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  • 1.
    Andersson, Yvonne
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Child Evacuations During World War II: This ShouldNot Happen Again2019In: Journal of Loss and Trauma, ISSN 1532-5024Article in journal (Refereed)
    Abstract [en]

    There is little research about the long-term effects on childrenthat were separated from their parents and moved fromFinland to Sweden during World War II. The aim of this studywas to capture these now-lifelong reflections, and so questionnaireswere sent to 14 potential participants. Ten personsaged 7381 responded. The themes that emerged concernedpride over professional achievements, the pain of separation,and feelings of alienation and loneliness. The informantsemphasized the importance of sibling relationships. The conclusionwas that the participants, despite the hardships connectedwith the migration, had successfully lived a good lifein Sweden.ARTICLE HISTORYReceived 16 July 2018Accepted 11 May 2018KEYWORDSFinnish war children; childseparations; childevacuation; importance ofsibling relationsAt

  • 2.
    Arnison, Tor
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Menon, JA
    Department of Psychology, University of Zambia, Lusaka, Zambia.
    Malambo, C
    Department of Psychology, University of Zambia, Lusaka, Zambia.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Posttraumatic Stress among women with HIV in Zambia2017In: The Medical Journal of Zambia, ISSN 0047-651X, Vol. 44, no 2, p. 100-105Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether HIV-positive women in Lusaka District, Zambia, displays a higher degree of PTSD-symptoms than a HIV-negative control group.

    Method: The study targeted 50 HIV-positive women from four ART-clinics and 42 HIV-negative women from corresponding VCT-units. All sites were located in Lusaka District, Zambia. The HIV-positive women were compared with the control group in regard for PTSD, PTSD-symptoms, dissociative symptoms and history of traumatic experiences. The instruments used were PCL-C, DES-T and LYLES-A. Prior to the main study, the validity of the instruments were assessed with a pilot-sample.

    Results: Three participants in the HIV-positive group fulfilled the criteria for clinical PTSD (10.7 %), as compared to none in the control group. The HIV-positive group also displayed a significantly higher degree of PTSD-symptoms and previous traumatic experiences, with strong effect sizes, but not for dissociative symptoms. The significant difference in PTSD-symptoms remained while trauma-history was controlled for.

    Conclusions: The results of this study clearly indicates that women with HIV are vulnerable to PTSD and that contracting HIV in itself can constitute a psychological trauma in itself. Since PTSD among persons with HIV has been associated with transmission risk behaviours, reduced treatment adherence and a faster disease progression, these findings are important to consider in actions against HIV and AIDS. 

  • 3.
    Briere, John
    Keck School of Medicine, University of Southern California, USA.
    Svedin, Carl Göran (Translator, Contributor)
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    TSCC, Trauma Symptom Checklist for Children: Manual Supplement, svensk version2010Other (Other academic)
    Abstract [sv]

    TSCC är ett självrapporteringsformulär som mäter posttraumatisk stress och relaterade symptom. Instrumentet är avsett att användas för barn och ungdomar som har upplevt traumatiska händelser såsom fysiska eller sexuella övergrepp, dödsfall av närstående, naturkatastrofer eller bevittnat hot och våld. TSCC mäter ett brett spektrum av traumatiska symptom och lämpar sig framförallt för screening men kan också användas för att utvärdera effekter av psykoterapeutiska interventioner.

  • 4.
    Briere, John
    Keck School of Medicine, University of Southern California, USA.
    Svedin, Carl Göran (Translator, Contributor)
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    TSCYC, Trauma Symptom Checklist for Young Children: Manual, Svensk version2012Other (Other academic)
    Abstract [sv]

    TSCYC är ett frågeformulär som används för att mäta ett brett spektrum av akuta eller kroniska posttraumatiska symptom hos barn som har upplevt traumatiska händelser såsom övergrepp eller misshandel eller har bevittnat våld i hemmet eller i sin närmiljö. Den svenska versionen av TSCYC har översatts av docent Doris Nilsson och professor Carl-Göran Svedin som även har översatt, normerat och standardiserat den svenska versionen av traumainstrumentet TSCC för äldre barn och ungdomar.

    Den svenska standardiseringen och normeringen av TSCYC har gjorts i en grupp om 629 barn ur normalpopulation och en klinisk grupp om 59 barn i åldrarna 3–11 år. Normerna är uppdelade utifrån ålder och kön.

