| 1. |
- Deyessa Kabeta, Negussie, 1966-
(författare)
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Intimate partner violence and depression among women in rural Ethiopia
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Several studies have reported socioeconomic, socio-demographic factors, including violence against women to be associated with depression among women, but knowledge in the area among women living under extreme poverty in developing countries remains scarce. Relationship between intimate partner violence and women’s literacy in societies where violence is normative is complex, there are only limited data describing this difference in the distribution of violence exposure by residency and literacy. Few studies have addressed consequences of maternal depression and experiencing violence among women on children’s survival. Objective: The aim of this thesis is to determine prevalence of depressive episode and examine its association with violence by intimate partner and socioeconomic status It also assesses contribution of residency and literacy of women on vulnerability to physical violence by intimate partner, and independent effect of intimate partner violence and maternal depression on the risk of child death in rural Ethiopia. Methods: A community-based cross-sectional study was undertaken among 3016 randomly selected women in the age group between 15-49 years conducted from January to December 2002. A cohort study was done through following up women who gave birth to a live child within a year of the survey, in rural Ethiopia. Analysis was made using all the 3016 women, 1994 of the married women and 561 of women who gave birth within a year of the data collection time. Cases of depression were identified using the Amharic version of the Composite International Diagnostic Interview, experience of physical, sexual and emotional violence by intimate partner was made using the WHO multi-country study on women’s life events, and child death was measured by continuous demographic surveillance data from the Butajira Rural Health Program. Result: The twelve-month prevalence of depression was estimated to be 4.4%. In the analyses being currently married, divorced and widowed women, living in rural villages, having frequent khat chewing habit, having seasonal job and living in extreme poverty were factors independently associated with depression. Similarly, among the married women, experiencing physical violence, childhood sexual abuse, emotional violence and spousal control were factors independently associated with depressive episode. Women in the overall study area had beliefs and norms permissive towards violence against women. Violence against women was more prevalent in rural communities, in particular, among rural literate women and rural women who married a literate spouse. In this study, maternal depression was associated with under five child death. Although no association was seen between experiencing violence and child death, the risk of child death increases when maternal depression is combined with physical and emotional violence. Conclusion: Prevalence of depression among women was still in the lower range as compared to studies from high-income countries. Though depression is associated with socio-demographic factors and extreme poverty, the association is complex. The high prevalence of violence against women could be a contributing factor for preponderance of depression among women than in men. Urbanization and literacy are thought to promote changes in attitudes and norms against intimate partner violence. However, literacy within rural community might expose women to the higher risk of violence. Improving awareness of clinicians and public health workers on the devastating consequences of violence against women and depression is essential in order to identify and take measure when violence and maternal depression co-occurred.
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| 2. |
- Ghanean, Helia, 1978-
(författare)
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Studies on the perception of mental illness and epilepsy in Tehran, Iran : a study in stigma and discrimination
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundStigma and discrimination because of medical conditions is a global phenomenon. Epilepsy and mental illness belong to the most stigmatizing disorders world-wide. Culture, religion, education, life-style influences the perception of stigma. There are two aspects of stigma of special interest for this thesis; internalized stigma, which is the perception of a person suffering from a condition and the public perception of this disorder. This study investigates both aspects of stigma because of mental illness and epilepsy. Internalized stigma of mental illness and epilepsy are also studied in Umea, Sweden, with the same instrument as in Iran in order to look at the cultural influence.MethodsPaper 1 and 2 on internalized stigma because of mental disorders and epilepsy in Tehran:These studies are cross-sectional with 138 persons with mental illness recruited from three different hospitals in Tehran and 130 persons with epilepsy from one neurologic clinic in Tehran and the Iran epilepsy association. Internalized stigma because of mental illness was measured using ISMI (Internalized Stigma of Mental Illness) questionnaire and because of epilepsy with the same instrument adapted for epilepsy (ISEP). ISMI/ISEP contains 29 items measured by a 4-point Likert scale. An open-ended question about the experiences of discrimination was added.Paper 3 and 4 on public attitudes towards mental disorders and epilepsy in Tehran:These two studies were performed with 800 individuals randomly chosen from households in four districts of Iran (north, south, east and west). In Paper 3 on attitudes and knowledge of mental illness a modified version of a questionnaire developed for the World Association program to reduce discrimination and stigma because of schizophrenia was used. In Paper 4 on awareness of and attitudes towards epilepsy a questionnaire originally developed by Caveness and Gallup in United States as early as 1949 was used and since used in many studies all over the world.Paper 5 and 6 comparing internalized stigma because of mental disorders and epilepsy in Tehran and Umea:These two studies included patients suffering from mental disorders (N=163) and epilepsy (N=93) recruited from the university hospital in Umea, Sweden. The same questions as used in Paper 1 and 2 were applied.ResultsThe experience of stigma because of mental disorders was high in the Iranian sample. The Swedish sample generally reported lower levels of experienced stigma than the Iranian except for items covering self-blame and feelings of alienation. As regards epilepsy the Iranian sample reported quite a high level of experienced stigma compared to the Swedish sample. Generally the patients with epilepsy reported lower levels of experienced stigma compared to patients with mental illness in the two settings. Attitudes towards mentally ill persons in Tehran were at the same levels as in western high income countries. The knowledge about and attitudes towards persons with epilepsy was also generally at the same level as found in other European studies expect for a much lower acceptance as regards accepting a person with epilepsy to marry someone in the family.ConclusionStigma because of mental illness and epilepsy is a reality even in Iran, which is an Islamic setting in spite of the teachings of the Koran to show mercy with people who suffer from different ailments and rather well developed health services. The levels of experienced stigma is higher in Iran compared to Sweden, but still there is quite a lot of stigma because of mental illness even in Sweden in spite of several national efforts to reduce stigma. The lower levels of stigma because of epilepsy in both settings and especially in Sweden, is suggested to be the consequence of effective treatments available for epilepsy compared to the less successful treatments available for mental illness. The differences in internalized stigma reported and the public perceptions of stigma because of both mental illness and epilepsy between Iran and Sweden is suggested partly a consequence of the different cultural settings, Sweden being an extremely individualistic society compared to the more collectivistic Iranian society.
