| 1. |
- Carlsson, Ninni, 1962, et al.
(författare)
-
”Visa i handling vad arbetet mot mäns våld är värt”
- 2019
-
Ingår i: Svenska Dagbladet. ; 2019:4 april
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Mitt i debatten om Josefin Nilsson och det våld mot henne som närstående berättar om i SVT-dokumentären ”Älska mig för den jag är”, tillkännager regeringen, C och L att de föreslår 45 miljoner i vårbudget för att bekämpa mäns våld mot kvinnor. Flera medier kallar det en storsatsning men är det verkligen det, frågar våldsforskare, #metoo-upprop och organisationer. Med hjälp av aktuell forskning argumenterar de för att detta är långt ifrån tillräckligt, kräver större vårbudget mot mäns våld mot kvinnor och bjuder in riksdag och regering till dialog.
|
|
| 2. |
- Rajan, Gita, et al.
(författare)
-
A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project : A Randomized Controlled Trial
- 2020
-
Ingår i: Journal of Interpersonal Violence. - : SAGE Publications. - 0886-2605 .- 1552-6518. ; 37:9-10, s. NP6582-NP6603
-
Tidskriftsartikel (refereegranskat)abstract
- Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov
|
|
| 3. |
- Rajan, Gita, et al.
(författare)
-
Delayed healthcare access among victims of sexual abuse, understood through internal and external gatekeeping mechanisms
- 2021
-
Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 75:5, s. 370-377
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sexual abuse is associated with severe health consequences, and the European Union has, through the Istanbul Convention, urged its member countries to provide specialist care for victims of sexual abuse.AIM: This aim of this study was to investigate patient- and abuse-related characteristics among patients seeking help at a specialist clinic in Sweden, with focus on disclosure, mental health and appropriate healthcare access.METHODS: This is a descriptive study where journal data from 100 consecutive patients January 2017 to February 2018 were analyzed. All adult individuals (women n = 80, men n = 8) who had taken part in the standardized semi-structured intake interview at the clinic were included (n = 88).RESULTS: At admission, mean age was 40.3 (SD 11.9), mean number of psychiatric diagnoses 6.3 (2.6), and 93% of the patients scored above cut-off (≥34) on IES-R for PTSD. A majority of the patients (87%) had been exposed to childhood sexual abuse (CSA), and mean time to first disclosure was 15.9 (SD 15.3) years. In total, 82% of the patients had, despite disclosure, experienced difficulties accessing appropriate healthcare before coming to the specialist clinic.CONCLUSION: Adult victims of sexual abuse have difficulties accessing appropriate healthcare. This constitutes a gender-based equality problem. A model of gatekeeping mechanisms with two dimensions (external and internal) and three categories (Competence related, Organizational and Emotional) is proposed to understand these difficulties.
|
|
| 4. |
- Rajan, Gita, et al.
(författare)
-
Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm
- 2017
-
Ingår i: Journal of Epidemiology and Community Health. - : BMJ PUBLISHING GROUP. - 0143-005X .- 1470-2738. ; 71:6, s. 592-598
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions.Methods: Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated.Results: Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 017 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1).Conclusions: Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.
|
|
| 5. |
- Rajan, Gita, et al.
(författare)
-
Health care consumption among adolescent girls prior to diagnoses of sexual abuse, a case-control study in the Stockholm Region
- 2020
-
Ingår i: European Child and Adolescent Psychiatry. - : SPRINGER. - 1018-8827 .- 1435-165X. ; 29, s. 1363-1369
-
Tidskriftsartikel (refereegranskat)abstract
- Victims of sexual abuse have more co-morbidities than other persons in the same age and the most affected group are adolescent girls. Little is known about how this is reflected in health care consumption patterns prior to the registered diagnosis. The aim of this investigation was to study health care consumption patterns among girls, 12-17 years old, 1 and 2 years prior to their diagnoses of sexual abuse. Through the Stockholm Region administrative database (VAL), data of co-morbidities, number of health care visits, and prescribed drugs were collected for cases (girls age 12-17 with diagnoses of sexual abuse, n = 519) and controls matched for age and socio-economic status (n = 4920) between 2011-2018. Health care consumption and co-morbidities were significantly higher for the cases compared to controls, with a rise 1 year before the diagnoses: the total number of health care visits (including no shows) 1 year prior to the first recording of the diagnosis was 20.4 (18.1-22.7) for the cases and 6.2 (5.8-6.6) for the controls. The most frequent visits 1 year prior to the diagnosis were to outdoor clinics, with a mean value of 19.1 (16.9-21.3) visits for the cases and 5.7 (5.3-6.1) for the controls, followed by psychiatric clinics with a mean value of 12.7 (10.6-14.8) visits for the cases and 2.0 (1.7-2.3) visits for the controls. The least visited health care clinic 1 year prior to the diagnosis was the emergency ward with a mean value of 1.3 (1.1-1.5) visits for the cases and 0.5 (0.4-0.5) visits for the controls. The most common psychiatric co-morbidities registered among the cases during the first year before the diagnosis of sexual abuse were stress, suicide attempt, and psychosis. Neuroleptics, sleeping pills, antidepressants, and tranquilizers were more frequently dispensed in cases than in controls. Similar patterns were found 2 years prior to the diagnosis. We encourage clinicians to actively ask for exposure of sexual abuse in girls with high health care consumption, making early detection and treatment of sexual abuse available as soon as possible.
|
|
| 6. |
- Rajan, Gita, et al.