    TSCYC-formuläret innehåller 90 frågor och handlar om olika typer av traumasymptom som barnet kan uppvisa. Frågorna besvaras av barnets förälder eller vårdnadshavare. TSCYC ger en detaljerad utvärdering av posttraumatiska symptom på åtta kliniska skalor. En summaskala ger värdefull information om akuta och kroniska symptom samt andra vanligt förekommande symptom hos traumatiserade barn. PTSD-diagnosbladet, som ingår i svarsblanketten, kan användas som stöd i evalueringen av möjlig PTSD-diagnos.

  • 5.
    Eckhardt, Anna
    et al.
    Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany.
    Aguilar Zambrano, Enrique
    Universidad Central del Ecuador, Instituto de Investigación y Postgrado, Facultad de Sciencias Médicas, Quito, Ecuador.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Traumatic experiences and dissociation in a non-clinical group of university students in Ecuador: a cross-sectional study2018In: Journal of Child and Adolescent Mental Health, ISSN 1728-0583, E-ISSN 1728-0591, Vol. 30, no 3, p. 191-202Article in journal (Refereed)
    Abstract [en]

    Background: In Ecuador, as in most Latin American countries, scientific research on trauma and dissociation is scarce. The aim of this study was to examine the prevalence of potentially traumatic experiences and dissociative symptoms in adolescents and young adults who were students at the Central University in Quito, Ecuador.

    Methods: A cross-sectional study in which 144 students completed a self-administrated questionnaire consisting of Linköping Youth Life Experience Scale (LYLES), Adolescent-Dissociation Experience Scale (A-DES ) and background variables. Data collection was conducted in autumn 2012. Standard multiple regression analysis was used to analyse the data.

    Results: All students reported a history of a minimum of five potentially traumatic experiences with a mean of 14.8. Eight participants (5.6%) scored above 3.7 on the Adolescent-Dissociation Experience Scale, which is considered clinically significant dissociation. No correlation was found between high scores on LYLES and A-DES.

    Conclusions: The prevalence of potentially traumatic experiences in the study population is very high compared to studies conducted in high-income settings. The low prevalence of dissociation suggests high resilience in the study population but more research on morbidity is needed to draw conclusions about mental health outcomes. Further research should include study populations in less advantageous contexts.

  • 6.
    Gustafsson, Per E
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Nilsson, Doris
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Polytraumatization and Psychological Symptoms in Children and Adolescents2009In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 18, no 5, p. 274-283Article in journal (Refereed)
    Abstract [en]

    Previous research on the impact of traumatic experiences in children and adolescents has focused almost entirely on the effect of single trauma. Research on cumulative traumas been lacking, but Finkelhor (2007) has recently directed the attention to the concept of polyvictimization. As an extension of this concept, this study examined the impact of polytraumatization, operationalized as the number of different potentially traumatic events. The study population comprised two cross-sectional samples of school-aged children (n = 270) and adolescents (n = 400). Information of life-time incidence of traumatic events was collected by the Life Incidence of Traumatic Events (LITE), and psychological symptoms by the parent version of the Strengths and Difficulties Questionnaire (SDQ) for the school children and the self-report Trauma Symptom Checklist for Children (TSCC) for the adolescents. We found that exposure to at least one traumatic event was common in both the samples (63% of the children and 89.5% of the adolescents). The number of different traumatic events, polytraumatization, was highly predictive of symptoms in both samples, and with a few exceptions surpassed the impact of specific events in exploratory analyses. We furthermore replicated previous findings of the important impact of interpersonal over noninterpersonal events on symptoms in both samples, and found an indication that this effect differed by gender in different manners in the two samples. This study emphasizes the significance of both the quantity of traumatic events, polytraumatization, as well as the quality, interpersonal events.

  • 7.
    Kjellgren, Cecilia
    et al.
    Linné Universitetet.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Child Physical Abuse—Experiences of Combined Treatment for Children and their Parents: A Pilot Study2013In: Child Care in Practice, ISSN 1357-5279, E-ISSN 1476-489X, Vol. 19, no 3, p. 275-290Article, review/survey (Refereed)
    Abstract [en]

    This paper reports on the results of treatment for families where child physical abuse has occurred. The Combined Parent–Child Cognitive–Behavioral Therapy for Families at Risk for Child Physical Abuse (CPC-CBT) model includes parent and child interventions. Four teams (within child protection and child and adolescent psychiatry services, based in Sweden) were trained to run the treatment. CPC-CBT is a 16-session programme where children and parents receive treatment in parallel groups and joint family sessions. A pilot study, with pre and post measures for both children and parents, was carried out to evaluate the treatment effects (18 families, 26 adults and 25 children). Significantly decreased symptoms of depression among parents, less use of violent parenting strategies and less inconsistent parenting were reported after treatment. Children initially reported high levels of traumatic experiences and symptoms of post-traumatic stress disorder. After treatment, trauma symptoms and depression among children were significantly reduced. Children also reported that parents used significantly less violence and increased positive parenting strategies after completion of the treatment. The implications of the findings are discussed.

