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Wijma, Klaas
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Nieminen, K., Berg, I., Frankenstein, K., Viita, L., Larsson, K., Persson, U., . . . Wijma, K. (2016). Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial. Cognitive Behaviour Therapy, 45(4), 287-306
Open this publication in new window or tab >>Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial
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2016 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 4, p. 287-306Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale—Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.

Place, publisher, year, edition, pages
Routledge, 2016
Keywords
Childbirth; Internet-based cognitive behaviour therapy (ICBT); posttraumatic stress disorder (PTSD); trauma-focused psychotherapy
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-127695 (URN)10.1080/16506073.2016.1169626 (DOI)000379764500003 ()27152849 (PubMedID)
Note

Funding agencies: Linkoping University (LiU) Department of Behavioral Sciences and Learning; Region Council in Ostergotland (RO)

Available from: 2016-05-09 Created: 2016-05-09 Last updated: 2018-03-20Bibliographically approved
Ayers, S., Bond, R., Bertullies, S. & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychological Medicine, 46(6), 1121-1134
Open this publication in new window or tab >>The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework
2016 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 6, p. 1121-1134Article, review/survey (Refereed) Published
Abstract [en]

There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.

Place, publisher, year, edition, pages
CAMBRIDGE UNIV PRESS, 2016
Keywords
Birth; labour; postpartum depression; post-traumatic stress disorder
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127260 (URN)10.1017/S0033291715002706 (DOI)000372513000001 ()26878223 (PubMedID)
Available from: 2016-04-20 Created: 2016-04-19 Last updated: 2017-11-30
Nieminen, K., Andersson, G., Wijma, B., Ryding, E.-L. & Wijma, K. (2016). Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study. Journal of Psychosomatic Obstetrics and Gynaecology, 37(2), 37-43
Open this publication in new window or tab >>Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study
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2016 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 37, no 2, p. 37-43Article in journal (Refereed) Published
Abstract [en]

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 (p < 0.0005) decrease of FOC [W-DEQ sum score decreased pre to post-therapy, with a large effect size (Cohen’s d = 0.95)].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.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
National Category
Clinical Medicine Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-126491 (URN)10.3109/0167482X.2016.1140143 (DOI)000372410100001 ()26918752 (PubMedID)
Note

Funding agencies: Swedish Research Council for Health, Working Life and Welfare (FORTE); Medical Research Council of Southeast Sweden (FORSS); County Council in Ostergotland (LIO)

Available from: 2016-03-29 Created: 2016-03-29 Last updated: 2018-11-15Bibliographically approved
Sluijs, A.-M., Cleiren, M. P. H., Scherjon, S. A. & Wijma, K. (2015). Does fear of childbirth or family history affect whether pregnant Dutch women prefer a home- or hospital birth?. Midwifery, 31(12), 1143-1148
Open this publication in new window or tab >>Does fear of childbirth or family history affect whether pregnant Dutch women prefer a home- or hospital birth?
2015 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 12, p. 1143-1148Article in journal (Refereed) Published
Abstract [en]

Objective: it is a generally accepted idea that women who give birth at home are less fearful of giving birth than women who give birth in a hospital. We explored fear of childbirth (FOC) in relation to preferred and actual place of birth. Since the Netherlands has a long history of home birthing, we also examined how the place where a pregnant womans mother or sisters gave birth related to the preferred place of birth. Design: a prospective cohort study. Setting: five midwifery practises in the region Leiden/Haarlem, the Netherlands. Participants: 104 low risk nulliparous and parous women. Method: questionnaires were completed in gestation week 30 (T1) and six weeks post partum (T2). Measurements and findings: no significant differences were found in antepartum FOC between those who preferred a home or a hospital birth. Women with a strong preference for either home or hospital had lower FOC (mean W-DEQ = 60.3) than those with a weak preference (mean W-DEQ= 71.0), t (102)= 2.60, p= 0.01. The place of birth of close family members predicted a higher chance (OR 3.8) of the same place being preferred by the pregnant woman. Pre- to postpartum FOC increased in women preferring home- but having hospital birth. Key conclusions: the idea that FOC is related to the choice of place of birth was not true for this low risk cohort. Women in both preference groups (home and hospital) made their decisions based on negative and positive motivations. Mentally adjusting to a different environment than that preferred, apart from the medical complications, can cause more FOC post partum. Implications for practice: the decreasing number of home births in the Netherlands will probably be a self-reinforcing effect, so in future, pregnant women will be less likely to feel supported by their family or society to give birth at home. Special attention should be given to the psychological condition of women who were referred to a place of birth and caregiver they did not prefer, by means of evaluation of the delivery and being alert to anxiety or other stress symptoms after childbirth. These women have higher chance of fear post partum which is related to a higher risk of psychiatric problems. (C) 2015 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2015
Keywords
Fear of childbirth; FOC; Home birth; Place of birth; Preference; Referral
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123774 (URN)10.1016/j.midw.2015.08.002 (DOI)000366009900006 ()26320703 (PubMedID)
Note

