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Sepa, Anneli
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Publications (10 of 28) Show all publications
Mörelius, E.-l., Örtenstrand, A., Theodorsson, E. & Frostell, A. (2015). A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Human Development, 91(1), 63-70
Open this publication in new window or tab >>A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding
2015 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 91, no 1, p. 63-70Article in journal (Refereed) Published
Abstract [en]

AIM:

To evaluate the effects of almost continuous skin-to-skin contact (SSC) on salivary cortisol, parental stress, parental depression, and breastfeeding.

STUDY DESIGN:

This is a randomised study engaging families of late preterm infants (32-35weeks gestation). Salivary cortisol reactivity was measured in infants during a nappy change at one month corrected age, and in infants and mothers during still-face at four month corrected age. Both parents completed the Swedish Parenthood Stress Questionnaire (SPSQ) at one month and the Edinburgh Postnatal Depression Scale (EPDS) at one and four months. Ainsworth's sensitivity scale was used to control for parental sensitivity.

SUBJECTS:

Thirty-seven families from two different neonatal care units in Sweden, randomised to either almost continuous SSC or standard care (SC).

RESULTS:

Infants randomised to SSC had a lower salivary cortisol reactivity at one month (p=0.01). There was a correlation between the mothers' and the preterm infants' salivary cortisol levels at four months in the SSC group (ρ=0.65, p=0.005), but not in the SC group (ρ=0.14, p=0.63). Fathers in SSC scored lower on the SPSQ sub-scale spouse relationship problems compared to fathers in SC (p<0.05).

CONCLUSIONS:

Almost continuous SSC decreases infants' cortisol reactivity in response to handling, improves the concordance between mothers' and infants' salivary cortisol levels, and decreases fathers' experiences of spouse relationship problems.

Keywords
Cortisol; Kangaroo Mother Care; Neonatal Care; Preterm infants; Stress
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-113796 (URN)10.1016/j.earlhumdev.2014.12.005 (DOI)000349592600011 ()25545453 (PubMedID)
Note

The authors gratefully acknowledge the participating families, Lisbet de Jounge, Birgitta Lundin, Elisabeth Olhager, and Ihsan Sarman, and staff members at the Neonatal Intensive Care Units at Linkoping University Hospital and at Sachs' Children's Hospital in Stockholm. This study was supported by the County Council of Ostergotland (LiO-12134, LiO-17711, LiO-278801), South Sweden Nursing Society (SSSH-2008), Halsofonden (LiU-2009), and Linkoping University.

Available from: 2015-01-30 Created: 2015-01-30 Last updated: 2017-12-05
Nygren, M., Carstensen, J., Koch, F.-S., Ludvigsson, J. & Frostell, A. (2015). Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study. Diabetologia, 58(6), 1188-1197
Open this publication in new window or tab >>Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study
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2015 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, no 6, p. 1188-1197Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis The aim of this study was to prospectively investigate whether psychological stress during childhood may be a risk factor for manifest type 1 diabetes. Methods The All Babies In Southeast Sweden (ABIS) study invited all families with babies born between 1 October 1997 and 30 September 1999 in southeast Sweden to participate. Our study subsample includes 10,495 participants in at least one of the data collections at 2-3, 5-6, 8 and 10-13 years of age not yet diagnosed with type 1 diabetes at inclusion; 58 children were subsequently diagnosed. Age at diagnosis was obtained from the national register SweDiabKids in 2012. Family psychological stress was measured via questionnaires given to the parents assessing serious life events, parenting stress, parental worries and the parents social support. Results Childhood experience of a serious life event was associated with a higher risk of future diagnosis of type 1 diabetes (HR 3.0 [95% CI 1.6, 5.6], p = 0.001) after adjusting for heredity of type 1 diabetes and age at entry into the study. The result was still valid when controlling for heredity of type 2 diabetes, size for gestational age, the parents education level and whether the mother worked at least 50% of full time before the childs birth (HR 2.8 [95% CI 1.5, 5.4], p = 0.002), and also when childhood BMI was added to the model (HR 5.0 [95% CI 2.3, 10.7], p less than 0.001). Conclusions/interpretation This first prospective study concluded that experience of a serious life event in childhood may be a risk factor for manifest type 1 diabetes.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Longitudinal studies; Prospective studies; Psychological stress; Risk factors; Stressful events; Type 1 diabetes mellitus
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-118842 (URN)10.1007/s00125-015-3555-2 (DOI)000353893000008 ()25870022 (PubMedID)
Note