  • 8.
    Lejoonclou, Annika
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Variants of Potentially Traumatizing Life Events in Eating Disorder patients2014In: Psychological Trauma, ISSN 1942-9681, E-ISSN 1942-969X, Vol. 6, no 6, p. 661-667Article in journal (Refereed)
    Abstract [en]

    Although many studies have found associations between trauma and eating disorders, it is important to study associations between the whole spectrum of potentially traumatic experiences and eating disorders. This study examined to what extent noninterpersonal traumas, interpersonal traumas, and adverse childhood circumstances were reported in a sample of patients with eating disorders, comparing this with ratings in a nonclinical group. Differences in trauma experiences between the different eating disorder diagnosis groups were assessed, and associations between trauma experiences and the reported severity of eating disturbance were analyzed. Fifty patients with eating disorders and a group of adolescent girls and young women (N = 245) without known psychological problems completed a self-report trauma-history questionnaire: the Linköping Youth Life Experience Scale. The eating disorder group also answered the Eating Disorder Examination Questionnaire. For several specific traumas, the eating disorder group had experienced a significantly larger number of potentially traumatizing events. With regard to the number of different traumas, the results were more equivocal; more experiences of adverse childhood circumstances and repeated traumas were reported in the eating disorder group, but more noninterpersonal traumas were reported in the nonclinical group. The number of adverse childhood experiences and repeated traumas was associated with the presence of eating disorders in outpatient adolescents and young women. The frequency and type of potentially traumatizing events need to be clearly assessed for these patients, placing particular focus on repeated traumas. Treatment may be improved through a focus on traumatic experiences in order to resolve the eating problems.

  • 9.
    Mauritzson, Margareta
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Bergendahl Odby, Elisabeth
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    The Fog Is Lifting; Veils of Mist Come and Go: An Interpretative Phenomenological Analysis of the Experiences of Six Women Recovering From Pathological Dissociation2015In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 30, no 1, p. 45-61Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to illuminate experiences of the process of recovering from pathological dissociation. The study used data from interviews with six female participants diagnosed with pathological dissociative disturbances. All the women had a history of having been sexually abused. Data were analyzed using Interpretative Phenomenological Analysis (IPA). Two main themes emerged in the analysis: social and relational change and self in movement. The themes mirror the interplay in the recovery process that took place both intrapsychically and with regard to the relational interplay between self and other significant people. The recovery process was dependent on an incipient sense of security in relational interaction, and this process was hindered by insecurity and ambivalence in relationships. Each patient’s relationship with her therapist also played a crucial role for the participants.

  • 10.
    Michel, Per-Olof
    Michel Mentor AB, Karlstad.
    Bergh Johannesson, Kerstin (Contributor)
    Uppsala Psykoterapimottagning.
    Nilsson, Doris (Contributor)
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Arnberg, Filip (Contributor)
    Kunskapscentrum för katastrofpsykiatri, Uppsala universitet.
    Psykotraumatologi2018 (ed. 3)Book (Other academic)
    Abstract [sv]

    Människosläktet har genom årtusenden exponerats för olyckor och naturkatastrofer. Transportolyckor och andra tekniska katastrofer, krig och flyktingtrauman, terrorhändelser liksom interpersonellt våld och traumatiska övergrepp under uppväxten kan utgöra påfrestningar under människors liv samt leda till svåra hälsoeffekter.

    Denna tredje upplaga av Psykotraumatologi riktar sitt fokus mot den utveckling som skett under senaste decenniet när det gäller forskningen inom området. Sålunda beskrivs hur människor reagerar på hot och på faktorer som både kan öka risken för och motverka utvecklingen av traumatisk stress. Komplicerade sorgereaktioner och traumarelaterade tillstånd beskrivs ingående både när det gäller barn och vuxna. Vidare är avsnitten om neurobiologi, krisstöd i akutfas och behandling uppdaterade.

    Syftet med Psykotraumatologi är att utgöra en samlad kunskapskälla för den som behöver det i sin utbildning och fortbildning. På så sätt kan alla som i sin profession kommer i kontakt med potentiellt traumatiserade individer, till exempel inom hälso- och sjukvården, skolväsendet samt inom kommunernas socialtjänst ha nytta av boken.

