1. |
- Alehagen, Siw, 1953-, et al.
(author)
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Can women's cognitive appraisals be registered throughout childbirth?
- 2000
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In: Gynecologic and Obstetric Investigation. - : S. Karger AG. - 0378-7346 .- 1423-002X. ; 49:1, s. 31-35
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Journal article (peer-reviewed)abstract
- The aims of the present study were: (a) to examine whether it was possible to measure women’s cognitive appraisals hourly during the whole process of labor and delivery, and (b) to explore how the appraisals varied during labor. Measurements from 12 nulliparous women are presented. The findings indicate that it is possible to study psychological appraisals directly, in detail and continuously during the process of labor and delivery. The women’s cognitive appraisals varied throughout labor both per individual woman and between the participating women.
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2. |
- Alehagen, Siw, 1953-, et al.
(author)
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Catecholamine and cortisol reaction to childbirth
- 2001
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In: International Journal of Behavioral Medicine. - 1070-5503 .- 1532-7558. ; 8:1, s. 50-65
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Journal article (peer-reviewed)abstract
- One way to study the stressfulness of childbirth is to examine the output of stress hormones. In this study, urinary catecholamines and salivary cortisol from 50 primiparous women were collected for 1 day during gestational weeks 37 to 39, hourly during labor and delivery, and 2 hr and 2 days postpartum. All three stress hormones increased statistically significantly from pregnancy to labor. The increase in adrenaline and cortisol was more than 500%, and the increase in noradrenaline was about 50%. After labor, the output decreased but not statistically significantly below the levels during late pregnancy. Hormone levels during late pregnancy, during labor and delivery, and during the period postpartum mostly did not correlate systematically. However, noradrenaline and adrenaline, as well as adrenaline and cortisol, were positively correlated during labor. After administration of epidural analgesia, there was a moderate but significant decrease in noradrenaline and adrenaline, whereas cortisol did not change. In conclusion, the results of this study support the assumption that childbirth is a very stressful event and that the stress responses vary considerably among women. The substantial increase of adrenaline and cortisol compared with noradrenaline indicates that mental stress is more dominant than physical stress during labor.
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3. |
- Alehagen, Siw, 1953-, et al.
(author)
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Fear during labor
- 2001
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 80:4, s. 315-320
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Journal article (peer-reviewed)abstract
- Background. The aims of the present study were to compare primiparous and multiparous women’s experiences of fear of delivery during an early stage of active labor (cervix dilatation 3–5 centimeters) and to study whether fear of delivery, measured during the early stage of active labor, was a predictor of the amount of pain relief received during the remaining part of labor (cervix dilatation 5 cm – partus), of the duration of the remaining part of labor, and of the occurrence of instrumental vaginal delivery and emergency cesarean section.Method. Thirty-five primiparous and 39 multiparous women answered the Delivery Fear Scale (DFS) once during the early stage of labor and before they had received any pain relief.Results. Primiparous women reported higher levels of fear than multiparous women did. Fear during the first phase of labor predicted only the total amount of pain relief received during labor.Conclusion. The clinical implications of the study are that the delivery staff should consider women’s fear during labor and pay attention especially to primiparous women’s increased risk of higher levels of fear during an early stage of active labor, as compared with multiparous women’s. The challenge for staff of a delivery ward is to support the woman in labor in a way that decreases fear, which in turn might reduce the woman’s need of pain relief.
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4. |
- Alehagen, Siw, 1953-, et al.
(author)
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Fear of childbirth before, during, and after childbirth
- 2006
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:1, s. 56-62
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Journal article (peer-reviewed)abstract
- Background. Only scanty research exists about the relationship between women's expectations during pregnancy and their experiences as reported during the actual process of labor and afterwards. The aims of the present study were: 1. to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during early active labor (phase 1: cervix dilatation 3–5 cm), and 2. to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia during labor.Methods. Fear of childbirth was measured in 47 nulliparous women during gestation weeks 37–39 by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ version A). During early active labor we measured women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale). Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery.Results. A positive correlation appeared between fear of childbirth during pregnancy, postpartum, and early active labor. There were no differences in fear of childbirth during late pregnancy between women who received epidural analgesia and those who did not. Postpartum fear was higher in the women who had received epidural analgesia.Conclusions. Pregnant women who fear childbirth are prone to report fear during the actual labor and postpartum. The administration of epidural analgesia is not a sufficient response to women's fear during the process of labor.
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5. |
- Alehagen, Siw, 1953-, et al.
(author)
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Fear, pain and stress hormones during childbirth
- 2005
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In: Journal of Psychosomatic Obstetrics and Gynaecology. - : Informa UK Limited. - 0167-482X .- 1743-8942. ; 26:3, s. 153-165
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Journal article (peer-reviewed)abstract
- Aims. To investigate the course of fear, pain and stress hormones during labor, and the associations between fear, pain, stress hormones and duration of labor in nulliparous women with and without epidural analgesia (EDA).Method. One day during gestation weeks 37–39, urinary and salivary samples were collected to measure catecholamines and cortisol. Hourly during labor, the participants answered the Delivery Fear Scale and a pain intensity scale, and urinary and salivary samples were collected to measure stress hormones.Results. The course of fear, pain and stress hormones differed throughout labor in women with and without EDA. Pain and cortisol increased throughout labor in women without EDA. Women who received EDA had more fear, but not more pain, before the administration of the EDA than women who did not receive EDA. Pain, fear and catecholamines decreased when women received EDA, but fear and pain increased again later in labor. Fear and pain correlated, as well as levels of fear in the different phases of labor. During phase one of labor epinephrine and duration of the phase were negatively correlated.Conclusion. The course of fear, pain and concentrations of stress hormones differed, highly influenced by the administration of EDA. Fear and pain correlated more pronounced than stress hormones and fear, pain and duration of labor.
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6. |
- Alehagen, Siw, et al.
(author)
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Fear, pain and stress hormones during labor and delivery
- 2005
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In: Journal of Psychosomatic Obstetrics and Gynaecology. - : Informa UK Limited. - 0167-482X .- 1743-8942. ; 26:3, s. 153-165
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Journal article (peer-reviewed)abstract
- Aims: To investigate the course of fear, pain and stress hormones during labor, and the associations between fear, pain, stress hormones and duration of labor in nulliparous women with and without epidural analgesia (EDA).Method: One day during gestation weeks 37-39, urinary and salivary samples were collected to measure catecholamines and cortisol. Hourly during labor, the participants answered the Delivery Fear Scale and a pain intensity scale, and urinary and salivary samples were collected to measure stress hormones.Results: The course of fear, pain and stress hormones differed throughout labor in women with and without EDA. Pain and cortisol increased throughout labor in women without EDA. Women who received EDA had more fear, but not more pain, before the administration of the EDA than women who did not receive EDA. Pain, fear and catecholamines decreased when women received EDA, but fear and pain increased again later in labor. Fear and pain correlated, as well as levels of fear in the different phases of labor. During phase one of labor epinephrine and duration of the phase were negatively correlated.Conclusion: The course of fear, pain and concentrations of stress hormones differed, highly influenced by the administration of EDA. Fear and pain correlated more pronounced than stress hormones and fear, pain and duration of labor.
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7. |
- Alehagen, Siw, et al.
(author)
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Pre- and postpartum fear of childbirth and fear and pain during labor
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Other publication (other academic/artistic)abstract
- Aims: The aims of the present study were 1) to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during labor (phase 1: cervix dilatation 3-5 cm), and 2) to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia (EDA) during labor.Method. During gestation weeks 37-39, in 47 nulliparous women fear of childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A. Early during labor (labor phase I = cervix dilatation 3-5cm) the women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale) were measured hourly. Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery.Results. Fear of childbirth during pregnancy and in the three postpartum measures was positively related to fear during labor, phase I. Pain during phase 1 of labor was neither associated with fear of childbirth measured during late pregnancy, nor with postpartum fear. There were no differences in fear of childbirth during late pregnancy between those women who received EDA and those who did not. Postpartum fear was higher in those women who had received EDA.Conclusion. Late pregnant women who fear childbirth are prone to have a fearful delivery, as reported during the actual labor and postpartum.
