment, their attitudes to psychiatry, psychiatric competence and psychiatric self-confidence were explored in order to develop an empirical model of the learning process. The participants were medical students at the University of Tromsoe, Norway. The study was prospective and based on studentsÕ self-reports, Structural panel modelling and growth curve analyses were used to explore the complex interactions between the variables over time and to create a model of the learning processes. The medical students significantly increased their subjective competence and psychiatric self-confidence during their clerkship in psychiatry and maintained them during their internship. Previous psychiatric experience, attitudes towards psychiatry and current psychiatric experience contributed to subjective psychiatric competence, Competence in turn had a positive effect on selfconfidence. Interestingly, those with greater subjective competence also appeared to have more psychiatric experience during their internship. An empirical model of the important aspects of the learning process was developed.
Nordic Journal of Psychiatry, 2002
Social Psychiatry and Psychiatric Epidemiology, Nov 11, 1999
Earlier studies on the direct effect of social support and social network upon mental health have... more Earlier studies on the direct effect of social support and social network upon mental health have mostly been done in cross-sectional studies and the results have been conflicting. The direct effect of social network and social support upon mental distress was tested in population-based health surveys conducted in 1987, 1990 and 1993. The population consisted of all persons aged 40-62 years and a random sample of persons aged between 20 and 39 years living in five small municipalities in Finnmark, the northernmost county in Norway. The attendance rates were 77%, 74% and 70% for the three health surveys, respectively. All those who had attended the health surveys more than once and answered the key questions about mental distress, social support and social network were selected for analyses (966 persons who attended both the two first health surveys and 1425 persons attending both the two last surveys). A theoretical full cross-lagged panel model was used to search for the predictive effects of time 1 variables (mental distress, social network and social support) upon corresponding subsequent variables. Mental distress, social support and social network at time 1 strongly predicted the corresponding variable at the next time point. Emotional support at time 1 exerted a weak positive effect upon mental distress on the next time point, explaining approximately 1% of the variance. Neither the social network nor instrumental support at time 1 predicted degree of mental distress at the subsequent time point. We conclude that social network and social support have very little direct predictive effect upon mental distress 3 years later in this population.
Tidsskrift for Den Norske Laegeforening, Mar 29, 1998
Medical Education, Apr 1, 2004
SETTING The clinical experience and the subjective learning of pre-registration house officers wh... more SETTING The clinical experience and the subjective learning of pre-registration house officers who completed 4 months' psychiatric rotation are described. METHOD The study was cross-sectional and based on self-report. The participants had responded to an anonymous questionnaire at the completion of their 4 months' psychiatric rotation in the period 1999-2001. Of those eligible (n ¼ 137), 85 (61%) completed the questionnaire. The relationships between individual background variables, different factors of the learning environment, and good learning outcome were explored. CONCLUSIONS The subjective learning benefit and positive learning environment were most related to the amount of practical experience, the degree of tailoring of the tasks to the house officers' competence, and to the formal intramural teaching programme. Supervision, gender, previous experience, and prior interest in psychiatry did not have significant impact on subjective learning. The findings are discussed in terms of the learning model that was developed.
Tidsskrift for Den Norske Laegeforening, 2005
Avdeling for hjerte, lunge og karkirurgi B A KG R U N N. Vi ønsket å undersøke hvilke sykdomsrela... more Avdeling for hjerte, lunge og karkirurgi B A KG R U N N. Vi ønsket å undersøke hvilke sykdomsrelaterte, psykososiale og behandlingsrelaterte faktorer det er som spår pasien ilfredshet e er kirurgisk opphold i kirurgisk avdeling.
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 30, 1998
Over 70% of the adult population of five rural communities in Northern Norway participated in a t... more Over 70% of the adult population of five rural communities in Northern Norway participated in a three-part epidemiological study that included identical questions on mental health. Data were collected in 1987/88, 1990 and 1993. Both repeated cross-sectional analyses and individual growth curve analyses on the 2,486 individuals who participated in either two or three surveys were carried out in order to reveal the changes in mental health over time. The proportion of the population using sleeping pills or psychotropic drugs decreased significantly as time progressed. There were also a significant decrease in the proportion of people who reported being depressed or dissatisfied with life, or who had insomnia or problems in coping. A similar improvement in mental health was noted for both sexes and it remained statistically significant even after adjusting for age and level of education. There was no decrease in the proportion of individuals who reported loneliness. The time effect rem...