  • 11.
    Michel, Per-Olof
    Nasjonalt kunnskapssenter om vold og traumatisk stress, Oslo universitet.
    Nilsson, Doris (Contributor)
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Bergh Johannesson, Kersin (Contributor)
    Uppsala Psykoterapimottagning.
    Lundin, Tom (Contributor)
    Institutionen för neurovetenskap, Ekselius: Psykiatri, Akademiska sjukhuset, Uppsala.
    Psykotraumatologi: bedömning, bemötande och behandling av stresstillstånd2010Collection (editor) (Other academic)
    Abstract [sv]

    Nya allvarliga händelser drabbar kontinuerligt människor runt om i världen och även i vårt land. Det gör att ämnet psykotraumatologi ständigt är aktuellt och som följd av att kunskapsmängden inom området har ökat under senare år har det blivit nödvändigt att sammanfatta det psykotraumatologiska fältet på nytt.I denna omarbetade och utökade upplaga har författarna behållit utgångspunkten med det psykiska traumat sett ur ett historiskt och socialt sammanhang, grundat på ett holistiskt synsätt. Vi beskriver hur den normala och den traumatiska stressen påverkar människan. Faktorer som kan verka skyddande och sådana som kan bidra till att utveckla psykiska störningar skildras även. Vi beskriver ingående krisstöd i akutfas och riktlinjer för modern traumafokuserad behandling.Syftet med boken är att utgöra en samlad kunskapskälla på svenska språket för den som behöver det i sin utbildning och fortbildning. De som på så sätt kan ha nytta av boken är personal i hälso- och sjukvården, kuratorer, läkare, psykologer, skötare inom vuxen-, barn- och ungdomspsykiatrin, primärvården och företagshälsovården samt även befattningshavare inom kommunernas krisstödsorganisation. Andra som kan ha nytta av boken är alla som i sin profession kommer i kontakt med traumatiserade individer.Boken kan med fördel användas både som lärobok och uppslagsbok.

  • 12.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Bedömningsinstrument2013In: Vad har du varit med om?: PTSD och dissociation hos barn och unga : förekomst, diagnostik och behandling / [ed] Anna Gerge, Vaxholm: Insidan , 2013, p. 527-Chapter in book (Other academic)
    Abstract [sv]

    Den här boken vänder sig till alla som i sitt yrke kommer i kontakt med traumatiserade barn och unga, oberoende av vilka diagnoser de eventuellt fått tidigare. Anna Gerge och medförfattare redogör för hur komplex psykisk traumatisering och dissociation kan ta sig uttryck hos barn och unga samt visar hur framgångsrik behandling kan se ut.Sambandet mellan anknytningsskador, inklusive svektraumatisering, och senare traumatiska händelser tydliggörs. Därefter beskrivs diagnostik, generella principer, även riktlinjer, för bedömningssamtal och behandling samt metoderna klinisk hypnos, EMDR och symboldrama.En stor del av boken utgörs av kliniska vinjetter skrivna av psykologer, socionomer och psykoterapeuter. Dessa belyser vikten av ett traumaperspektiv i barn- och ungdomspsykiatrin, liksom inom socialtjänsten och elevhälsan. Flera vinjetter visar att enkel PTSD ofta läker ut snabbt om patienterna erbjuds t ex EMDR-behandling. Vid behandlingsarbete med komplext traumatiserade barn och unga kan - och behöver - olika terapimetoder anpassas. Metoder som bygger på ett tydligt traumaperspektiv, med förståelse för betydelsen av fasspecifikt arbete på relationell grund, kan bidra till en initial stabilisering och reglering. Då kan kvarstående symptom efter försummelse och övergrepp i barndomen, liksom traumatiska upplevelser, som t ex flykt, svår mobbing och våldtäkter, bearbetas och läka ut.Vissa symptom, som t ex nedstämdhet, aggressivitet, koncentrationssvårigheter, självskadebeteende eller missbruk, kan tidigare ha diagnostiserats som något annat än traumarelaterade

  • 13.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Symbolhantering via symboldrama, psykoterapi och lekterapi med barn och ungdomar med symptom av posttraumatisk stress och dissociation2013In: Vad har du varit med om?: PTSD och dissociation hos barn och unga : förekomst, diagnostik och behandling / [ed] Anna Gerge, Vaxholm: Insidan , 2013, p. 527-Chapter in book (Other academic)
    Abstract [sv]

