Topic: Disasters, terror and stress management

PATHWAYS – Children’s PATHWAYS After Trauma for Health and Well-being through Adolescence and Young Adulthood (PATHWAYS)

PATHWAYS is an epidemiological study that examines how violence, sexual abuse, bullying and other childhood traumas are associated with children and young people’s health, health behaviours and trajectories in health and welfare services from childhood into young adulthood. By linking data from the Trøndelag Health Study (HUNT/YoungHUNT) with national health registries, we follow children and young people over time to identify how trauma exposure, related risk and resilience factors influence health and service use through childhood, adolescence and young adulthood, in order to generate the knowledge needed to ensure earlier and better support for those who are exposed.

 
2020 This project is ongoing 2034

Project Manager

  • Stensland, Synne Øien

    Stensland, Synne Øien

    Head of Section / Senior Researcher

    View profile

Project Members

To improve trauma-exposed children’s and young people’s access to timely, targeted services by generating knowledge on how childhood trauma affects their mental and physical health, health behaviours, medication use, and trajectories in health and welfare services from childhood, through adolescence and into young adulthood. 

Assess prevalence

To assess the prevalence of childhood trauma, mental disorders, headaches, pain, sleep problems, adverse health behaviours and the use of analgesics, other potentially addictive medications and substances among children and adolescents.

Examine associations between trauma, health and medication/substance use
To describe how childhood trauma is associated with the development of mental disorders, substance use problems (including problematic alcohol use), headaches, pain, sleep problems, overweight/obesity, and the use of potentially addictive medications (over-the-counter and prescription analgesics, opioids, anxiolytics and hypnotics) across adolescence and young adulthood.

Analyse service trajectories and health service use
To describe how children and young people use health and welfare services (e.g. consultation frequency, type of contacts, diagnoses at different levels of care and associated costs), and to identify differences in service use between young people exposed to childhood trauma and those      without such experiences.

Develop evidence-based recommendations (“Healthy PATHWAYS”)
In collaboration with young people with lived experience, clinicians and services, to develop a concise recommendations report with concrete advice for health authorities and services on how care pathways, organisation and follow-up can be improved for young people exposed to childhood trauma.

  

The PATHWAYS study uses data from the large, widely acknowledged Trøndelag Health Study (HUNT) linked to national health registries, providing a unique longitudinal dataset following children and youth from birth to early adulthood (0–34 years). The data sources include:

Data are linked and analysed on a secure server (TSD) at the University of Oslo. Direct identifiers (such as names and personal identity numbers) are replaced with codes, and researchers do not have access to information that can identify individuals.

We use advanced quantitative methods to study developmental trajectories, identify risk and resilience factors, and estimate resource use and costs in health and welfare services.

  

About PATHWAYS

Mental disorders, sleep problems, headaches, chronic pain and adverse health behaviours such as low physical activity, sedentary behaviour and overweight/obesity together constitute major contributors to the burden of disease in the population. Young people with substantial and overlapping complaints often respond less well to conventional treatment. As these conditions typically onset in adolescence or young adulthood, knowledge about care needs, contact with services and key risk and protective factors in this period is crucial for developing effective measures to reduce the burden of disease.

Experiences of violence, sexual abuse, bullying and other childhood traumas appear to play an important role in the development and chronification of such problems. However, we still lack knowledge about how childhood trauma is related to young people’s health trajectories and their contact with health and welfare services across development. This hampers the provision of evidence-based and trauma-informed care.

The PATHWAYS study aims to close this knowledge gap. The study is based on a unique linkage between self-reported data and objective measurements from the Trøndelag Health Study (YoungHUNT3 and YoungHUNT4) and national health registries (Norwegian Patient Registry, KPR/KUHR and the Norwegian Prescription Database/Medicines Registry). 

PATHWAYS consists of one ongoing and two completed subprojects:

  • PATHWAYS – Pathways After Trauma for Health and Well-being Among Young People in Services: Funded by South-Eastern Norway Regional Health Authority (Helse Sør-Øst), project no. 2024086, Postdoctoral fellow: Maren Caroline Frogner Werner, MD, PhD (2024–2027).
  • A pill for the pain? Use of analgesics, addictive medications and the development of mental disorders in young people: Funded by the Dam Foundation 2020–2024, project no. 802001, PhD candidate Helle Håve Stangeland, PhD awarded 2024.
  • Killing Pain? Use of painkillers, addictive drugs and the development of psychiatric illness in adolescents. Funded by South-Eastern Norway Regional Health Authority 2020–2024, project no. 2020059, PhD candidate MD Monica Baumann-Larsen, PhD awarded 2024.

Project owner and collaboration

The project is a collaborative effort between Oslo University Hospital (OUS) and NKVTS. Link to the project presentation at OUS: https://www.oslo-universitetssykehus.no/avdelinger/nevroklinikken/forskning-og-utvikling-nevroklinikken/forsknings-og-formidlingsenheten-for-muskelskjeletthelse-formi/pathways/. The institution with overall research responsibility is Oslo University Hospital HF (OUS), the Research and Communication Unit for Musculoskeletal Health (FORMI), with Professor John Anker Zwart as project owner. The Principal Investigator (PI) is Synne Øien Stensland (research professor, MD, PhD), and Maren Caroline Frogner-Werner (MD, PhD) is Co-PI. NKVTS is a key collaborating partner in the study. The project group also includes researchers from NTNU/HUNT, NORCE and the Norwegian Institute of Public Health (FHI), as well as international experts. 

User involvement and service anchoring: PATHWAYS has a broadly composed user panel that includes i) young people with lived experience of services, through collaboration with youth councils at OUS and representatives from the Norwegian Foster Care Association / user organisations (e.g. Landsforeningen for barnevernsbarn), as well as ii) clinicians from paediatrics and adolescent medicine, social paediatrics, Children’s Advocacy Centres (Barnehus), RVTS East and psychosocial services in Oslo Municipality.

In addition, the project has an advisory group with national and international experts in epidemiology, child and adolescent psychiatry and social paediatrics. This structure is intended to ensure that research questions, interpretation of findings and recommendations are firmly grounded in both user experience and clinical practice.

Ethics, privacy and data security

  • Research-responsible institution: Oslo University Hospital HF
  • Ethical approval: Regional Committees for Medical and Health Research Ethics (REK) through the project “Violence and health complaints in adolescents” (REK no. 2017/2229)
  • Registered with NSD/SIKT (no. 735966)
  • Data are used in de-identified/coded form and analysed in TSD (UiO). No individual can be recognised in results or publications.

Publications and dissemination

PATHWAYS is also disseminated through scientific and professional presentations for health personnel, decision-makers and user organisations, participation in conferences and public debate arenas (e.g. Arendalsuka), and through a planned concise recommendation report (“Healthy PATHWAYS”).