Implementation of Stress and Adversity Inventory i multidisciplinary assessment of patients with obesity at Akershus University Hospital.

The purpose of this pilot project was to implement a validated method for stress assessment at the Outpatient clinic for morbid obesity at Ahus. During the project period, education and training should be carried out using the online questionnaire, Stress and Adversity Inventory for Adults (STRAIN). Training was to take place partly through a study trip to the University of California Los Angeles (UCLA) and partly through online training thereafter. Two health care professionals completed a two-week study trip to UCLA in November 2019. During the visit at the "Laboratory of Stress Assessment and Research, Cousins Center for Psychoneuroimmunology" we gained a thorough understanding of the background to the establishment of STRAIN as well as how the online stress questionnaire can be used clinically and in research. Users at the out patients clinic at Ahus have helped to assess user perspective in the questionnaire. The use of STRAIN was approved in December 2019 by the Regional Ethics Committee for use in the ongoing Register study of patients with morbid obesity at Ahus. We plan to use STRAIN in clinical practice and will also include STRAIN in research projects on patients with morbid obesity in the future.

Effekter av forprosjektet har vært økt kjennskap til en metode for vurdering av stress. Gjennom hospitering og kunnskapsutveksling har vi etablert et samarbeid med et etablert forskningsmiljø ved UCLA, USA. Bruk av STRAIN som metode er etablert ved Ahus og vi planlegger fortsatt bruk av STRAIN i tverrfaglig utredning av pasienter med sykelig overvekt. Det er også inngått et samarbeid, inklusive skrevet en data håndteringsavtale som gir mulighet for å bruke STRAIN i videre forskning ved den pågående Registerstudie for sykelig overvekt ved Ahus. Som et resultat at etablert samarbeid er det skrevet en artikkel som nylig er akseptert forpublisering i det amerikanske tidskriftet Obesity med forfattere fra Ahus og UCLA.

Multimorbidity is prevalent in obesity. Morbid obesity comprises of complex metabolic, functional and psychological dysfunctions with increased risk of future morbidity and mortality. A recent population based study recently showed positive associations between adverse life experience and allostatic overload and multimorbidity in a Norwegian cohort followed for 11 years. Also, a general trend of dose-response association between lifestyle related conditions (i.e. obesity and diabetes mellitus) and increasing number of childhood difficulties was reported in a recent Norwegian cohort study. Implementations of validated clinical tools for psychosocial evaluation may improve current health services and help standardization of treatment. A prospective registry and biobank study of patients with morbid obesity at Ahus is ongoing (since Jan 2014). Data collection is performed in collaboration with EpiGen Department of clinical Molecular Biology (Head Professor Böttcher). Preliminary data indicate a high prevalence of lifetime adversity with 46% of the patients reporting adverse events during their life course. Self-reported adverse events during the life course correlated with lower odds of choosing bariatric surgery for subsequent obesity treatment. In this study, information on lifetime adversity was assessed in dialog with the patients. The suspected high prevalence of adverse events needs verification in prospective studies using validated methods. Assessments of lifetime stress exposure using the Stress and Adversity Inventory for Adults (STRAIN) has demonstrated good usability and acceptability in clinical practice, but has previously not been assessed in Norway. We hereby apply for funding to educate two health care personnel and to implement STRAIN in clinical practice. We also apply for funding to purchase a biobank freezer for use in the main project. Finally, we apply for funding for user honoraria for the implementation of the Norwegian version of STRAIN.