    Den här boken vänder sig till alla som i sitt yrke kommer i kontakt med traumatiserade barn och unga, oberoende av vilka diagnoser de eventuellt fått tidigare. Anna Gerge och medförfattare redogör för hur komplex psykisk traumatisering och dissociation kan ta sig uttryck hos barn och unga samt visar hur framgångsrik behandling kan se ut.Sambandet mellan anknytningsskador, inklusive svektraumatisering, och senare traumatiska händelser tydliggörs. Därefter beskrivs diagnostik, generella principer, även riktlinjer, för bedömningssamtal och behandling samt metoderna klinisk hypnos, EMDR och symboldrama.En stor del av boken utgörs av kliniska vinjetter skrivna av psykologer, socionomer och psykoterapeuter. Dessa belyser vikten av ett traumaperspektiv i barn- och ungdomspsykiatrin, liksom inom socialtjänsten och elevhälsan. Flera vinjetter visar att enkel PTSD ofta läker ut snabbt om patienterna erbjuds t ex EMDR-behandling. Vid behandlingsarbete med komplext traumatiserade barn och unga kan - och behöver - olika terapimetoder anpassas. Metoder som bygger på ett tydligt traumaperspektiv, med förståelse för betydelsen av fasspecifikt arbete på relationell grund, kan bidra till en initial stabilisering och reglering. Då kan kvarstående symptom efter försummelse och övergrepp i barndomen, liksom traumatiska upplevelser, som t ex flykt, svår mobbing och våldtäkter, bearbetas och läka ut.Vissa symptom, som t ex nedstämdhet, aggressivitet, koncentrationssvårigheter, självskadebeteende eller missbruk, kan tidigare ha diagnostiserats som något annat än traumarelaterade

  • 14.
    Nilsson, Doris
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Trauma, Posttraumatic Stress and Dissociation Among Swedish Adolescents: Evaluation of Questionnaires2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main aim of this thesis has been to investigate trauma and dissociation among Swedish adolescents and to evaluate the psychometric properties such as reliability and various kinds of validity of three screening instruments for assessment of dissociation and other symptoms of post traumatic stress. The three instruments in question have been Dis-Q-Sweden, A-DES and TSCC, the symptoms measured by these instruments are neither easy to capture nor easy for the adolescent to talk about. Therefore these self report scales are essential. A second aim has been to compare the results with results from other countries and to develop preliminary Swedish norms for the clinician to use. Age and gender differences have been looked upon as well as assessed symptoms connected to known experienced trauma/sexual and/or physical abuse and self-reported trauma in normal and clinical populations.

    The populations, in this thesis have been children and adolescents age 10 -19 years old from the general population; the clinical groups have had the same age range. All children and adolescents in the clinical groups have been sexually and/or physically abused. Participants have answered the questionnaires Dis-Q-Sweden, A-DES and/or TSCC and their answers have been statistically analysed.

    All three instruments have been shown to have good reliability, such as internal consistency and test-retest. Validity has been established through factor analyses, concurrent, and criterion related validity. Clinical groups with known experienced trauma/sexual abuse and/or physical abuse gave significantly higher scores on all the instruments compared to normative groups. Also self-reported trauma in a normative group gave significantly higher scores even if the significances are not as high as between the normative and clinical groups. Girls scored significantly higher than boys in both the clinical and normative groups. Girls in the age range 14-15 years old gave the significantly highest scores on both Dis-Q-Sweden and ADES. Swedish adolescents gave lower mean scores on all three instruments than have been reported from other studies in other countries. The scores from the clinical groups gave about the same mean as have been reported elsewhere.

    The conclusion from this thesis is that all the three questionnaires Dis-Q-Sweden, A-DES and TSCC have shown satisfactory psychometrics properties and can very well be used by Swedish clinicians in Child and Adolescents Psychiatry.

    List of papers
    1. Traumatic experiences and dissociative symptoms among Swedish adolescents: A pilot study using Dis-Q-Sweden
    Open this publication in new window or tab >>Traumatic experiences and dissociative symptoms among Swedish adolescents: A pilot study using Dis-Q-Sweden
    2004 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, Vol. 58, no 5, p. 349-355Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to explore the occurrence of dissociative symptoms in relation to reported traumatic experiences among adolescents. A normative sample of 216 adolescents and a clinical sample of 30 cases with a history of traumatization were given the Swedish translation of Dissociation Questionnaire, DIS-Q. The results showed that 8.8% of the adolescents reported scores above the cut-off score of 2.5 on the Dis-Q-Sweden, with a female-male ratio of 2.6:1. In the normative sample, 53 (24.5%) of the adolescents reported one or more trauma experiences. The adolescents who self-reported trauma experiences in the normative sample scored higher on the total Dis-Q-Sweden scores and on three of the four subscales compared to the adolescents with no such experiences. The clinical group exhibited significantly higher Dis-Q-Sweden scores than the normative sample on every scale, with 60% above the cut-off score. The study confirms the results from earlier studies that adolescents with a history of trauma exhibit more dissociative symptoms in this study according to Dis-Q-Sweden. The impact of trauma qualities and background factors on the development of dissociative symptoms need to be studied further.