Funding Agencies|Swedish Research Council [K2005-72X-11242-11A, K2008-69X-20826-01-4]; Swedish Child Diabetes Foundation (Barndiabetesfonden); JDRF Wallenberg Foundation [K 98-99D-12813-01A]; Medical Research Council of Southeast Sweden (FORSS); Swedish Council for Working Life and Social Research [FAS2004-1775]

Available from: 2015-06-08 Created: 2015-06-04 Last updated: 2018-01-11
Nygren, M., Carstensen, J., Koch, F.-S., Ludvigsson, J. & Frostell, A. S. (2015). Serious life events across childhood and mental health problems in early adolescence: The moderating role of family climate. Results from the ABIS population-based longitudinal study.
Open this publication in new window or tab >>Serious life events across childhood and mental health problems in early adolescence: The moderating role of family climate. Results from the ABIS population-based longitudinal study
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2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

This study aims to investigate the association between experiences of serious life events assessed by checklists longitudinally across childhood (at age 5-6, age 8, and age 12-14 years) and level of mental health problems in early adolescence (at age 12-14), and the mediating role of family climate factors across childhood. Questionnaire data from the All Babies In Southeast Sweden (ABIS) population based cohort-study were used (n=1132). The association were best modelled with a sequential cumulative approach; that means that the number of time-periods at least one serious life event was experienced were linearly related to the level of mental health problems (SDQ-score) after controlling for age, sex/gender, parental educational level, immigrant status and fuzzy/difficult temperament at age 2-3 (b=0.58 [95% CI 0.28, 0.87], p<0.001). Parenting stress and the parents size and satisfaction of social support were found as moderating factors, where the association between serious life events and mental health problems only were found in the subgroups of families where the parent perceive chronically high levels of parenting stress (high at 3-4 times of 4 possible; n=163, b=1.28 [0.55, 2.01], p=0.001), have a small social network (n=108, p=1.75 [0.86, 2.64], p<0.001), and are dissatisfied with their social support (n=95, p=1.22 [0.36, 2.09], p=0.006). An absence of parenting stress across childhood and adequate social support for the parents are suggested as resilient factors. To avoid negative consequences for child mental health after experiences of stressful life events, parents should get adequate support in child health services.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes Pediatrics
Identifiers
urn:nbn:se:liu:diva-121065 (URN)
Available from: 2015-09-04 Created: 2015-09-04 Last updated: 2017-11-02Bibliographically approved
Mörelius, E., Örtenstrand, A. & Frostell, A. (2014). Kan hud-mot-hud vård dygnet runt påverka det för tidigt födda barnets kortisolvärden?. In: : . Paper presented at Vårmöte i perinatologi, 8-9 maj 2014, Visby.
Open this publication in new window or tab >>Kan hud-mot-hud vård dygnet runt påverka det för tidigt födda barnets kortisolvärden?
2014 (Swedish)Conference paper, Oral presentation only (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-107421 (URN)
Conference
Vårmöte i perinatologi, 8-9 maj 2014, Visby
Available from: 2014-06-12 Created: 2014-06-12 Last updated: 2016-05-04
Carlsson, E., Frostell, A., Ludvigsson, J. & Faresjo, M. (2014). Psychological stress in children may alter the immune response. Journal of Immunology, 192(5), 2071-2081
Open this publication in new window or tab >>Psychological stress in children may alter the immune response
2014 (English)In: Journal of Immunology, ISSN 0022-1767, E-ISSN 1550-6606, Vol. 192, no 5, p. 2071-2081Article in journal (Refereed) Published
Abstract [en]