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8. |
- Brohede, Sabina
(author)
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Body Dysmorphic Disorder : Capturing a prevalent but under-recognized disorder
- 2017
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Doctoral thesis (other academic/artistic)abstract
- BackgroundIndividuals with body dysmorphic disorder (BDD) are highly distressed due to defects they perceive in their physical appearance that are not noticeable to others. The condition often leads to impaired functioning in relationships, socialization, and intimacy and a decreased ability to function in work, school, or other daily activities. Although BDD seems to be relatively prevalent, it is under-recognized by people in general and by health care professionals. Individuals with BDD are secretive about their symptoms, and they usually do not recognize that they are suffering from a psychiatric disorder. Instead, in an attempt to relieve their symptoms by correcting their perceived defects, they commonly seek dermatological treatment or cosmetic surgery. However, such interventions usually do not result in any decrease in BDD symptom severity, but can rather aggravate the symptoms. Therefore, it is crucial that health care professionals recognize BDD in order to offer adequate care. Prior to the studies conducted for this thesis, there were no known data regarding the prevalence of BDD in Sweden.Main aims(i) To translate a screening questionnaire for BDD (the Body Dysmorphic Disorder Questionnaire, BDDQ) into Swedish and validate the questionnaire in a community sample. (ii) To estimate the prevalence of BDD in the general population of Swedish women and in female dermatology patients. (iii) To explore BDD patients’ experiences of living with the disorder, including their experiences of the health care system.MethodsThe BDDQ was validated using the Structured Clinical Interview for DSM-IV (SCID) as the gold standard for diagnosing BDD (Study I). The validated BDDQ was used to estimate the prevalence of BDD in a randomly selected population-based sample of Swedish women (n=2 885) (Study II) and in a consecutive sample of female dermatology patients (n=425) (Study III). In Studies II and III, the Hospital Anxiety and Depression Scale was used to assess symptoms of depression and anxiety. In Study III, quality of life was evaluated by the Dermatology Life Quality Index. BDD patients’ lived experiences were explored using a qualitative research design (Study IV). Fifteen individuals with BDD were interviewed, and the interviews were analysed using Interpretive Description.ResultsThe Swedish translation of the BDDQ displayed a sensitivity of 94%, a specidicity of 90% and a (positive) likelihood ratio of 9.4. The prevalence of women screening positive for BDD was 2.1% (95% CI 1.7–2.7) in the population-based sample of women and 4.9% (95% CI 3.2–7.4) in the dermatology patients’ sample. The positive predictive value of the BDDQ (71%) gave an estimated BDD prevalence of 1.5% (95% CI 1.1–2.0) in the female Swedish population. Women screening positive for BDD had signidicantly more symptoms of anxiety and depression compared to those screening negative for BDD in both samples. In the dermatology patients, quality of life was severely impaired in patients with positive BDD screening. The overarching concept found in Study IV was that patients with BDD felt imprisoned and were struggling to become free and to no longer feel abnormal. The participants had encountered difdiculties in accessing health care and had disappointing experiences of the health care system.ConclusionThe findings of this thesis indicate that BDD is a relatively common disorder in the Swedish female population, and that it is more prevalent in dermatology patients. BDD patients struggle to be free from a feeling of imprisonment, and in this struggle they encounter difficulties in accessing health care. Therefore, it is important to increase awareness and recognition of BDD among health care professionals to ensure that patients with BDD receive the appropriate care.
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9. |
- Brohede, Sabina, et al.
(author)
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Body dysmorphic disorder in female Swedish dermatology patients
- 2017
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In: International Journal of Dermatology. - : WILEY. - 0011-9059 .- 1365-4632. ; 56:12, s. 1387-1394
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Journal article (peer-reviewed)abstract
- BackgroundIndividuals with body dysmorphic disorder (BDD) are highly distressed and impaired owing to perceived defects in their physical appearance that are not noticeable to others. They are frequently concerned about their skin and often present to dermatologists rather than psychiatrists. However, BDD patients attending dermatology clinics may be at risk of not receiving an appropriate assessment and beneficial treatment. The aims of this study were to estimate the BDD prevalence rate among Swedish female dermatology patients and to assess the psychological condition of BDD patients compared to that of other dermatology patients. MethodsThe occurrence of BDD was estimated using the Body Dysmorphic Disorder Questionnaire (BDDQ), a validated self-report measure for BDD. Symptoms of depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI). ResultsThe prevalence rate of BDD among female Swedish dermatology patients was 4.9% (95% CI 3.2-7.4). Anxiety (HADS A11) was 4-fold more commonly reported by patients with positive BDD screening (48% vs. 11%), and depression (HADS D11) was over 10-fold more common in patients with positive BDD screening (19% vs. 1.8%) (Pamp;lt;0.001). The median DLQI score was 18 in the BDD group, compared to a score of 4 in the non-BDD group (Pamp;lt;0.001). ConclusionsOur results indicate that BDD is fairly common among female Swedish dermatology patients (4.9%) and that BDD patients have high levels of depression and anxiety and severely impaired quality of life.
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10. |
- Brohede, Sabina, et al.
(author)
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'I will be at death's door and realize that I've wasted maybe half of my life on one body part' : the experience of living with body dysmorphic disorder
- 2016
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In: International journal of psychiatry in clinical practice (Print). - : Taylor & Francis. - 1365-1501 .- 1471-1788. ; 20:3, s. 191-198
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Journal article (peer-reviewed)abstract
- Objectives: The purpose of this study was to explore the experiences of patients living with body dysmorphic disorder (BDD), including their experiences with the health care system.Methods: Fifteen individuals with BDD were interviewed, and interpretive description was used to analyse the interviews.Results: The following six themes were identified: being absorbed in time-consuming procedures, facing tension between one's own ideal and the perceived reality, becoming the disorder, being restricted in life, attempting to reduce one's problems and striving to receive care. The overarching concept derived from the themes was feeling imprisoned - struggling to become free and to no longer feel abnormal.Conclusions: Ideas of imprisonment and abnormality compose the entire experience of living with this disorder. Although the participants suffered greatly from their BDD, these patients encountered difficulties in accessing health care and had disappointing experiences during their encounters with the health care system. Therefore, it is important to increase awareness and knowledge of BDD among health care professionals to ensure that patients with BDD receive the appropriate care.
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11. |
- Brohede, Sabina, et al.
(author)
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Prevalence of body dysmorphic disorder among Swedish women: A population-based study
- 2015
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In: Comprehensive Psychiatry. - : WB Saunders. - 0010-440X .- 1532-8384. ; 58, s. 108-115
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Journal article (peer-reviewed)abstract
- Background: Body dysmorphic disorder (BDD) is characterized by a highly distressing and impairing preoccupation with nonexistent or slight defects in appearance. Patients with BDD present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in representative samples of the general population and have demonstrated that this disorder is relatively common. Our primary objective was to assess the prevalence of BDD in the Swedish population because no data are currently available. Methods: In the current cross-sectional study, 2891 randomly selected Swedish women aged 18-60 years participated. The occurrence of BDD was assessed using the Body Dysmorphic Disorder Questionnaire (BDDQ), which is a validated self-report measure derived from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for BDD. In addition, symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of BDD among Swedish women was 2.1%. The women with BDD had significantly more symptoms of depression and anxiety than the women without BDD. Depression (HADS depression score greater than= 8) and anxiety (HADS anxiety score greater than= 8) were reported by 42% and 72% of the women with BDD, respectively. Conclusions: The results of the present study indicate that BDD is relatively common among Swedish women (2.1%) and that it is associated with significant morbidity.
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12. |
- Brohede, Sabina, et al.
(author)
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Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women
- 2013
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In: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 210:2, s. 647-652
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Journal article (peer-reviewed)abstract
- Body Dysmorphic Disorder (BDD) is characterized by a distressing and impairing preoccupation with a nonexistent or slight defect in appearance. Patients with the disorder present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in the general population and have shown that the disorder is relatively common. To date, no BDD assessment instruments have been validated in the general population. Our aim was to validate a brief self-screening instrument, the Body Dysmorphic Disorder Questionnaire (BDDQ), in a female community sample. The BDDQ was translated into Swedish and filled out by 2891 women from a randomly selected community sample. The questionnaire was validated in a subsample of 88 women, using the Structured Clinical Interview for DSM-IV (SCID) together with clinical assessment as the gold standard. In the validation subsample, the BDDQ showed good concurrent validity, with a sensitivity of 94%, a specificity of 90% and a likelihood ratio of 9.4. The questionnaire can therefore be of value when screening for BDD in female populations.