Funding Agencies|KNOV; LUMC

Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2017-11-30
Nieminen, K., Malmquist, A., Wijma, B., Ryding, E.-L., Andersson, G. & Wijma, K. (2015). Nulliparous pregnant womens narratives of imminent childbirth before and after internet-based cognitive behavioural therapy for severe fear of childbirth: a qualitative study. British Journal of Obstetrics and Gynecology, 122(9), 1259-1265
Open this publication in new window or tab >>Nulliparous pregnant womens narratives of imminent childbirth before and after internet-based cognitive behavioural therapy for severe fear of childbirth: a qualitative study
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2015 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, no 9, p. 1259-1265Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley: 12 months, 2015
Keywords
Active coping; appraisal; delivery; fear of childbirth; internet cognitive behavioural therapy; self-confidence
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-120728 (URN)10.1111/1471-0528.13358 (DOI)000358619900020 ()25817045 (PubMedID)
Note

Funding Agencies|Swedish Research Council for Health, Working Life and Welfare (FORTE); Medical Research Council of Southeast Sweden (FORSS); County Council in Ostergotland (LIO)

Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2018-11-15
Brohede, S., Wingren, G., Wijma, B. & Wijma, K. (2015). Prevalence of body dysmorphic disorder among Swedish women: A population-based study. Comprehensive Psychiatry, 58, 108-115
Open this publication in new window or tab >>Prevalence of body dysmorphic disorder among Swedish women: A population-based study
2015 (English)In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 58, p. 108-115Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
WB Saunders, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117368 (URN)10.1016/j.comppsych.2014.12.014 (DOI)000351807800015 ()25617963 (PubMedID)
Note

Funding Agencies|Linkoping University; Ostergotland County Council

Available from: 2015-04-24 Created: 2015-04-24 Last updated: 2018-11-15
Siwe, K. & Wijma, K. (2015). Validation of the Fear of Pelvic Examination Scale (F-PEXS) - measuring students fear of performing a pelvic examination. Journal of Psychosomatic Obstetrics and Gynaecology, 36(1), 23-28
Open this publication in new window or tab >>Validation of the Fear of Pelvic Examination Scale (F-PEXS) - measuring students fear of performing a pelvic examination
2015 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 36, no 1, p. 23-28Article in journal (Refereed) Published
Abstract [en]

Introduction: Medical students of both genders often show signs of fear before they perform their first pelvic examination. This situation puts a novice in a special setting of intimacy never experienced before and where different emotions may emerge. A specially designed questionnaire, the Fear of Pelvic Examination Scale (F-PEXS) has been developed to assess fear in this context. The aim of this paper is to describe the validation of the F-PEXS. Methods: Undergraduate medical students (N = 100) answered the F-PEXS one week before, prior to and after a learning session with professional patients to assess levels of anxiety towards performing the pelvic exam. The validity of the scale was examined using item analysis, reliability assessments and analysis of the construct validity in comparing the F-PEXS with the Spielberger State and Trait Anxiety Inventory and Becks Anxiety Inventory. Results: The F-PEXS has very good reliability (Cronbachs alpha 0.96) and good construct validity. The mean score on the F-PEXS did not differ between gender either before or after the learning session. Conclusions: The F-PEXS can be used to assess students fear of performing the pelvic examination, to evaluate new strategies for learning the pelvic exam and to evaluate the outcome of such interventions.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
Keywords
Fear; measurement; medical student; Pelvic examination; validation
National Category
Basic Medicine Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117247 (URN)10.3109/0167482X.2014.994500 (DOI)000351351200004 ()25541215 (PubMedID)
Available from: 2015-04-22 Created: 2015-04-21 Last updated: 2018-01-11
Klabbers, G. A., Wijma, K., Paarlberg, K. M., Emons, W. H. M. & Vingerhoets, A. J. J. (2014). Treatment of severe fear of childbirth with haptotherapy: design of a multicenter randomized controlled trial. BMC Complementary and Alternative Medicine, 14(385)
Open this publication in new window or tab >>Treatment of severe fear of childbirth with haptotherapy: design of a multicenter randomized controlled trial
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2014 (English)In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 14, no 385Article in journal (Refereed) Published
Abstract [en]