    Keywords
    Adolescents, DIS-Q, Dissociation, Measurement, Trauma
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-14266 (URN)10.1080/08039480410005891 (DOI)
    Available from: 2007-01-31 Created: 2007-01-31 Last updated: 2013-09-16
    2. Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, Among Adolescents
    Open this publication in new window or tab >>Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, Among Adolescents
    2006 (English)In: Journal of Trauma & Dissociation, ISSN 1529-9732, Vol. 7, no 3, p. 65-89Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).

    Keywords
    Dis-Q-Sweden; method; dissociation; adolescents; trauma
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14267 (URN)10.1300/J229v07n03_05 (DOI)
    Available from: 2007-01-31 Created: 2007-01-31
    3. Dissociation among Swedish Adolescents and the connection to trauma: An Evaluation of the Swedish version of Adolescent Dissociative Experience Scale
    Open this publication in new window or tab >>Dissociation among Swedish Adolescents and the connection to trauma: An Evaluation of the Swedish version of Adolescent Dissociative Experience Scale
    2006 (English)In: Journal of Nervous and Mental Disease, ISSN 0022-3018, Vol. 194, no 9, p. 684-689Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to investigate the psychometric properties of the Swedish version of Adolescent Dissociative Experience Scale (A-DES), dissociative symptoms among Swedish adolescents, and dissociative symptoms connected to trauma and sexual and physical abuse. A normative group of 400 adolescents aged 12 to 19 years and a clinical group of 20 adolescents with known experienced trauma were given A-DES. A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability, internal consistency and test-retest. Factor analysis in the normative sample (N = 400) resulted in a one factor solution. Correlation between A-DES and other measures of dissociation was high (r = .86). Significant differences for the total sum of A-DES were found in the normative group between adolescents with and without self-reported trauma and between the normative group and the clinical group with known experienced trauma. The Swedish version of A-DES was shown to be a screening instrument with satisfactory psychometric qualities and the capability of capturing dissociative symptoms in adolescents with self-reported trauma as well as clinical cases with identified trauma.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14268 (URN)10.1097/01.nmd.0000235774.08690.dc (DOI)
    Available from: 2007-01-31 Created: 2007-01-31
    4. The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children
    Open this publication in new window or tab >>The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children
    2008 (English)In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 32, no 6, p. 627-636Article in journal (Refereed) Published
    Abstract [en]

    Objective: To evaluate the psychometric properties of the Swedish version of the Trauma Symptom Checklist for Children (TSCC) and to study traumatic symptoms in a normative group of Swedish children and adolescents. Method: A normative group of 728 children and adolescents age 10-17 and a clinical group of 91 children and adolescents known to have experienced sexual abuse participated in the study. A test-retest procedure was conducted with 79 participants from the normative group. Results: Good reliability such as internal consistency (Cronbach's alpha) for the total scale .94 (ranging in the clinical scales .78-.83) and test-retest for the total scale r = .81 (ranging in the clinical scales .67-.81) were found. The confirmatory 6-factor analysis explained 50.7% of the variance. Other validity measures such as concurrent validity and criterion related validity were also shown to be satisfactory. The normative sample of Swedish children and adolescents showed lower means on the subscales than has been reported in previous studies from a number of other countries. Conclusion: The Swedish version of TSCC has been shown to be a screening instrument with satisfactory psychometric qualities that is capable to identify trauma symptoms among children and adolescents who have themselves self-reported experiencing trauma or for whom clinicians have identified traumatic experiences. © 2008 Elsevier Ltd. All rights reserved.

    Keywords
    TSCC, method, children, adolescents, trauma, sexual abuse
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-42956 (URN)10.1016/j.chiabu.2007.09.009 (DOI)70185 (Local ID)70185 (Archive number)70185 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2019-01-17
  • 15.
    Nilsson, Doris
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Dissociation among Swedish Adolescents and the connection to trauma: An Evaluation of the Swedish version of Adolescent Dissociative Experience Scale2006In: Journal of Nervous and Mental Disease, ISSN 0022-3018, Vol. 194, no 9, p. 684-689Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the psychometric properties of the Swedish version of Adolescent Dissociative Experience Scale (A-DES), dissociative symptoms among Swedish adolescents, and dissociative symptoms connected to trauma and sexual and physical abuse. A normative group of 400 adolescents aged 12 to 19 years and a clinical group of 20 adolescents with known experienced trauma were given A-DES. A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability, internal consistency and test-retest. Factor analysis in the normative sample (N = 400) resulted in a one factor solution. Correlation between A-DES and other measures of dissociation was high (r = .86). Significant differences for the total sum of A-DES were found in the normative group between adolescents with and without self-reported trauma and between the normative group and the clinical group with known experienced trauma. The Swedish version of A-DES was shown to be a screening instrument with satisfactory psychometric qualities and the capability of capturing dissociative symptoms in adolescents with self-reported trauma as well as clinical cases with identified trauma.