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13. |
- Engman, Maria, et al.
(author)
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Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis
- 2007
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In: Journal of Sex and Marital Therapy. - : Informa UK Limited. - 0092-623X .- 1521-0715. ; 33:2, s. 171-186
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Journal article (peer-reviewed)abstract
- Fifty-three women with partial vaginismus with or without vulvar vestibulitis and 27 asymptomatic women estimated sensations of burning pain and itch at 20 standardized moments during a standardized penetration situation, including vaginal muscle contractions. Forty-three women with partial vaginismus (81.1%) reported burning pain, 23 (43.4%) itch, and 22 (41.5%) both complaints, compared to 0% of the asymptomatic women. In 17 of 22 cases, burning pain preceded the appearance of itch and in four cases the two complaints coincided. The median time from the moment when burning pain started until itch appeared was 150 seconds.
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14. |
- Engman, Maria, et al.
(author)
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Long-term coital behaviour in women treated with cognitive behaviour therapy for superficial coital pain and vaginismus
- 2010
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In: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 39:3, s. 193-202
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Journal article (peer-reviewed)abstract
- The purpose of the present study was to investigate long-term coital behaviour in women treated with cognitive behaviour therapy (CBT) for superficial coital pain and vaginismus. Data were taken from a questionnaire concerning long-term coital behaviour sent to 59 women who presented to Linköping University Hospital because of superficial coital pain, had been diagnosed with vaginismus, and had been treated with CBT. Data were also traced from therapy records: mean follow-up time was 39 months, the women had suffered for an average of almost 4 years, and required a mean of 14 treatment sessions. Forty-four of the 59 women returned the questionnaire, for a response rate of 74.6%. At follow-up, 81% of the treated women had had intercourse. A majority (61%) rated their ability to have intercourse without pain as 6 or higher (on a scale from 0-10), and 61% rated their ability to enjoy intercourse as 6 or higher (on a scale from 0-10). The proportion of women with positive treatment outcome at follow-up ranged from 81% (able to have intercourse) to 6% (able to have pain-free intercourse). An ability to have intercourse at end of therapy was maintained at follow-up. Two-thirds of the women reported high fulfillment of individual treatment goals. At follow-up, the women estimated a significantly higher self-worth as sex partners, and as women and human beings, than before treatment. Twelve per cent of the original sample had healed after a few assessment sessions and without treatment.
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15. |
- Engman, Maria, et al.
(author)
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Postcoital burning pain and pain at micturition : early symptoms in women with partial vaginismus with or without vulvar vestibulitis?
- 2008
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In: Journal of Sex and Marital Therapy. - : Informa UK Limited. - 0092-623X .- 1521-0715. ; 34:5, s. 413-428
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Journal article (peer-reviewed)abstract
- Twenty-four women with partial vaginismus with or without vulvar vestibulitis participated in a semi-structured telephone interview concerning early signs and development of their pain symptoms during/after intercourse. At the onset of the problem, pain after intercourse was more common than pain during penetration. Pain intensity during penetration increased from the onset of the problem to when the women ceased having intercourse. Pain during penetration lasted for 1 minute, and was most often described as sharp/incisive/bursting, while pain after intercourse had a duration of 2 hours and was described as burning and/or smarting. Post-coital pain during micturition was described by 70% of the women.
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16. |
- Nieminen, Katri, 1965-
(author)
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Clinical aspects of childbirth-related anxiety
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Background: Although giving birth is a positive experience for many, some 10% of pregnant Swedish women suffer from severe fear of childbirth (FOC), which impairs their daily functioning and poses a risk for a negative delivery experience. This thesis focuses on the mental and health-economic effects of severe FOC, and explores new treatment options for childbirth-related anxiety.Aims: (i) to investigate the prevalence of and variables associated with severe FOC, (ii) to estimate the cost of illness of severe FOC and (iii) to explore whether Internetbased cognitive behaviour therapy (ICBT) is feasible for treating pregnant women with severe FOC and those with childbirth-related symptoms of posttraumatic stress disorder (PTSD).Design and Results: Study 1: In a cross-sectional study 1635 pregnant women were asked about their FOC via the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), and provided socio-demographic data and information of their preferred mode of delivery. It was found that 15.6% of the participants had a severe FOC, which also strongly correlated with the preference of a caesarean section. Study 2: In a prospective case-control cohort study we mapped all visits, in-patient care, sick leave and delivery variables from medical records and estimated the societal costs in two groups of women; one group with severe FOC and one with low FOC. The costs for the group with severe FOC were 38% higher than for the low FOC group. Study 3: Twenty-eight nulliparous women with severe FOC were self-recruited to an eight weeks ICBT program for severe FOC. Fifteen women followed the entire program. Their FOC decreased significantly after treatment (Cohen’s d=0.95, p<0.0001), which means that ICBT is feasible and an option for treating women with severe FOC. Study 4: Fifteen participants in Study 3 wrote narratives of the imminent delivery before as well as after therapy. After treatment, the women had a more realistic attitude towards childbirth, more self-confidence and more active coping strategies. Partners and staff were perceived as more helpful, and the women were more aware of the child they were bearing. Study 5: Fifty-six women with a traumatic delivery experience were included in a randomized wait-list controlled study (RCT) of the effects of an eight week long ICBT program for childbirth-related PTSD symptoms. These symptoms decreased in both groups during active therapy, while the between-group effect size varied depending on measurements. Psychiatric comorbidity decreased in both groups after active treatment.Conclusion: Severe FOC is prevalent among Swedish pregnant women, and the cost of illness of this marker of peripartum psychological vulnerability is considerable when treated using standard care. A new treatment option for this group with ICBT seems feasible and is associated with more realistic attitudes towards the imminent delivery. An RCT with eight weeks of ICBT for parous women with PTSD symptoms also had promising results.As severe FOC is prevalent and associated with mental and economic burdens for the individual and the society, there is an urgent need to expand the research field. It is important to find feasible and effective treatments that can be applied on a large scale.
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17. |
- Nieminen, Katri, et al.
(author)
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Nulliparous pregnant womens narratives of imminent childbirth before and after internet-based cognitive behavioural therapy for severe fear of childbirth: a qualitative study
- 2015
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In: British Journal of Obstetrics and Gynecology. - : Wiley: 12 months. - 1470-0328 .- 1471-0528. ; 122:9, s. 1259-1265
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Journal article (peer-reviewed)abstract
- ObjectiveTo describe the expectations concerning imminent childbirth before and after 8weeks of internet-based cognitive behavioural therapy (ICBT) among nulliparous pregnant women with severe fear of childbirth. DesignQualitative study of nulliparous pregnant womens narratives before and after CBT. SettingThe first ICBT programme for treating severe fear of childbirth. SampleFifteen nulliparous pregnant Swedish women with severe fear of childbirth participating in an ICBT self-help programme. MethodsSemi-structured open-ended questions over the internet before and after 8weeks of ICBT. The data were analysed using thematic analysis. Main outcome measuresThe participants narratives pertaining to five different situations during labour and delivery before and after ICBT. ResultsAfter therapy, participants described a more realistic attitude towards imminent childbirth, more self-confidence and more active coping strategies. They perceived their partners and the staff as more supportive. They were more aware of the approaching meeting with their baby when giving birth. ConclusionsFollowing the ICBT programme, participants changed their attitude towards imminent childbirth from negative to more positive. This was manifested in positive and more realistic expectations regarding themselves, their partner and the staff that would look after them.
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18. |
- Nieminen, Katri, et al.
(author)
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Severe fear of childbirth indicates high perinatal costs for Swedish women giving birth to their first child.
- 2017
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In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 96:4, s. 438-446
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Journal article (peer-reviewed)abstract
- INTRODUCTION: The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC.MATERIAL AND METHODS: In a prospective case-control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared.RESULTS: When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC.CONCLUSION: Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual.