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| 3. |
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| 4. |
- Herrera Rodríguez, Andrés, 1966-
(författare)
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Heaven can wait : studies on suicidal behaviour among young people in Nicaragua
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.
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| 5. |
- Jegannathan, Bhoomikumar, 1953-
(författare)
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‘Striving to negotiate… dying to escape’ : suicidal expressions among young people in Cambodia
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Suicide among young people is a global public health problem, but information on determinants and understanding of suicidal expressions are lacking in low and middle income countries (LMIC). Though school-based interventions are common in many parts of the world, evidence for efficacy is less reported, particularly from post-conflict countries.Aim To explore suicidal expressions and their determinants with psychosocial and gender perspective in Cambodia and Nicaragua and to evaluate a school based intervention to promote mental health and prevent suicidal behavior among young people in Cambodia.Method School students between the age of 15-19 from Cambodia and Nicaragua responded to Attitude Towards Suicide (ATTS) and Youth Self-Report (YSR) questionnaires. In addition, Life Skill Dimension Scale Adolescent Form (LSDS-AF) was used in schools in Cambodia, one experimental and the other control, to measure the impact of intervention. Six focus group discussions (FGDs), both gender-specific and mixed groups, were held to understand young people’s perception of gender, culture, religion and media and their impact on suicide among them.Results Paper I. Revealed few gender differences in suicidal expressions, except girls reporting more attempts than boys. Girls exposed to suicide among friends and partners were likely to report own suicidal expressions and girls with internalizing syndrome were at risk for suicidal expressions. Paper II. Cambodian teenagers reported more mental health problems but fewer suicidal expressions as compared to Nicaragua. The determinants varied between countries. Paper III. Participants of FGDs mentioned “Plue Plun” male and “Kath Klei” female to describe gender difference in suicidal behavior among young people in Cambodia who found it a challenge to negotiate between traditional and modern values.Paper IV. Suicide ambiguity in Buddhism, stigmatizing culture and double edged media were seen as suicide-provoking by the young people in Cambodia, who recommended peer-focused, school based program.Paper V. School based Life Skills Intervention overall benefited girls. Boys with high risk behavior had shown improvement on many Life Skills dimensions, as well as in their mental health profile.Conclusion The gender and cultural differences in suicidal expressions and their determinants among teenagers emphasize the importance of culturally sensitive and gender-specific suicide prevention programs. The influence of religion and media ought to be considered while planning intervention programs. School-based program may be a window of opportunity to promote mental health and prevent suicide among young people in Cambodia.
