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- Gustafsson, Per E, 1981-
(författare)
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Psychosocial Stress, Mental Health and Salivary Cortisol in Children and Adolescents
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stressful experiences and conditions in childhood influence the health and well-being of the growing individual, and can also confer a long-lasting impact into adult life. Delineating the social, mental and biological aspects of stress in children and adolescents is therefore of great concern for human beings. Despite these notions, much knowledge is lacking regarding stress in childhood.This thesis aimed at examining diverse aspects of stress in children and adolescents: associations between social conditions, traumatic life events, mental health, and salivary cortisol as a measure of the activity of a major physiological stress system. Cross-sectional samples included two non-clinical samples of school-aged children (N=240-336) and adolescents (N =400), and two clinical samples of children with obsessive-compulsive disorder (OCD) (N =23) and adolescents who had experienced childhood abuse (N =15). Main measures were salivary cortisol sampled three times a day, and questionnaires to teachers, parents and children with questions about each child’s mental health, traumatic life events and about the socioeconomic situation of the parents.The main findings include observation of 1) higher cortisol levels in children with a moderate level of psychosocial burden (low socioeconomic status, immigrant family, social impairment of mental health problems), 2) higher cortisol levels in children with OCD who also displayed a tendency to decreasing cortisol in the face of an acute stressor, and 3) cortisol was positively related to mental health problems in abused adolescents. Furthermore, the deleterious effect of 4) traumatic events involving a social dimension, interpersonal traumas, and 5) cumulative traumatic events, polytraumatization, on the mental health of children and adolescents was indicated.The findings are discussed with respect to the complex interactions between social, mental and biological aspects of children and adolescents. The consequences of adverse experiences in childhood may represent pathways to future health problems. Consideration of the social circumstances in childhood might in the future guide public health policies and the identification of target groups for preventive interventions as well as leading to improvements in treatment for children exposed to severe stress.
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| 2. |
- Back, Christina
(författare)
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The Legal Process in Child Sexual Abuse : Difficulties in confirming evidence and providing support
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall purpose of this thesis was to study the situation of such children in the legal process. In depth-interviews were carried out on ten children aged 8-18 years old. The interviews focused on the children´s experiences and perceptions of meeting with various professionals in the legal process. In-depth interviews were also conducted with nine parents of children who had been sexually abused and who had entered into a legal process. Parents described how they experienced the situation for their children as victims, but also their experiences as parents whose children participated in a legal process. Seven prosecutors with experience of cases where children were plaintiffs were also interviewed in this study.The interviews were analysed using Interpretative Phenomenological Analysis (IPA). This is an appropriate method to explore the participants´ life-world/personal-world and the individuals´ personal perceptions of objects or events, as opposed to an attempt to produce an objective account. In the first study (study I) on the children, five major themes emerged through the analysis: not being believed, making child sexual abuse visible, need for support, sanctions for offenders and lack of respect for the child´s integrity. Almost all of the children had a feeling of not being believed.In the study (study II) on the parents, three superordinate themes emerged from an analysis of the data: stigmatization, need for support in the parental role and transforming consequences to reality.Three themes emerged from prosecutors study (study III) difficulties with the evidence of crime, children´s special needs and children´s dependence on adults. The informants´ descriptions of how they perceived the children in the legal process were associated with their experience of the difficulty of finding proof of the crime.The aim of study IV was to identify and describe the obstacles that can prevent children from talking about sexual abuse in a police interview. Data consisted of 28 investigative interviews with children and 12 police interrogations with non-offending parents. Data interpretation and analysis were based on content analysis. The following categories were identified: not being believed/telling the truth, need for support and dependence on adults, guilt and shame, fear and difficulty in spatial and temporal characterization.The main conclusion of the thesis is that there are difficulties in confirming evidence when children who have suffered sexual abuse are involved in a legal process. It is also concluded that there is an absence of models with the aim to support children and parents going through the process.
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- Jarkman Björn, Gunilla, 1980-
(författare)
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Refugee Children and Families : Psychological Health, Brief Family Intervention and Ethical Aspects
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: There are more than 45 million refugees and displaced people in the world. Children constitute almost half of the refugee population. It is an enormous challenge and a complex situation for refugee children and families escaping from their home country, to a new system of society to which they have to adapt and where they have to recapture a sense of coherence. This thesis focuses on the psychological health of younger refugee children before and after an intervention with family therapy sessions. The experiences and perceptions of refugee families who fled to Sweden as a result of the war in Bosnia and Herzegovina from 1992 to 1995 and who have permanent residence permits were explored. The ethical aspects of treatment of traumatized refugee children and families were also analysed.Aims: To investigate parent-child agreement on the psychological symptoms of the refugee children; to explore refugee children’s well-being before and after three sessions of family therapy; to explore, in more detail, the complexity of various family members’ experiences and perceptions of their life before the war, during the war and their escape, and in their new life in Sweden; and also to highlight ethical issues and conduct ethical analyses using basic ethical principles that take into account the varying perspectives of the actors involved with regard to the psychological treatment of refugee children and families.Methods: Data was collected using parental interviews and psychological assessments of children aged five to twelve years. In the first study, 13 children were assessed using the Erica Method and compared with a Swedish reference group consisting of 80 children. In the second study, the Erica Method assessments from before and after an intervention with brief family therapy were compared for ten out of those 13 children, complemented by parental interviews. Family therapy sessions were videotaped, and in the third study, the verbatim transcripts of nine family therapy sessions were analysed using a qualitative method with directed content analysis. Finally, the basic ethical principles in two case studies of teenage refugee children concerning psychological treatment were analysed taking into account the varying perspectives of the actors involved in the treatment.Results: Parents’ assessments of their children’s psychological health according to a symptom and behaviour interview did not correlate with the findings of the psychological assessments of children using the Erica Method. The majority of the parents were unaware of their children’s psychological problems, as identified in the psychological assessments. There was a higher rate of not-normal sandboxes (Erica Method) in this group of refugee children, compared to the Swedish reference group. A statistically significant number of cases had improved after a brief family therapy intervention when evaluated with Erica Method. Three main categories emerged from the analysis of the family therapy sessions: “Everyday life at home”, “Influence of war on everyday life”, and “The new life”. The three main categories were comprised of a total of ten subcategories: the family, work and school/preschool, the war, the escape, reflections, employment, health, relatives and friends, a limited future, and transition to the new life. A structured ethical analysis concerning the principles of autonomy, beneficence, non-maleficence, and justice is feasible and valuable when dealing with refugee children and families in clinical practice as well as in research.Conclusion: The findings from these studies show the importance of highlighting individual perspectives from the point of view of children, parents, and siblings in order to better understand the complexity of family systems. Family interventions could be beneficial for refugee children and families, even if the children do not present with overt psychological problems. Salutogenic perspectives facilitate the provision of support to refugee families. Such support helps refugee families to adapt to a new system of society and recapture a sense of coherence. In research as well as in treatment sessions, basic ethical principles, from the point of view of all actors involved, is recommended to be taken into consideration.
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