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19. |
- Nieminen, Katri, et al.
(author)
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Treatment of nulliparous women with severe fear of childbirth via the Internet : a feasibility study
- 2016
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In: Journal of Psychosomatic Obstetrics and Gynaecology. - : Taylor & Francis. - 0167-482X .- 1743-8942. ; 37:2, s. 37-43
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Journal article (peer-reviewed)abstract
- Objective: The aim of the present study was to test the feasibility of Internet interventions among nulliparous women suffering from severe fear of childbirth (FOC) by means of an Internet-delivered therapist-supported self-help program based on cognitive behavioral therapy (ICBT).Design: Prospective, longitudinal cohort study.Setting: A feasibility study of an ICBT program for the treatment of severe FOC in pregnant women.Sample: Twenty-eight Swedish-speaking nulliparous women with severe FOC recruited via a project home page from January 2012 to December 2013.Methods: The main components of the ICBT program for the treatment of severe FOC comprised psycho-education, breathing retraining, cognitive restructuring, imaginary exposure, in vivo exposure and relapse prevention. The study participants were anonymously self-recruited over the Internet, interviewed by telephone and then enrolled. All participants were offered 8 weeks of treatment via the Internet. Participants reported their homework weekly, submitted measurements of their fear and received feedback from a therapist via a secure online contact management system.Main outcome measures: Level of FOC measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) during screening at enrollment and weekly during the treatment (W-DEQ version A), and after the delivery (W-DEQ version B).Results: A statistically significant (pâ<â0.0005) decrease of FOC [W-DEQ sum score decreased pre to post-therapy, with a large effect size (Cohenâs dâ=â0.95)].Conclusions: The results of this feasibility study suggest that ICBT has potential in the treatment of severe FOC during pregnancy in motivated nulliparous women. The results need to be confirmed by randomized controlled studies.
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20. |
- Ryding, E.L., et al.
(author)
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Emergency cesarean section : 25 Women's experiences
- 2000
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In: Journal of Reproductive and Infant Psychology. - : Informa UK Limited. - 0264-6838 .- 1469-672X. ; 18:1, s. 33-39
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Journal article (peer-reviewed)abstract
- The purpose of this study was to investigate the possibility to categorize women's experiences of emergency cesarean section based on the patterns displayed in their narration of the event, and to describe, if possible, typical features of those categories. Twenty-five consecutive women were interviewed a few days and 1-2 months after emergency cesarean section. The narratives of the women were recorded according to a time-spatial model from disaster psychiatry. The occurrence of a traumatic delivery experience and of posttraumatic intrusive stress reactions 6 weeks postpartum in the various categories was assessed. The narratives of the 25 women can be categorized as follows: Pattern 1 - confidence whatever happens (n = 5), Pattern 2 - positive expectations turning into disappointment (n = 7), Pattern 3 - fears that come true (n = 9), and Pattern 4 - confusion and amnesia (n = 4). In the second and third groups all women had experienced the delivery as traumatic. The women in the second group had the highest prevalence of posttraumatic intrusive stress reactions 6 weeks after the emergency cesarean section.
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21. |
- Samelius, Charlotta, 1964-
(author)
-
Abused Women : Health, Somatization, and Posttraumatic Stress
- 2007
-
Doctoral thesis (other academic/artistic)abstract
- The aims of this thesis were to estimate the lifetime prevalence of physical, sexual, and psychological abuse in a random population-based sample of women aged 18-60 years; to estimate current suffering thereof; and to investigate associations between abuse and health problems, more specifically to study abuse related variables associated with somatization and PTSD, respectively.The studies had a cross-sectional design. Studies I and II comprised 4150 women 18-60 years. Study III included 547 women, and study IV consisted of 213 women, randomly selected from the population-based sample of the first two studies.The first study found lifetime prevalence rates of 19.4% for physical abuse, 9.2% for sexual abuse, and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Even a low magnitude of abuse was substantially associated with ill-health. In the second study we found that of the 27.5% of women who had reported any kind of abuse in the first study, 69.5 % reported current suffering thereof. Abused suffering women reported more health problems than abused non-suffering women and non-abused women, and abused non-suffering women reported more health problems than non-abused women. In study three, psychological abuse and sexual abuse without penetration were found to be associated with somatization. Physical abuse and sexual abuse with penetration were not associated with somatization, when adjustments for other kinds of abuse were made. In study four, PTSD and somatization were found to be separately reported phenomena in abused women, although PTSD was positively associated with having somatic symptoms. Women with PTSD reported higher total magnitude of abuse and a higher number of perpetrators than women with somatization. Sexually abused women with PTSD more often described their experience as an act of abuse compared with sexually abused women with somatization.The present thesis demonstrates that even a low magnitude of abuse is associated with health problems. It also shows that a majority of the abused women, when investigating lifetime history of abuse, reported current suffering thereof, which warrants considering abuse an important societal problem. The relationship between somatization and posttraumatic stress in abused women is discussed in relation to abuse variables. Other factors than severity of abuse, such as whether the abused woman herself perceives her experience as abuse, seem to be more decisive for development of somatization in abused women. The findings suggest that PTSD is not a necessary mediator between abuse and somatization.
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22. |
- Samelius, Charlotta, et al.
(author)
-
Lifetime history of abuse, suffering, and psychological health
- 2010
-
In: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 64:4, s. 227-232
-
Journal article (peer-reviewed)abstract
- Background: In a representative Swedish sample, we investigated lifetime prevalence of physical, sexual and psychological abuse of women and their current suffering. The relationship between current suffering from abuse and psychological health problems was also studied. Method: The study was cross-sectional and population-based. The Abuse Screening Inventory (ASI), measuring experiences of physical, sexual and psychological abuse and including questions on health and social situation, was sent by mail to 6000 women, randomly selected from the population register. The questionnaire was completed and returned by 4150 (70%) of 5896 eligible women. Results: 27.5% of the women reported abuse of any kind. Of those, 69.5% reported current suffering from abuse. Abused suffering women reported more anxiety, depression and sleep disturbances, and a less advantageous social situation than both non-abused and abused non-suffering women. Also, abused non-suffering women reported more depression than non-abused women. Somatization was reported more often by both abused suffering and non-suffering women than by non-abused women, with no difference between suffering and non-suffering women when adjusted for possible confounders. Conclusion: A majority of abused women, when investigating lifetime history of abuse, report current suffering thereof, which warrants considering abuse an important societal problem. Suffering could be a valuable construct, possibly useful to assess psychological health problems normally not captured by existing diagnostic instruments, although further investigations of the concept are needed.
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23. |
- Samelius, Charlotta, et al.
(author)
-
Post-traumatic stress and somatization in abused women
- 2009
-
In: Traumatology. - : Sage Publications. - 1534-7656 .- 1085-9373. ; 15:1, s. 103-112
-
Journal article (peer-reviewed)abstract
- This study examines the relationship between posttraumatic stressdisorder (PTSD) and somatization in abused women; 213 abusedwomen were assessed for PTSD, somatization, health care contacts,and abuse-related variables. The main analyses in this exploratorystudy are based on the 91 respondents reporting either PTSDor somatization. We found no association between the occurrenceof PTSD and somatization in abused women. Women with PTSD reportedhigher total magnitude of abuse and a larger number of perpetratorsthan women with somatization. Sexually abused women with PTSDmore often described their experience as an act of abuse comparedwith sexually abused women with somatization. Results suggestthat PTSD might not be a necessary mediator between abuse andsomatization and that variables other than abuse magnitude aredecisive for the development of somatization in abused women.
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24. |
- Siwe, Karin, et al.