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| 6. |
- Lloyd, Christina
(författare)
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Moments of meaning – Towards an assessment of protective and risk factors for existential vulnerability among young women with mental ill-health concerns : A mixed methods project in clinical psychology of religion and existential health
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present sequential mixed-methods project was conducted in the area of clinical psychology of religion and existential health. The central aim of the project was to investigate clinically relevant areas for an assessment of protective and risk factors for existential vulnerability and dysfunctional existential meaning-making in a clinical sample of young women with mental ill-health concerns. Three theoretical areas were applied and operationalized for the project: Existential meaning-making; Ontological security; and, Emotion regulation. The sample was composed of female participants at an outpatient psychodynamic psychotherapy clinic for young adults in Sweden, with depression as the most common preliminary diagnosis. Study I, quantitative, comprised an online questionnaire of established assessment-measures, completed by 53 women (17–30 y., M = 22.4 y.). Depression-related personality traits were explored as possible underlying variables when studying relations between mental ill-health and a dysfunctional existential meaning-making process, by comparing groups pertaining to different levels of depression-related personality traits to explore possible differences between groups in the areas studied. Study II, qualitative, comprised an in-depth interview, with a subgroup (n = 10; range 21-25 y, M=22.7) drawn from the preceding study, and representative of those high on depression-related scales. Interrelations between existential meaning-making and emotion regulation were explored in relation to everyday life, critical life-events, and ultimate concerns through a systematic text condensation process. Study III, multi-method, comprised several assessment steps of data from the subgroup, and an assessment of inter-rater reliability (IRR). Possible functional factors (protective) and dysfunctional factors (risk) for mental ill-health were explored through an assessment of Existential worldview function, by the exploration of interrelations among existential worldview, ontological security and self-concept. According to our hypothesis, high scores on the depression-related personality scale Inhibition of aggression were strongly associated with a less functional existential meaning-making process in this sample of young clinical females. Among the High scorers, a crisis of meaning was found in terms of weak or no access to sufficient cultural knowledge or existential resources in intergenerational, emotionally-nurturing relationships. Results further indicated a general lack of an operating existential worldview accompanied by little or no reflection on existential worldview matters among a majority of the subjects and their parents.
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| 7. |
- Loureiro, Tatiana, et al.
(författare)
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District Energy Systems : A Collaborative Exchange of Results on Planning, Operation and Modelling for Energy Efficiency
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Workshop organized by INDIGO project as a collaborative activity among EU funded projects in the area of District Heating and Cooling. The objective of the workshop was twofold: (1) to create a cluster of European funded projects working in the area of District Energy Systems; and (2) to create a networking opportunity in which to share experiences on the results and difficulties of the researches, and to identify synergies.
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| 8. |
- Melder, Cecilia A., 1966-
(författare)
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Vilsenhetens epidemiologi : en religionspsykologisk studie i existentiell folkhälsa
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The existential dimension has gained importance in health studies in the last decades (Moreira-Almeida & Koenig, 2006; DeMarinis, 2008). Little Swedish research exists in this area. A pilot study was conducted in a suburban Stockholm, Church of Sweden parish. Research question was: “How does the existential dimension of health, understood as the ability to create and maintain a functional meaning-makings system, affect the person’s self-rated health and quality of life?” Theoretical framework included: health research focusing the existential dimension; public health through psychology of religion; and, object-relations theory. The mixed-methods format included semi-structured interviews, and surveys: 1) on meaning-making, and 2) Swedish pilot translation of WHOQOL-SRPB (self-rated health and quality of life including spirituality, religiousness and personal beliefs). Central results showed a positive relation between the existential health dimension and: overall ratings of physical, mental, social, and environmental health (p = .008); the overall existential health dimension and mental health (p = .008); and, social health (p = .046) and, the combined health items “How do you feel?” and “How satisfied are you with your health?” (p = .001). These results find support in WHO’s health perspective, and are linked to DeMarinis’ health dimensions and Winnicott’s understanding of potential space. Health dimensions: physical, mental, social, ecological and existential, are closely interlinked. The existential dimension is important through interaction with the others, and through its function as an autonomous health dimension. The study underlines the need for – and offers a culturally-tested method and model to explore existential needs in this secularized context.
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| 9. |
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| 10. |
- Rutz, Wolfgang
(författare)
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Evaluation of an educational program on depressive disorders given to general practitioners on Gotland : Short and long-term effects
- 1992
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the years 1983-1984, the Swedish Comittee for the Prevention and Treatment of Depression (PTD) offered an educational program to all general practitioners (GP:s) on the Swedish island of Gotland. 1982 was used as a baseline year. An evaluation of the short-term effects was made continuously until 1985. The long-term effects were followed 1985-1988. According to the immediate evaluation, 80% considered the practical applicability of the program to be high, and the GP:s achieved increasing competence and stringency in handling depressive states.The referrals to the local psychiatric unit decreased to 50% of those at baseline. The total in-patient days due to depressive disorders decreased as well as the average stay. The sick-leave consumption decreased by approximately 50%. In 1982, the prescription of antidepressants was low, 54% of that in the rest of Sweden. In 1985 the corresponding figure was 77%. The prescriptions of lithium remained stable while the prescriptions of sedatives and major tranquilizers decreased as compared to the rest of Sweden. The suicide rate decreased relative to the trends on Gotland and in the rest of Sweden. During the long-term evaluation, the in-patient care for depressive disorders increased again and the suicidal rate returned almost to control values. The prescriptions of antidepressants stabilised. Thus, the effects were strictly time related to the educational program indicating real effects and not only coincidence with local trends on the island.In a cost-benefit analysis the costs for the educational programs, the changes in drug prescriptions and in in-patient care were evaluated as well as indirect costs concerning changes in morbidity and mortality. The results indicate that the PTD educational program on Gotland resulted in savings to the society in the order of about SEK 155 million (USD 26 million). It is concluded that educational programs of this kind should be repeated every second to third year.
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