Background: About six percent of pregnant women suffer from severe fear of childbirth. These women are at increased risk of obstetric labour and delivery interventions and pre- and postpartum complications, e.g., preterm delivery, emergency caesarean section, caesarean section at maternal request, severe postpartum fear of childbirth and trauma anxiety. During the last decade, there is increasing clinical evidence suggesting that haptotherapy might be an effective intervention to reduce fear of childbirth in pregnant women. The present study has been designed to evaluate the effects of such intervention. Methods/Design: Included are singleton pregnant women with severe fear of childbirth, age greater than= 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20-24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction. Discussion: The treatment, a standard haptotherapeutical treatment for pregnant women with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Pregnant women; Fear of childbirth; Haptotherapy; Treatment; Delivery; Anxiety; Well-being; Childbirth outcomes
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113379 (URN)10.1186/1472-6882-14-385 (DOI)000346677400003 ()25293834 (PubMedID)
Available from: 2015-01-16 Created: 2015-01-16 Last updated: 2017-12-05
Salomonsson, B., Gullberg, M. T., Alehagen, S. & Wijma, K. (2013). Self-efficacy beliefs and fear of childbirth in nulliparous women. Journal of Psychosomatic Obstetrics and Gynaecology, 34(3), 116-121
Open this publication in new window or tab >>Self-efficacy beliefs and fear of childbirth in nulliparous women
2013 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, no 3, p. 116-121Article in journal (Refereed) Published
Abstract [en]

Objective: To explore how childbirth self-efficacy, i.e. outcome expectancy and efficacy expectancy, was associated with fear of childbirth (FOC) and how efficacy expectancy and FOC, respectively were related to socio-demographic characteristics, mental problems and preference for a caesarean section.

Methods: In this cross-sectional study, a consecutive sample of 1000 pregnant nulliparous women was sent the Wijma Delivery Expectancy Questionnaire and Childbirth Self-Efficacy Inventory. Statistical analyses were performed on data from 423 women.

Results: Outcome expectancy and efficacy expectancy correlated significantly and positively, FOC correlated significantly and negatively with both outcome expectancy and efficacy expectancy. Women with severe FOC (20.8%) had a significantly lower level of education (p = 0.001), and had more often sought help because of mental problems (p = 0.004). They were more likely to have low-efficacy expectancy (p < 0.001) and to prefer a caesarean section instead of a vaginal birth (p < 0.001).

Conclusions: Lower efficacy expectancy was associated with higher FOC while preference for a caesarean section was not. Improvement of self-efficacy could be a part of care for women with FOC during pregnancy; however, it would not be enough for fearful women who wish to have a caesarean section.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
Caesarean section, CBSEI, Fear of childbirth, Self-Efficacy, W-DEQ
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-85647 (URN)10.3109/0167482X.2013.824418 (DOI)000323332400004 ()
Available from: 2012-11-27 Created: 2012-11-27 Last updated: 2017-12-07Bibliographically approved
Brohede, S., Wingren, G., Wijma, B. & Wijma, K. (2013). Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women. Psychiatry Research, 210(2), 647-652
Open this publication in new window or tab >>Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women
2013 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 210, no 2, p. 647-652Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Self-report instrument; Measurement; Somatoform disorders; Appearance concerns; Body image
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103301 (URN)10.1016/j.psychres.2013.07.019 (DOI)000328518600044 ()
Available from: 2014-01-17 Created: 2014-01-16 Last updated: 2018-11-15
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