Psychological stress is a public health issue even in children and has been associated with a number of immunological diseases. The aim of this study was to examine the relationship between psychological stress and immune response in healthy children, with special focus on autoimmunity. In this study, psychological stress was based on a composite measure of stress in the family across the domains: 1) serious life events, 2) parenting stress, 3) lack of social support, and 4) parental worries. PBMCs, collected from 5-y-old high-stressed children (n = 26) and from 5-y-old children without high stress within the family (n = 52), from the All Babies In Southeast Sweden cohort, were stimulated with Ags (tetanus toxoid and b-lactoglobulin) and diabetes-related autoantigens (glutamic acid decarboxylase 65, insulin, heat shock protein 60, and tyrosine phosphatase). Immune markers (cytokines and chemokines), clinical parameters (C-peptide, proinsulin, glucose), and cortisol, as an indicator of stress, were analyzed. Children from families with high psychological stress showed a low spontaneous immune activity (IL-5, IL-10, IL-13, IL-17, CCL2, CCL3, and CXCL10; p less than 0.01) but an increased immune response to tetanus toxoid, b-lactoglobulin, and the autoantigens glutamic acid decarboxylase 65, heat shock protein 60, and tyrosine phosphatase (IL-5, IL-6, IL-10, IL-13, IL-17, IFN-g, TNF-A, CCL2, CCL3, and CXCL10; p less than 0.05). Children within the high-stress group showed high level of cortisol, but low level of C-peptide, compared with the control group (p less than 0.05). This supports the hypothesis that psychological stress may contribute to an imbalance in the immune response but also to a pathological effect on the insulin-producing b cells.Copyright © 2014 by The American Association of Immunologists.

Place, publisher, year, edition, pages
American Association of Immunologists, 2014
National Category
Basic Medicine Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-110525 (URN)10.4049/jimmunol.1301713 (DOI)000332701400011 ()24501202 (PubMedID)2-s2.0-84896524481 (Scopus ID)
Note

Funding text:

This work was supported by the Swedish Research Council (Grant K2009-70X-21086-01-3), the Swedish Council for Working Life and Social Research (Grant 2008-0284), the Medical Research Council of Southeast Sweden, and the Swedish Child Diabetes Foundation.                           

Available from: 2014-09-18 Created: 2014-09-12 Last updated: 2018-01-11
Nygren, M., Ludvigsson, J., Carstensen, J. & Sepa Frostell, A. (2013). Family psychological stress early in life and development of type 1 diabetes: The ABIS prospective study. Diabetes Research and Clinical Practice, 100(2), 257-264
Open this publication in new window or tab >>Family psychological stress early in life and development of type 1 diabetes: The ABIS prospective study
2013 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 100, no 2, p. 257-264Article in journal (Refereed) Published
Abstract [en]

Aims: This study investigated whether psychological stress in the family during the childs first year of life are associated with the risk of childhood type 1 diabetes (T1D). According to the beta-cell stress hypothesis all factors that increase the need for, or the resistance to, insulin may be regarded as risk factors for T1D. less thanbrgreater than less thanbrgreater thanMethods: Among 8921 children from the general population with questionnaire data from one parent at childs birth and at 1 year of age, 42 cases of T1D were identified up to 11-13 years of age. Additionally 15 cases with multiple diabetes-related autoantibodies were detected in a sub-sample of 2649 children. less thanbrgreater than less thanbrgreater thanResults: Cox regression analyses showed no significant associations between serious life events (hazard ratio 0.7 for yes vs. no [95% CI 0.2-1.9], p = 0.47), parenting stress (0.9 per scale score [0.5-1.7], p = 0.79), or parental dissatisfaction (0.6 per scale score [0.3-1.2], p = 0.13) during the first year of life and later diagnosis of T1D, after controlling for socioeconomic, demographic, and diabetes-related factors. Inclusion of children with multiple autoantibodies did not alter the results. less thanbrgreater than less thanbrgreater thanConclusions: No association between psychological stress early in life and development of T1D could be confirmed.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Diabetes mellitus, Type 1, Stress, Psychological, Life change events, Educational status, Prospective studies
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-95975 (URN)10.1016/j.diabres.2013.03.016 (DOI)000320590900024 ()
Note

Funding Agencies|Swedish Research Council|K2005-72X-11242-11AK2008-69X-20826-01-4|Swedish Child Diabetes Foundation (Barndiabetesfonden)||JDRF Wallenberg Foundation|K 98-99D-12813-01A|Medical Research Council of Southeast Sweden (FORSS)||Swedish Council for Working Life and Social Research|FAS2004-1775|