(author)
-
Medical students learning the pelvic examination : Comparison of outcome in terms of skills between a professional patient and a clinical patient model
- 2007
-
In: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 68:3, s. 211-217
-
Journal article (peer-reviewed)abstract
- Objective: To compare two models of learning the pelvic examination (PE) for medical students, with professional patients (PP) or with clinical patients (CP), by measuring perceived distress and learning outcome in terms of skills. Methods: Prospective longitudinal study. Assessments of self-perceived distress on four occasions at the prospect of performing a PE. Evaluation of the learning session (LS) and clinical clerkship concerning outcome of palpation skills. Results: During the LS, students in the PP model (PP students) received enough guidance from their coaches, were certain they had palpated the uterus and at least one ovary, and were less distressed afterwards compared with students who were instructed using the CP model (CP students). During the clinical clerkship, the PP students performed twice as many PEs as CP students did and had more often confirmed palpating the uterus and an ovary. Conclusion: PP students were more skilful in palpating the uterus and ovaries and performed more PEs during the clinical clerkship than did CP students. Practice implications: Engaging healthy and voluntary women as PPs takes time and effort. It is, however, worthwhile as it increases the confidence of students who perform PEs, makes them more competent, and ultimately improves their skills in performing the examination during their clinical clerkship.
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25. |
- Sluijs, Anne-Marie, et al.
(author)
-
Is fear of childbirth related to the womans preferred location for giving birth? A Dutch low-risk cohort study
- 2020
-
In: Birth. - : WILEY. - 0730-7659 .- 1523-536X. ; 47:1, s. 144-152
-
Journal article (peer-reviewed)abstract
- Background In The Netherlands, women with low-risk pregnancy are routinely given the option of home birth, providing a unique opportunity to study the relationship between fear of childbirth (FOC) and preference for childbirth location, and whether women experience higher FOC when the actual location differs from their preference. Methods In this prospective cohort study, 331 nulliparous and parous women completed a questionnaire at gestational week 30 (T1) and two months postpartum (T2). FOC was assessed using versions A (T1) and B (T2) of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Results At T1, women who preferred home birth had significantly lower FOC compared with women who preferred a hospital birth (mean +/- SD W-DEQ scores: 55 +/- 19.8 and 64 +/- 18.3, respectively, P amp;lt; .01). About 28% of women who responded at T2 gave birth at home. Congruence between the preferred and actual childbirth location was not predictive of FOC assessed at T2 when adjusted for obstetric and psychological variables. In an extended analysis, we found that except for prepartum FOC, the following variables also correlated with postpartum FOC: being referred because of complications and poor neonatal condition. Conclusions Compared to women who prefer hospital birth, women who prefer home birth have lower prepartum and postpartum FOC. Giving birth at a location other than the preferred location does not appear to affect postpartum FOC. Whether giving birth at home or in the hospital, caregivers should pay extra attention to women with high FOC because they are vulnerable to postpartum FOC, especially after a complicated birth and referral.
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26. |
- Sluijs, Anne-Marie, et al.
(author)
-
Preferred and actual mode of delivery in relation to fear of childbirth
- 2020
-
In: Journal of Psychosomatic Obstetrics and Gynaecology. - : TAYLOR & FRANCIS LTD. - 0167-482X .- 1743-8942. ; 41:4, s. 266-274
-
Journal article (peer-reviewed)abstract
- Purpose: This prospective cohort study aimed to investigate the interrelation between preferred/actual mode of delivery and pre- and postpartum fear of childbirth (FOC). Material and methods: Participants from 13 midwifery practices and four hospitals in Southwest Netherlands filled out questionnaires at 30 weeks gestation (n = 561) and two months postpartum (n = 463), including questions on preferred mode of delivery, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and Hospital Anxiety Depression Scale (HADS). Results were related to obstetric data. Results: Both severe FOC (OR 7.0, p amp;lt; .001) and previous Cesarean section (CS) (OR 16.6, p amp;lt; .001) predicted preference for CS. Severe prepartum FOC also predicted actual CS. Preferring a vaginal delivery (VD) and actually having a CS predicted higher postpartum W-DEQ scores (partial r = 0.107, p amp;lt; .05). Other significant predictors for high postpartum W-DEQ scores were high prepartum W-DEQ (partial r = 0.357) and HADS anxiety scores (partial r = 0.143) and the newborn in need of medical assistance (partial r = -0.169). Conclusions: Women preferring a VD but ending up with a CS are at risk for severe FOC postpartum, while the same risk was not demonstrated for women who preferred a CS but had a VD. Prepartum FOC is strongly associated with postpartum FOC, regardless of congruence between preferred and actual mode of delivery.
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27. |
- Söderquist, Johan, et al.
(author)
-
Risk factors in pregnancy for post-traumatic stress and depression after childbirth
- 2009
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In: BJOG - An international journal of obstetrics and gynaecology. - : Wiley. - 1470-0328. ; 116:5, s. 672-680
-
Journal article (peer-reviewed)abstract
- Objective The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored.Design A prospective longitudinal study.Setting Pregnant women in Linköping and Kalmar, Sweden.Population A total of 1224 women were assessed in pregnancy, week 12–20 and 32, as well as 1 month postpartum.Methods Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records.Main outcome measures Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to DSM-IV) and depression (Beck’s depression inventory).Results One month postpartum, 12 (1.3%) women had post-traumatic stress (met symptom criteria B, C, and D for post-traumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR = 16.3), severe fear of childbirth (OR = 6.2), and ‘pre’-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR = 12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors.Conclusions Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.
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28. |
- Söderquist, Johan, 1968-, et al.
(author)
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The longitudinal course of post-traumatic stress after childbirth
- 2006
-
In: Journal of Psychosomatic Obstetrics and Gynaecology. - : Informa UK Limited. - 0167-482X .- 1743-8942. ; 27:2, s. 113-119
-
Journal article (peer-reviewed)abstract
- Post-traumatic stress was assessed in early and late pregnancy, and 1, 4, 7, and 11 months postpartum by means of questionnaires among 1224 women. Thirty-seven women (3%) had post-traumatic stress (meeting criteria B, C, and D for PTSD) at least once within 1–11 months postpartum. In pregnancy, depression, severe fear of childbirth, ‘pre’-traumatic stress, previous counseling related to pregnancy/childbirth, and self-reported previous psychological problems were associated with an increased risk of having post-traumatic stress within 1–11 months postpartum. Sum-scores of post-traumatic stress did not decrease over time among women who at least once had post-traumatic stress (criteria B, C, and D) within 1–11 months postpartum. Women with post-traumatic stress also showed a decrease in perceived social support over time postpartum.
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29. |
- Söderquist, Johan, 1968-, et al.
(author)
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Traumatic stress after childbirth : the role of obstetric variables
- 2002
-
In: Journal of Psychosomatic Obstetrics and Gynaecology. - : Informa UK Limited. - 0167-482X .- 1743-8942. ; 23:1, s. 31-39
-
Journal article (peer-reviewed)abstract
- In a sample of 1550 recently delivered women, traumatic stress after childbirth was studied in relation to obstetric variables.A post-traumatic stress disorder (PTSD) symptom profile and traumatic stress symptoms were assessed by means of the Traumatic Event Scale (TES) Obstetric data comprised delivery mode, duration of the second stage of labor (the time from cervical dilation of 10 cm to partus) and the use of analgesia/anesthesia.Traumatic stress symptoms and having a PTSD symptom profile were both significantly related to the experience of an emergency cesarean section or an instrumental vaginal delivery It is of clinical importance, however that most women with a PTSD symptom profile were found in the normal vaginal delivery group (NVD) This implies that a normal vaginal delivery can be experienced as traumatic, lust as an emergency cesarian section is not necessarily traumatic Traumatic stress symptoms were neither substantially correlated to the duration of the second stage of labor, nor to the use of analgesia/anesthesia.
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30. |
- Söderquist, Johan, et al.
(author)
-
Traumatic stress in late pregnancy
- 2004
-
In: Journal of Anxiety Disorders. - 0887-6185 .- 1873-7897. ; 18:2, s. 127-142
-
Journal article (peer-reviewed)abstract
- Traumatic stress has traditionally been studied in the aftermath of traumatic events. In contrast, this study aimed to explore if traumatic stress can occur before an event that is perceived as threatening or feared. Traumatic stress, as related to the forthcoming delivery, was studied in 1224 women. Background data and psychological characteristics were assessed in early pregnancy and traumatic stress and fear of childbirth in late pregnancy. Of all subjects, 2.3% met all DSM-IV criteria for posttraumatic stress disorder (PTSD) and 5.8% fulfilled criteria B, C, and D in late pregnancy. Traumatic stress and fear of childbirth correlated significantly. High trait anxiety, depressive symptomatology, psychological/psychiatric counseling related to childbirth, and self-reported psychological problems, measured in early pregnancy, were risk factors for traumatic stress and fear of childbirth in late pregnancy. Results suggest the occurrence of “pre”traumatic stress (i.e., a threatening forthcoming event provoking symptoms similar to those after a traumatic event).