  • 16.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping. Linköping University, Faculty of Arts and Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Pribe, Gisela
    Linnaeus Univ, Dept Psychol, SE-35195 Vaxjo, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Polytraumatization in an adult national sample and its association with psychological distress and self-esteem2015In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 5, no 1, p. 62-74Article in journal (Refereed)
    Abstract [en]

    AbstractObjective

    The objective of this study was to examine the prevalence of self-reported experiences of potential childhood traumas and polytraumatization, and to find cut-off values for different kinds of potential traumatic events in a national representative sample of adults in Sweden. In addition, to analyse the association between polytraumatization and both psychological distress and global self-esteem.

    Method

    A web-based survey - containing SCL-25 and Rosenberg Self-Esteem Scale, and Linköping Difficult Life Events Scale - Adult - was sent out to a nationally reprative sample and 5062 people chose to participate in the study.

    Results

    Results showed that almost everyone (97%) has experienced at least one potential traumatic event and that polytraumatization (the 10% of the participants with most reported traumas) was significantly (Z = 12.57, P < 0.001, r = 0.18) associated with psychological distress and global self-esteem. Gender differences were significant (Z = 8.44, P < 0.001, r = 0.12), in that men experience more noninterpersonal traumas but women report more symptoms. The effect sizes regarding the impact of potential trauma on self-esteem were largest for women with experience of polytraumatization in the age group 18–25 (r = 0.48). There was almost linear increase in psychological distress and linear decrease in self-esteem with increasing number of traumatic events experienced.

    Conclusion

    Experience of polytrauma can be considered an important factor to take into account in psychiatric settings as well.

  • 17.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Bergh Johannesson, Kerstin
    National centre for disaster psychiatry, department of neuroscience, Uppsala university, Uppsala, Sweden.
    Evaluation of the Swedish Trauma Symptom Inventory -2 in a clinical and a studnet population2018In: European Journal of Trauma and Dissociation, ISSN 2468-7499, Vol. 2, no 2, p. 71-82Article in journal (Refereed)
    Abstract [en]

    Introduction. – The Trauma Symptom Inventory-2 (TSI-2) is a broad-spectrum assessment instrumentdesigned to identify symptoms that can appear in the aftermath of potentially traumatic experiences.

    Objective. – This study aimed to evaluate the external and internal validity of this newly reconstructedinstrument.Method. – In total, 696 individuals participated in the study, including 83 psychiatric outpatients. Participants answered the TSI-2, together with a trauma history questionnaire, and other questionnairesassumed to correlate with the different scales included in the TSI-2.

    Results. – Validity was evaluated by correlations between the TSI-2 and the other instruments and bythe differences between clinical and non-clinical populations. Reliability was calculated by testinginternal consistency and test-re-test reliability. A confirmatory factor analysis (CFA) was computed totest the postulated four-factor structure. Cronbach’s alpha was found to be good and ranged froma = .77 to .91 and test-retest reliability was strong. Strong to satisfactory correlations were foundbetween the TSI-2 and the other instruments. The student sample scored significantly lower than theclinical group on all clinical scales. Sensitivity and specificity were calculated with different cut-offscores.

    Conclusion. – Despite the CFA demonstrating a questionably good model of fit, most of the scales provedto be sound and the TSI-2 could be recommended as a broad-spectrum assessment instrument.

  • 18.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Bergh Johannesson, Kerstin
    Uppsala Psykoterapimottagning, Smedsgränd.
    Trauma Symptom Inventory™ -2 TSI-2: Svensk Version2015Book (Other academic)
    Abstract [sv]

    TSI-2 är ett självrapporteringsformulär som mäter posttraumatisk stress och relaterade symptom och beteenden. TSI-2 syftar till att identifiera symptom som kvarstår hos individen efter en eller flera svåra livshändelser. Mer specifikt är instrumentet avsett att användas för vuxna som har upplevt traumatiska händelser i livet såsom exempelvis fysiska eller sexuella övergrepp, olyckor, katastrofhändelser, traumatiska förluster, dödsfall av närstående, medicinska trauman eller bevittnat hot och våld. TSI-2 mäter ett brett spektrum av traumatiska symptom och lämpar sig framförallt för screening men kan också användas för att utvärdera effekter av psykoterapeutiska interventioner.