Available from: 2013-08-19 Created: 2013-08-12 Last updated: 2017-12-06Bibliographically approved
Karlén, J., Frostell, A., Theodorsson, E., Faresjö, T. & Ludvigsson, J. (2013). Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair. Pediatrics, 132(5), E1333-E1340
Open this publication in new window or tab >>Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair
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2013 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 132, no 5, p. E1333-E1340Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate cortisol concentrations in hair as biomarker of prolonged stress in young children and their mothers and the relation to perinatal and sociodemographic factors. less thanbrgreater than less thanbrgreater thanMETHODS: Prospective cohort study of 100 All Babies In Southeast Sweden study participants with repeated measures at 1, 3, 5, and 8 years and their mothers during pregnancy. Prolonged stress levels were assessed through cortisol in hair. A questionnaire covered perinatal and sociodemographic factors during the childs first year of life. less thanbrgreater than less thanbrgreater thanRESULTS: Maternal hair cortisol during the second and third trimester and child hair cortisol at year 1 and 3 correlated. Child cortisol in hair levels decreased over time and correlated to each succeeding age, between years 1 and 3 (r = 0.30, P = .002), 3 and 5 (r = 0.39, P andlt; .001), and 5 and 8 (r = 0.44, P andlt; .001). Repeated measures gave a significant linear association over time (P andlt; .001). There was an association between high levels of hair cortisol and birth weight (beta = .224, P = .020), nonappropriate size for gestational age (beta = .231, P = .017), and living in an apartment compared with a house (beta = .200, P = .049). In addition, we found high levels of cortisol in hair related to other factors associated with psychosocial stress exposure. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: Correlation between hair cortisol levels in mothers and their children suggests a heritable trait or maternal calibration of the childs hypothalamic-pituitary-adrenocortical axis. Cortisol output gradually stabilizes and seems to have a stable trait. Cortisol concentration in hair has the potential to become a biomarker of prolonged stress, especially applicable as a noninvasive method when studying how stress influences childrens health.

Place, publisher, year, edition, pages
American Academy of Pediatrics, 2013
Keywords
stress, children, mother, cortisol, hair, health disparities
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102501 (URN)10.1542/peds.2013-1178 (DOI)000326475000026 ()
Note

Funding Agencies|Swedish Child Diabetes Foundation (Barndiabetesfonden)||Research Council of Southeast Sweden|FORSS-87771FORSS-36321|Swedish Medical Research Council (MRF)|VR: K99-72X-11242-05A|JDRF Wallenberg Foundation|K 98-99D-12813-01A|County Council of Ostergotland, ALF project grant, Linkoping, Sweden||

Available from: 2013-12-12 Created: 2013-12-12 Last updated: 2017-12-06Bibliographically approved
Nygren, M., Carstensen, J., Ludvigsson, J. & Sepa, A. (2012). Adult attachment and parenting stress among parents of toddlers. Journal of Reproductive and Infant Psychology, 30(3), 289-302
Open this publication in new window or tab >>Adult attachment and parenting stress among parents of toddlers
2012 (English)In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 30, no 3, p. 289-302Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was to revise the dimensionality of the Relationship Scales Questionnaire (RSQ) assessing adult attachment and relate it to parenting stress within a large sample of parents of toddlers. Methods: As part of a longitudinal population-based study, 8122 parents (97% mothers) completed the 18-item version of RSQ and the Swedish Parenthood Stress Questionnaire (SPSQ) when their child was 2-3 years of age. Results: Exploratory factor analyses gave three uncorrelated RSQ factors named (1) Importance of Independence, (2) Relationship-related Anxiety, and (3) Discomfort with Closeness, with Cronbachs alpha andgt;= 0.65. In a linear regression Parenting Stress was most closely related to Relationship-related Anxiety (b = 0.20, t = 39.0), weaker associations were found with the attachment dimensions capturing avoidance: Importance of Independence (b = 0.07, t = 13.40) and Discomfort with Closeness (b = 0.07, t = 12.04). The SPSQ subscales Incompetence (R-2 = 17%) and Social Isolation (R-2 = 22%) showed stronger association with adult attachment than the remaining three. Conclusion: The agreement with previous findings in other study populations indicates that substantial and meaningful dimensions of attachment have been captured. Attachment anxiety and discomfort with closeness seem to have an important relationship with the perception of parenting stress, especially concerning feelings of incompetence and social isolation.