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31. |
- Wijma, Barbro, 1944-, et al.
(author)
-
A model for critical review of literature - With vaginismus as an example
- 2007
-
In: Journal of Psychosomatic Obstetrics and Gynaecology. - : Informa UK Limited. - 0167-482X .- 1743-8942. ; 28:1, s. 21-36
-
Journal article (peer-reviewed)abstract
- In this article we present a behavioral model for the critical review of the literature within a certain research field, using vaginismus as an example. We searched the literature for the title word "vaginismus" and analyzed to what extent the articles dealt with the following seven categories: prevention, etiology, maintaining factors, consequences, object of intervention, method of intervention, and method of evaluation. In each category we scrutinized the content of the articles for biological, psychological, social, relational, and gender aspects. Quality requirements of etiological and treatment studies were then added and the results presented in a "quality-adjusted" model. There were 102 articles during 1985-2001, of which 22 were included in the review. Most of the articles deal with supposed predisposing factors of etiology and different aspects of intervention. Only a few articles discuss precipitating factors, maintaining factors, or consequences of the problem. No article had a gender analysis. Only 11 of the articles fulfilled some of the proposed quality criteria. We found the behavioral model with quality requirements useful for classifying and evaluating the literature of vaginismus. The model may also be used as a guide to design methodologically good studies. © 2007 Informa UK Ltd.
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32. |
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33. |
- Wijma, Barbro, et al.
(author)
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Kronisk bäckensmärta
- 2004
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In: Öppenvårdsgynekologi. - Stockholm : Liber. - 9147050799 - 9789147050796 ; , s. 268-280
-
Book chapter (peer-reviewed)abstract
- Öppenvårdsgynekologi är en lärobok som riktar sig främst till läkarstuderande och allmänmedicinare. Vanliga åkommor och problem belyses och boken försöker att ge aktuella behandlingsråd och riktlinjer som går att tillämpa i det dagliga sjukvårdsarbetet. Den är därför en värdefull kunskapskälla även för gynekologer, distriktssjuksköterskor och barnmorskor. I denna andra upplaga har ett helt nyskrivet kapitel tillkommit som behandlar ultraljud inom gynekologin. Boken har försetts med en ny layout, delvis nya illustrationer och med mjuka pärmar för att göra boken mer lättillgänglig och användarvänlig i det dagliga arbetet.
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34. |
- Wijma, Barbro, 1944-, et al.
(author)
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Total och partiell vaginism
- 2003
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In: Vulvasjukdomar. - Stockholm : Svensk Förening för Obstetrik och Gynekologi (SFOG). ; , s. 59-62
-
Book chapter (other academic/artistic)
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35. |
- Wijma, Klaas, 1946-, et al.
(author)
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Development of the delivery fear scale
- 2002
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In: Journal of Psychosomatic Obstetrics and Gynaecology. - : Informa UK Limited. - 0167-482X .- 1743-8942. ; 23:2, s. 97-107
-
Journal article (peer-reviewed)abstract
- This article reviews the development of the Delivery Fear Scale (DFS) to measure fear during labor and delivery.In an initial study, 92 women in labor answered a list of 60 items, expressing fear-related appraisals and their contrasts that were characteristic of women in labor. Ten items were then selected by means of an item-total analysis. In a second study, the final list of ten items was tested psychometrically and a semi-structured interview was performed on 45 women in labor, to explore the women s descriptions of the content of each of the ten items. According to the content analysis of the interviews, the dominating connotation of the ten items is fear based on the appraisal of being captured. The studies show that the DFS is a questionnaire that almost effortlessly can be completed within 60-90 seconds during any moment of labor and delivery. The scale has a good reliability: Cronbach‘s alpha was 0.88 in both studies.
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36. |
- Wijma, Klaas, et al.
(author)
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Posttraumatic stress disorder after childbirth : a cross sectional study
- 1997
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In: Journal of Anxiety Disorders. - 0887-6185 .- 1873-7897. ; 11:6, s. 587-597
-
Journal article (peer-reviewed)abstract
- The prevalence of having a posttraumatic stress disorder (PTSD) profile after childbirth and women's cognitive appraisal of the childbirth were studied cross sectionally in an unselected sample of all women who had given birth over a 1-year period in Linköping, Sweden. The PTSD profile was assessed by means of Traumatic Event Scale (TES), which is based on diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994). The women's cognitive appraisal of the childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Twenty-eight women (1.7%) of 1640 met criteria for a PTSD profile related to the recent delivery. A PTSD profile was related to a history of having received psychiatric/psychological counseling, a negative cognitive appraisal of the past delivery, mulliparity, and rating the contact with delivery staff in negative terms.
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37. |
- Wijma, Klaas, et al.
(author)
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Predicting psychological well-being after emergency caesarean section : A preliminary study
- 2002
-
In: Journal of Reproductive and Infant Psychology. - : Informa UK Limited. - 0264-6838 .- 1469-672X. ; 20:1, s. 25-36
-
Journal article (peer-reviewed)abstract
- The experience of emergency caesarean section (EmCS) is traumatic for many women. Up to now, a possible relationship between psychological variables before and after EmCS has not been studied. Therefore, the present study was designed, to examine whether the women's psychological condition during pregnancy correlates with their psychological well-being after EmCS. Questionnaires were administered in gestation week 32, a few days and one month after EmCS. A consecutive sample of pregnant women (N = 1981) completed questionnaires (the predictors) at Time 1. Predictors were operationalized by means of the Wijma-Delivery Expectancy/Experience Questionnaire (W-DEQ vers. A), the Spielberger Trait Anxiety Inventory (STAI) and the Stress Coping Inventory (SCI). Of those women who had an EmCS (N = 97), a selection (N = 40) completed questionnaires (the criterion variables) at Times 2 and 3. The criterion variables were operationalized by means of the W-DEQ vers. B, the Impact of Event Scale (IES), and the Symptom Checklist (SCL). Fear of childbirth (W-DEQ vers. A) was the best overall predictor of the three criterion variables, whereas general anxiety (STAI) was the best predictor of mental distress (SCL) after EmCS. In conclusion, according to the results of this study, particularly fear of childbirth during late pregnancy, but also general anxiety, is associated with mental distress after a subsequent EmCS. Maternal follow-up after a complicated delivery should perhaps be directed especially to women with a history of serious fear of childbirth and/or other anxiety difficulties during gestation.
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38. |
- Wijma, Klaas, 1946-, et al.
(author)
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Prevalence of post-traumatic stress disorder among gynecological patients with a history of sexual and physical abuse
- 2000
-
In: Journal of Interpersonal Violence. - 0886-2605 .- 1552-6518. ; 15:9, s. 944-958
-
Journal article (peer-reviewed)abstract
- All patients who visited the Department of Obstetrics and Gynaecology of Link÷ping, Sweden over a 2-week period were sent a questionnaire about experiences of sexual/physical abuse and the Traumatic Event Scale, assessing post-traumatic stress disorder (PTSD). Of 649 patients, 26.3% showed a history of sexual or physical abuse in childhood or adulthood. Childhood and adulthood sexual abuse were experienced by 11.6% and 6.5%, respectively, childhood and adulthood physical abuse by 16.9% and 7.9%, respectively. Twenty-nine of all participants (4.5%) met PTSD criteria, according to the Diagnostic and Statistical Manual. PTSD was associated with multiple experiences of abuse. The frequency of PTSD symptoms was positively related to the amount and recency of abuse. PTSD participants reported more visits to a physician than abused non-PTSD and nonabused participants. The PTSD group reported less satisfaction than the other two groups with (a) contact with the physician and (b) the help received during visits to the clinic.
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39. |
- Wijma, Klaas, et al.