(författare)
-
Health care consumption and psychiatric diagnoses among adolescent girls 1 and 2 years after a first-time registered child sexual abuse experience : a cohort study in the Stockholm Region
- 2021
-
Ingår i: European Child and Adolescent Psychiatry. - : Springer Nature. - 1018-8827 .- 1435-165X. ; 30, s. 1803-1811
-
Tidskriftsartikel (refereegranskat)abstract
- Child sexual abuse (CSA) is a crime against human rights with severe health consequences, and suicidal actions, stress, eating disorders, and borderline disorder are common among survivors of CSA. The objective of this study was to analyze how health care consumption patterns developed among adolescent girls in the Stockholm Region, Sweden, 1 and 2 years after the first registration of CSA experience appeared in their medical record, as compared to age-matched controls without such registration. In this cohort study, number of healthcare visits, comorbidities, and prescribed drugs were collected through the Stockholm Region administrative database (VAL), for girls age 12-17 with registration of CSA experience in their medical record (n = 519) and age-matched controls (n = 4920) between 2011 and 2018. Healthcare consumption patterns remained higher among the girls with a registered CSA experience compared to the controls, both 1 and 2 years after the first CSA experience registration. Highest odds ratios (ORs) were found for suicide attempts [OR 26.38 (12.65-55.02) and 6.93 (3.48-13.49)]; stress disorders [25.97 (17.42-38.69) and 15.63 (9.82-24.88)]; psychosis [OR 19.39 (1.75-214.13) and 9.70 (1.36-68.95)], and alcohol abuse [OR 10.32 (6.48-16.44) and 6.09 (1.98-18.67)], 1 and 2 years, respectively, after the first CSA experience registration. The drug prescriptions were also significantly higher among the girls with a CSA experience registration than for the controls. The results highlight the need to systematically evaluate and develop assessment, treatment planning, and interventions offered to adolescent girls after their first CSA experience registration.
|
|
| 7. |
- Rajan, Gita
(författare)
-
Sexual violence : epidemiology, treatment and access to health care
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sexual violence is recognized by the World Health Organization as a “… global public health problem of epidemic proportions, requiring urgent action” [1]. In Sweden, the estimated incidence of penetrative sexual violence is 45 000 per year [2-4] . Whilst anyone may be exposed to sexual violence, the vast majority of victims are girls and women. Access to good quality health care for victims of sexual violence is hence a prerequisite for gender-equal health care. The overarching aim of this thesis is to increase the epidemiological knowledge about the health consequences of sexual violence, the access to good quality health care among victims of sexual violence in Sweden, and to identify key factors with the potential to increase the access to good quality health care for victims of sexual violence. More specifically to: 1) Quantify and compare comorbidities, number of visits and prescribed medicines among individuals with a recorded diagnosis of sexual violence compared to those without such a registration; 2) Analyze patient and sexual violence characteristics, diagnoses and perceived access to good quality health care among patients at a specialist clinic for victims of sexual violence; 3) Evaluate a one-session treatment method for posttraumatic stress disorder (PTSD) after penetrative sexual violence. Three different data sources and five different study designs were used to cover the aims. Using register data from the Stockholm Regional Healthcare Data Warehouse (VAL), one cross sectional study, one case-control study and one cohort study were performed. Journal data from a non-emergency specialist clinic for victims of sexual violence were used for a descriptive study with the construction of a tool for analysis of health care access for victims of sexual violence, and finally, self-rating data were used to analyze treatment outcomes in a randomized controlled treatment study. The results from the register-based studies revealed high burdens of disease and different health care seeking patterns among individuals with a registration of sexual violence as compared with individuals without such a registration. For example, ORs > 19 for alcohol violence, and > 15 for psychotic disorders, were found for adults with a registration of sexual violence, as compared to adults without such a registration. ORs for suicide attempts among adolescent girls 1 year prior to the first registration of sexual violence in the journal record were 15.5 (7.9–30.5) and 26.4 (12.7–55.0) the year after the registration, as compared to same-aged girls from the same neighborhood without such a registration. The descriptive data confirmed the high burden of disease and high risk for suicide attempts found in the register-based studies. The descriptive data also revealed large difficulties in the access to good quality health care: 82% of the patients had tried to get access to good health care prior to admission to the specialist clinic, but felt their needs had not been met. Furthermore, at the intake visit, 90% of the patients scored for PTSD or/and depression regardless of prior health care access. A two-dimensional gatekeeping model was constructed and proposed as a tool for evaluation of factors directly impacting health care access for victims of sexual violence. By facilitating accountability and enabling patients to claim their rights the gatekeeping model also promotes a human rights-based approach. The self-rating data were collected from a pilot study (n=36), where the method Lifespan Integration (LI) was modified (MLI) and tested as a one-session treatment of PTSD symptoms after rape. In the study, 72% of participants in the treatment arm no longer scored for PTSD at follow up, with an mean score reduction of 50% on the Impact of Event Scale after the intervention, while the waiting list arm IES-scores were essentially unchanged. No drop-out rates or adverse effects were reported and the results were stable at the six-month follow up. In conclusion, the burden of disease is high and access to good quality health care is very limited for victims of sexual violence in Sweden. This violation of a universal human right hinders progression towards gender-equal health care access. Specialist clinics and treatment methods adapted to the needs of victims of sexual abuse are two key factors for change. The gatekeeping model for health care access and the MLI PTSD-protocol are promising and may be developed to increase access and lower costs for good quality healthcare for victims of sexual violence.
|
|