Place, publisher, year, edition, pages
Taylor and Francis (Routledge): STM, Behavioural Science and Public Health Titles / Taylor and Francis (Routledge), 2012
Keywords
adult attachment, attachment styles, parenting stress, parenting, family relations
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84912 (URN)10.1080/02646838.2012.717264 (DOI)000308760100006 ()
Available from: 2012-10-26 Created: 2012-10-26 Last updated: 2017-12-07
Hallin, A.-L., Bengtsson, H., Sepa Frostell, A. & Stjernqvist, K. (2012). The effect of extremely preterm birth on attachment organization in late adolescence. Child Care Health and Development, 38(2), 196-203
Open this publication in new window or tab >>The effect of extremely preterm birth on attachment organization in late adolescence
2012 (English)In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 38, no 2, p. 196-203Article in journal (Refereed) Published
Abstract [en]

Background Prior studies have examined the impact of preterm birth on the quality of the attachment relationship to the mother in infancy, but few have examined extremely preterm born infants and almost no data have been reported on prematurity and its impact on the attachment organization attained after childhood. less thanbrgreater than less thanbrgreater thanMethods Thirty-nine adolescents born extremely preterm and 39 full-term born control participants were assessed with the Adult Attachment Interview. less thanbrgreater than less thanbrgreater thanResults The prematurely born showed lower scores regarding measures of attachment security and, in particular, a higher proportion of insecure dismissive patterns. This difference seemed to be clear and persistent even when controlled for intelligence and socio-economic variables. less thanbrgreater than less thanbrgreater thanConclusions Because insecure attachment as well as prematurity may be considered as significant risk factors for developing psychopathology, they deserve careful attention in future research and clinical follow-ups.

Place, publisher, year, edition, pages
Blackwell Publishing, 2012
Keywords
adolescence, attachment, follow-up, preterm
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-75269 (URN)10.1111/j.1365-2214.2011.01236.x (DOI)000299776100005 ()
Note

Funding Agencies|Linnea and Josef Carlsson Research Foundation||May Flower Foundation||

Available from: 2012-02-27 Created: 2012-02-24 Last updated: 2017-12-07Bibliographically approved
Karlén, J., Ludvigsson, J., Frostell, A., Theodorsson, E. & Faresjö, T. (2011). Cortisol in hair measured in young adults - a biomarker of major life stressors?. BMC Clinical Pathology, 11(1), 12
Open this publication in new window or tab >>Cortisol in hair measured in young adults - a biomarker of major life stressors?
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2011 (English)In: BMC Clinical Pathology, ISSN 1472-6890, E-ISSN 1472-6890, Vol. 11, no 1, p. 12-Article in journal (Refereed) Published
Abstract [en]

Background Stress as a cause of illness has been firmly established. In public health and stress research a retrospective biomarker of extended stress would be an indispensible aid. The objective of this pilot study was to investigate whether concentrations of cortisol in hair correlate with perceived stress, experiences of serious life events, and perceived health in young adults. Methods Hair samples were cut from the posterior vertex area of (n = 99) university students who also answered a questionnaire covering experiences of serious life events, perceived Stress Scale and perceived health during the last three months. Cortisol was measured using a competitive radioimmunoassay in methanol extracts of hair samples frozen in liquid nitrogen and mechanically pulverised. Results Mean cortisol levels were significantly related to serious life events (p = 0.045), weakly negatively correlated to perceived stress (p = 0.025, r = -0.061) but nor affected by sex, coloured/permed hair, intake of pharmaceuticals or self-reported health. In a multiple regression model, only the indicator of serious life events had an independent (p = 0.041) explanation of increased levels of cortisol in hair. Out of four outliers with extremely high cortisol levels two could be contacted, both reported serious psychological problems. Conclusions These findings suggest that measurement of cortisol in hair could serve as a retrospective biomarker of increased cortisol production reflecting exposure to major life stressors and possibly extended psychological illness with important implications for research, clinical practice and public health. Experience of serious life events seems to be more important in raising cortisol levels in hair than perceived stress.

Place, publisher, year, edition, pages
BioMed Central, 2011
Keywords
Biomarker; Coping; Cortisol; Hair; Serious life events; Stress
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-74866 (URN)10.1186/1472-6890-11-12 (DOI)22026917 (PubMedID)
Available from: 2012-02-10 Created: 2012-02-10 Last updated: 2017-12-07Bibliographically approved
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