(author)
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The association between ill-health and abuse: a cross-sectional population-based study
- 2007
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In: Scandinavian Journal of Psychology. - : Wiley-Blackwell. - 0036-5564 .- 1467-9450. ; 48:6, s. 567-575
-
Journal article (peer-reviewed)abstract
- The lifetime prevalence of physical, sexual and psychological abuse was studied cross-sectionally in a representative sample of Swedish women. The association between the three kinds of abuse and ill-health, and the relation between magnitude of abuse and various health problems were also investigated. The Abuse Screening Inventory (ASI), measuring experiences of physical, sexual and psychological abuse and including questions on health and social situation, was sent by mail to 6,000 women, randomly selected from the population register. The questionnaire was completed and returned by 4,150 (70%) of 5,896 eligible women. Various kinds of abuse were reported by 1,142 women (27.5%). The prevalence rates were 19.4% for physical abuse, 9.2% for sexual abuse and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Also a low magnitude of abuse was substantially associated with ill-health.
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40. |
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41. |
- Zar, M, et al.
(author)
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Relations between anxiety disorders and fear of childbirth during late pregnancy
- 2002
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In: Clinical Psychology and Psychotherapy. - : Wiley. - 1063-3995 .- 1099-0879. ; 9:2, s. 122-130
-
Journal article (peer-reviewed)abstract
- In a group of late pregnant women we investigated the prevalence of extreme fear of childbirth and anxiety disorders, both assessed by means of diagnostic interviews. We also explored the relation between anxiety disorders and extreme fear of childbirth on the one hand and fear of childbirth, as measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), on the other hand. A subgroup of women (2.4%) fulfilled the criteria for a phobia-like fear of childbirth. Anxiety disorders were related to fear of childbirth, as measured by the W-DEQ. The group of women with extreme fear of childbirth (with or without anxiety disorders) had obviously the highest W-DEQ scores. But also in the group of women with anxiety disorders only the W-DEQ scores were high. Clinical assessment of anxiety disorders among pregnant women should be considered, above all in women who report fear of the anticipated delivery. Copyright ⌐ 2002 John Wiley & Sons, Ltd.
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42. |
- Adolfsson, Annsofie, et al.
(author)
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Guilt and emptiness : women's experiences of miscarriage
- 2004
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In: Health Care for Women International. - : Informa UK Limited. - 0739-9332 .- 1096-4665. ; 25:6, s. 543-560
-
Journal article (peer-reviewed)abstract
- Women who lose an early pregnancy are shocked when they are first given the information that they have miscarried. Later they feel guilt and emptiness. Heideggerian interpretive phenomenology has been used with 13 women from southwest Sweden to uncover their lived experience of miscarriage. Women plan their future with a child during early pregnancy. When miscarriage occurs it is not a gore, an embryo, or a fetus they lose, it is their child. They feel that they are the cause of the miscarriage through something they have done, eaten, or thought. They feel abandonment and they grieve for their profound loss; they are actually in bereavement.
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43. |
- Blomberg, Karin, 1970-
(author)
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Från inbjudan till uppföljning : kvinnors erfarenheter av att delta eller inte delta i cervixcancerscreening
- 2009
-
Doctoral thesis (other academic/artistic)abstract
- Population-based cervical cancer screening programs (PCCSPs) were introduced in Stockholm in the 1960s; today all women residents aged 23-60 are invited to a cost-free Pap smear at regular intervals. A shift in scientific knowledge has occurred, with clarification of the link between human papilloma virus (HPV) and cervical cancer (CC), and the introduction of HPV-vaccines for primary prevention of CC. While there is a large body of research on CC screening, fewer studies address screening experiences of women in different phases of life with different screening histories. The aim of this thesis was to explore how women reason about CC, its causes, prevention and participation in CC screening. Method: These studies were guided by the inductive approach interpretive description . Sub-study I is based on qualitative analysis of 12 telephone interviews and 86 fax messages sent to the screening organisation by women who actively chose not to participate in PCCSP. Sub-study II is based on longitudinal interview data from 30 women, who underwent medical follow-up of an abnormal Pap smear. Sub-studies III and IV are based on data from 30-year old women with varied screening background and experiences, derived from 9 face-to-face focus group discussions (FGD) (sub-studies III, IV) and 30 internet-based FGDs (sub-study IV). Results: Women s ways of conceptualizing health, illness, and risk for disease in general impacted on their decision-making about attending PCCSP. Matters related to sickness, including CC and its prevention, were generally described as distant and unprioritized by many women. The manner 30-year old women self-defined themselves in the transition between youth and adulthood appears to strongly influence their reasoning not only about PCCSP, but also about other forms of health maintenance and disease prevention. How women defined and conceptualized distinctions between, and roles and responsibilities of, the private and the public was also found to be central in explanations of decision-making, especially among women who actively chose not to take a Pap smear. Women described a wide range of factors which could motivate them to participate in PCCSP, related to all aspects of the program, from invitation through follow-up, and a need for different types and forms of information. Many suggestions were related to individualization of the PCCSP; a need to understand the relationship between HPV and CC also was addressed. We also found that medical follow-up of an abnormal Pap smear involved an experience of both having and being a body, which changed over time. The conceptualization of bodily boundaries appeared to change, e.g. through vaginal discharges and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Conclusion: All facets of the PCCSP and social marketing were found to influence women s experiences of and decisions about screening attendance. Women s views of the PCCSP as a comprehensive system suggest a need for increased collaboration among the many professionals with direct and indirect involvement in the PCCSP. These studies suggest that coordination with and information about PCCSP is an important implication for when initiating HPV vaccination programs, as a means of aiding women in integration of different types of knowledge and information.
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44. |
- Brüggemann, Adrianus Jelmer, 1981-, et al.
(author)
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Abuse in health care : a concept analysis
- 2012
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 26:1, s. 123-132
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Journal article (peer-reviewed)abstract
- Aims and objectives: To analyse the concept of abuse in health care. This analysis also covers how abuse in health care is different from the related concepts of medical error, patient satisfaction and personal identity threat.Background: Abuse in health care is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated.Design: Concept analysis as developed by Walker and Avant.Method: The databases Cumulative Index to Nursing and Allied Health Literature, Medline, and Google Scholar were used to obtain articles published between 1997 and 2009. A total of eleven articles are referred to on abuse in health care, four on medical error, six on patient satisfaction and three on personal identity threat.Results: Abuse in health care is defined by patients’ subjective experiences of encounters with the health care system, characterized by devoid of care, where patients suffer and feel they lose their value as human beings. The events are most often unintended. We also found differences with the aforementioned related concepts: medical error does not share the patients’ perspective, and patient satisfaction does not offer room for patients’ abusive experiences. The concept of personal identity threat shares all attributes with abuse in health care, but it lacks an antecedent that signifies the social structures underlying the phenomenon.Conclusions: Abuse in health care covers a phenomenon that has severe consequences but is invisible if seen from a medical error or patient satisfaction perspective.
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45. |
- Brüggemann, Adrianus Jelmer, 1981-, et al.
(author)
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Bystander passivity in health care and school settings : Moral disengagement, moral distress, and opportunities for moral education
- 2019
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In: Journal of Moral Education. - : Routledge. - 0305-7240 .- 1465-3877. ; 48:2, s. 199-213
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Journal article (peer-reviewed)abstract
- Bystander passivity has received increased attention in the prevention of interpersonal harm, but it is poorly understood in many settings. In this article we explore bystander passivity in three settings based on existing literature: patient abuse in health care; bullying among schoolchildren; and oppressive treatment of students by teachers. Throughout the article we develop a theoretical approach that connects Obermann's unconcerned and guiltybystanders to theories of moral disengagement and moral distress respectively. Despite differences between the three settings, we show striking similarities between processes of disengagement, indicators of distress, and the constraints for intervention that bystanders identify. In relation to this, we discuss moral educational efforts that aim to strengthen bystanders’ moral agency in health care and school settings. Many efforts emphasize shared problem descriptions and collective responsibilities. As challenging as such efforts may be, there can be much to gain in terms of welfare and justice.
