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

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 collaboration between Oslo University Hospital (OUS) and the Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS). Link to the OUS project presentation:
(https://www.oslo-universitetssykehus.no/avdelinger/nevroklinikken/forskning-og-utvikling-nevroklinikken/forsknings-og-formidlingsenheten-for-muskelskjeletthelse-formi/pathways/) 

Research-responsible institution and project owner: Oslo University Hospital HF (OUS), Research and Communication Unit for Musculoskeletal Health (FORMI). Project owner is John-Anker Zwart. Principal Investigator (PI) is Synne Øien Stensland (MD, PhD, Research professor), and Maren Caroline Frogner-Werner (MD, PhD) is Co-PI. 

Key partner: Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS) 

Other central collaborators: Researchers and clinicians from the Norwegian Institute of Public Health (FHI), NTNU/HUNT, NORCE, RVTS East, Oslo Municipality, and 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) 
• PATHWAYS has been approved by the Data Protection Officer at OUS. The completed subprojects Killing Pain and A Pill for Pain were 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 

Barndomstraumer og langvarige smerter hos barn, ungdom og unge voksne. 
Baumann-Larsen M, Reme SE, Stensland SØ. 
Tidsskrift for Norsk psykologforening. 2024;12:829–842. Publisert 2. desember 2024. Lenke: https://www.psykologtidsskriftet.no/artikkel/2024as11ae-Barndomstraumer-og-langvarige-smerter-hos-barn-ungdom-og-unge-voksne  

Prevalence and risk of psychiatric disorders in young people: prospective cohort study exploring the role of childhood trauma (the HUNT study): commentary, Stangeland et al. 
Stangeland H, Wentzel-Larsen T, Stensland SØ. 
Br J Psychiatry. 2026 Jan;228(1):83-84. doi: 10.1192/bjp.2025.10437. Epub 2025 Oct 24. 
PMID: 41133349. Free PMC article. No abstract available. Lenke: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/prevalence-and-risk-of-psychiatric-disorders-in-young-people-prospective-cohort-study-exploring-the-role-of-childhood-trauma-the-hunt-study-commentary-stangeland-et-al/6F1FB1E5B193707B5CB03DE6E5CF4918  

Prevalence and risk of psychiatric disorders in young people: prospective cohort study exploring the role of childhood trauma (the HUNT study). 
Stangeland H, Aakvaag HF, Baumann-Larsen M, Wentzel-Larsen T, Ottesen A, Zwart JA, Storheim K, Dyb G, Stensland SØ. 
Br J Psychiatry. 2024 Nov;225(5):476-483. doi: 10.1192/bjp.2024.98. 
PMID: 39114956. Free PMC article. Lenke: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/prevalence-and-risk-of-psychiatric-disorders-in-young-people-prospective-cohort-study-exploring-the-role-of-childhood-trauma-the-hunt-study/0D38260DA0CA5CA277846BA74B74F7D2  

Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT Study. 
Baumann-Larsen M, Storheim K, Stangeland H, Zwart JA, Wentzel-Larsen T, Skurtveit S, Dyb G, Stensland SØ. 
Pain. 2024 Jun 1;165(6):1317-1326. doi: 10.1097/j.pain.0000000000003131. Epub 2024 Feb 29. 
PMID: 38126936. Free PMC article. Lenke: https://journals.lww.com/pain/fulltext/2024/06000/childhood_trauma_and_the_use_of_opioids_and_other.13.aspx  

Problematic alcohol use in young adults exposed to childhood trauma: The Trøndelag Health (HUNT) Study. 
Stangeland H, Aakvaag HF, Baumann-Larsen M, Wentzel-Larsen T, Storheim K, Zwart JA, Dyb G, Stensland SØ. 
J Trauma Stress. 2023 Oct;36(5):968-979. doi: 10.1002/jts.22965. Epub 2023 Sep 4. PMID: 37665694. Lenke: Problematic alcohol use in young adults exposed to childhood trauma: The Trøndelag Health (HUNT) Study  

Killing pain?: a population-based registry study of the use of prescription analgesics, anxiolytics, and hypnotics among all children, adolescents and young adults in Norway from 2004 to 2019. 
Stangeland H, Handal M, Skurtveit SO, Aakvaag HF, Dyb G, Wentzel-Larsen T, Baumann-Larsen M, Zwart JA, Storheim K, Stensland SØ. 
Eur Child Adolesc Psychiatry. 2023 Nov;32(11):2259-2270. doi: 10.1007/s00787-022-02066-8. Epub 2022 Aug 27. 
PMID: 36030342. PMCID: PMC9419914. Lenke: https://link.springer.com/article/10.1007/s00787-022-02066-8  

Killing pain? A prospective population-based study on trauma exposure in childhood as predictor for frequent use of over-the-counter analgesics in young adulthood. The HUNT study. 
Baumann-Larsen M, Zwart JA, Dyb G, Wentzel-Larsen T, Stangeland H, Storheim K, Stensland SØ. 
Psychiatry Res. 2023 Sep;327:115400. DOI: 10.1016/j.psychres.2023.115400.115400. Epub 2023 Aug 1. 
PMID: 37574601. Free article. Lenke: https://www.sciencedirect.com/science/article/pii/S0165178123003505  

Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study. 
Baumann-Larsen M, Dyb G, Wentzel-Larsen T, Zwart JA, Storheim K, Stensland SØ. 
BMJ Open. 2023 Mar 17;13(3):e066058. doi: 10.1136/bmjopen-2022-066058. 
PMID: 36931675. PMCID: PMC10030485. Lenke: https://bmjopen.bmj.com/content/13/3/e066058.long  

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”).