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46. |
- Brüggemann, A. Jelmer
(author)
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Toward an Understanding of Abuse in Health Care : A Female Patient Perspective
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Background. High numbers of incidents of abuse in health care (AHC) have been reported by patients in Sweden. In questionnaire studies (n=9600), every fifth Swedish woman and every tenth Swedish man reported any lifetime experience of AHC, and a majority reported suffering from their experiences. Female patients with experiences of AHC described them as experiences of being nullified, and male patients as experiences of being mentally pinioned. Little is known about why AHC occurs and how it can prevail in a health care system that aims to relieve patients’ suffering.Aim. The overall aim of the thesis was to bring understanding to what AHC is and to start exploring what contributes to its occurrence, focusing on a female patient perspective.Methods. In study I, a concept analysis of AHC was conducted based on the concept’s appearance in scientific literature and through case studies. Also, AHC was demarcated against the related concepts patient dissatisfaction, medical error, and personal identity threat, in order to analyze differences and similarities with these concepts. For studies II and III the Transgressions of Ethical Principles in Health Care Questionnaire (TEP) was developed to measure to what extent female patients remain silent toward the health care system after having experienced abusive or wrongful ethical transgressions in the Swedish health care system. It was hypothesized that to a high degree female patients remain silent toward the health care system after such experiences, and this lack of feedback may in turn contribute to the hampering of structural change toward better encounters. The questionnaire was answered by female patients recruited at a women’s clinic in the south of Sweden (n=530). Study IV built on a constructed grounded theory design and included informants who reported experiences of AHC in TEP (n=12). The interviews focused on the informants’ stories of what contributed to their experiences of AHC.Results.Results. Based on the concept analysis, AHC was described as patients’ subjective experiences in health care of encounters devoid of care, in which they experienced suffering and loss of their human value. Study II showed that a majority of the female patients who perceived one or more transgressions as abusive or wrongful remained silent about at least one of them (70.3%). In 60% of all cases, patients remained silent about abusive or wrongful events. In study III it was examined whether patients remaining silent could be associated with any patient characteristics. Remaining silent was only found to be associated with younger age and a lower self-rated knowledge of patient rights. In study IV, female patients’ stories of what contributed to their experiences of AHC were analyzed. This was best characterized as a process where the patient loses power struggles. According to these patients, not only their vulnerability, but also their level of competence contributed to staff’s unintended use of domination techniques by which they felt abused.Conclusions. As AHC is defined from patients’ subjective experiences it is necessary for the prevention of AHC to listen to patients’ stories and complaints. The prevalence of female patients’ silence after abusive events could be worrying, as it constitutes a loss of essential feedback for the health care system. Patients do not bear responsibility for the quality of health care processes, but their knowledge may be very valuable for structural improvement of these processes and could be valued as such. Clinical interventions that stimulate these patients to speak up, accompanied by health care staff’s reflections on how to respond to patients speaking up, must therefore be explored.
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47. |
- Brüggemann, Jelmer, et al.
(author)
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A first online intervention to increase patients’ perceived ability to act in situations of abuse in health care : reports of a Swedish pre-post study
- 2015
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In: BMC Medical Ethics. - : Springer Science and Business Media LLC. - 1472-6939. ; 16
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Journal article (peer-reviewed)abstract
- BackgroundEfforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients’ intention and perceived ability to act in future situations where they risk experiencing abuse.MethodsParticipants were recruited through a nephrology clinic in Sweden. The intervention consisted of an online program that aimed to stimulate patients to think of possible actions in situations in which they risk experiencing abuse. The program comprised stories and exercises in text and comic form. The participants filled out a questionnaire immediately before and after going through the program, as well as during follow-up four to eight weeks later.ResultsForty-eight patients (39 %) participated in the study and spent, on average, 41 min responding to questions and going through the program. Both men and women, of various ages and educational backgrounds, participated. An increase in participants' self-reported ability to identify opportunities to act in a given situation was seen immediately afterwards, as well as during follow up.ConclusionThe current study suggests that it is feasible and most likely useful to a variety of patients to work with the provided material that has the aim of counteracting abuse in health care. It would be of interest to further develop ways of using comics and to test similar interventions in other health care settings.
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48. |
- Brüggemann, Jelmer, et al.
(author)
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Patients’ silence following healthcare staff’s ethical transgressions
- 2012
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In: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 19:6, s. 750-763
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Journal article (peer-reviewed)abstract
- The aim of this study was to examine to what extent patients remained silent to the health care system after they experienced abusive or wrongful incidents in health care. Female patients visiting a women’s clinic in Sweden (n = 530) answered the Transgressions of Ethical Principles in Health Care Questionnaire (TEP), which was constructed to measure patients’ abusive experiences in the form of staff’s transgressions of ethical principles in health care. Of all the patients, 63.6% had, at some point, experienced staff’s transgressions of ethical principles, and many perceived these events as abusive and wrongful. Of these patients, 70.3% had remained silent to the health care system about at least one transgression. This silence is a loss of essential feedback for the health care system and should not automatically be interpreted as though patients are satisfied.
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49. |
- Brüggemann, Jelmer, 1981-, et al.
(author)
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Understanding and preventing situations of abuse in health care : Navigation work in a Swedish palliative care setting
- 2019
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In: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 222, s. 52-58
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Journal article (peer-reviewed)abstract
- In their everyday work, health professionals find themselves in situations that they perceive to be abusive to patients. Such situations can trigger feelings of shame and guilt, making efforts to address the problem among colleagues a challenge. This article analyzes how health professionals conceptualize abusive situations, and how they develop collective learning and explore preventive strategies. It is based on an interactive research collaboration with a hospice and palliative care clinic in Sweden during 2016–2017. The empirical material consists of group discussions and participant observations collected during interactive drama workshops for all clinic staff. Based on three types of challenges in the material, identified through thematic analysis, we establish the concept of navigation work to show how health professionals prevent or find ways out of challenging and potentially abusive situations. First, the navigation of care landscapes shows how staff navigate the different territories of the home and the ward, reflecting how spatial settings construct the scope of care and what professionals consider to be potentially abusive situations. Second, the negotiation of collective navigations addresses the professionals' shared efforts to protect patients through the use of physical and relational boundaries, or mediating disrupted relationships. Third, the navigation of tensions in care highlights professionals’ strategies in the confined action space between coercing and neglecting patients who oppose necessary care procedures. Theoretically, the concept of navigation work draws upon work on care in practice, and sheds light on the particular kind of work care professionals do, and reflect on doing, in order to navigate the challenges of potentially abusive situations. By providing a perspective and shared vocabulary, the concept may also elicit ways in which this work can be verbalized, shared, and developed in clinical practice.
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50. |
- Davidsson Simmons, Johanna, et al.
(author)
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Association between experiencing rape, police reporting, and self-reported health among women visiting three gynecology clinics in Sweden
- 2009
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 88:9, s. 1000-1005
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Journal article (peer-reviewed)abstract
- Objective. To describe the frequency of police reporting among rape victims based on two hypotheses: (1) victims of rape more often report poor health than those who have not been victims of any abuse, and (2) victims who report abuse to the police are more likely to state poor self-reported health than those who do not report any abuse. Design. Cross-sectional questionnaire study. Setting. Three Swedish departments of obstetrics and gynecology. Sample. From an original sample of 2,439 women, those who had experienced rape and those who had no history of abuse were included (n = 1,319). Method. Analysis of associations between self-reported poor health, rape, and police reporting among rape victims were assessed by multivariate models adjusted for type of abuse, perpetrator, and sociodemographic factors. Main outcome measures. Odds ratios (ORs) for poor health among rape victims. Results. Rape was seldom reported to the police (23.5%, 44/187). Both hypotheses were confirmed; rape victims more often state poor health than non-abused women (adjusted OR 3.9; 95% confidence interval (CI) 2.4–6.3), and women who had reported abuse to the police stated poor health more often than those who had not reported abuse to the police (adjusted OR 3.0; 95% CI 1.1–8.1). Conclusions. Three of four rape victims had not reported any abuse to the police, and those who had were more likely to report poor health. Rape myths are prevalent in society and affect how victims of sexual abuse are treated both by formal and informal support providers, which in turn may affect the recovery and health of victims. Our results send an urgent message to the current debate on sexual abuse against women: Why do women not report rape to the police?
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