    TSI-2 består av 136 påståenden som ger resultat på:

    Två validitetsskalor

    Underrapportering eller förnekande av symptom, samt en skala gällande överrapportering av traumarelaterade symptom.

    Fyra faktorer

    Självförvirring, Posttraumatisk stress, Externalisering och Somatisering.

    Tolv kliniska skalor

    Ångestfylld spändhet, Depression, Ilska, Invaderande återupplevande, Undvikande, Dissociation, Somatisk upptagenhet, Sexuella svårigheter, Självmordsbenägenhet, Osäker anknytning, Skadad självkänsla, Spänningsreducerande beteende.

    Den svenska versionen av TSI-2 är standardiserad och normerad vid Linköpings universitet och Uppsala universitet under åren 2012-2014. Normgruppen består av sammanlagt 693 individer i åldrarna 18-65 år. En klinisk grupp med 83 individer ingår också i valideringen av den svenska versionen av TSI-2. Utvecklingsarbetet och den svenska versionens psykometriska egenskaper beskrivs i manualen, som även innehåller anvisningar för administrering, poängsättning och tolkning samt köns- och åldersspecifika normtabeller.

  • 19.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Green, Sara
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Psychoform and somatoform dissociation among children and adolescents: An evaluation of a new short screening instrument for dissociation, DSQ-122019In: European journal of trauma and dissociation, ISSN 2468-7499, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Introduction

    Today's assessment instruments for dissociation among adolescents are either relatively extensive or are specifically designed to identify either psychoform or somatoform dissociation.

    Objective

    A questionnaire that is shorter than any of the existing questionnaires and is concerned with both forms of dissociation would be helpful for both clinicians and researchers.

    Method

    Existing data from 462 adolescents who had answered Dis-Q Sweden and SDQ-20 were used to create a new questionnaire consisting of 12 items. A pilot study with 42 participants 15-19 years old, was carried out to test this new instrument, Dissociation Screening Questionnaire 12 (DSQ-12). DSQ-12 was then tested on 451 adolescents 10 to 20 years old. A matched clinical group of 25 adolescents in the same age range was used, in order to test the classification performance of DSQ-12.

    Results

    Results showed good reliability, convergent and construct validity was satisfactory, and dissociation differed between age groups as well as between genders.

    Conclusions

    Conclusions are that the developed DSQ-12 performed well psychometrically, was reliable and valid. DSQ-12 is easy to answer and is suitable for clinical screening purposes and future research.

  • 20.
    Nilsson, Doris
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Gustafsson, Per E
    Lund University.
    Goran Svedin, Carl
    Lund University.
    Self-reported potentially traumatic life events and symptoms of post-traumatic stress and dissociation2010In: NORDIC JOURNAL OF PSYCHIATRY, ISSN 0803-9488, Vol. 64, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate single potentially traumatic events and cumulative effects of these events based on the reported symptoms of post-traumatic stress and dissociation. An additional goal was to evaluate the psychometric properties of Life Incidence of Traumatic Events-Student scale (LITE-S). Methods: 400 adolescents from the normative population answered the questionnaire Life Incidence of Traumatic Experiences (LITE-S) together with Trauma Symptom Checklist for Children (TSCC), Dissociation-Questionnaire-Sweden (Dis-Q-Sweden) and Adolescent-Dissociative Experience Scale (A-DES). The single self-reported traumas, and the cumulative self-reported traumas and their effects on post-traumatic stress disorder and dissociative symptoms scales were examined. The psychometric properties of LITE-S were first investigated through calculating, test-retest reliability by Pearson correlation for the total scale and by Cohens kappa item per item. Results: Self-reported symptoms were related to both the cumulative traumas and exposure to some single traumas, such as seeing somebody get hurt, having parents destroy things or hurting each other, being whipped or hit, or even being made to carry out some kind of sexual act. Interpersonal events were consistently more strongly related to symptoms across the TSCC clinical scales. Finally, test-retest reliability as found to be for the total scale r = 0.76 and kappa item per item ranging between k = 0.33 and 0.86. Conclusion: The cumulative effects of potentially traumatic events on adolescents are significant, and interpersonal traumas results in more self-reported symptoms of post-traumatic stress and dissociation than non-interpersonal. LITE has satisfactory psychometric properties concerning reliability. Clinical implications: The results underline the importance in clinical practice of taking into consideration how many potentially traumatic events an adolescent has experienced before, seeking help on specific occasion. This knowledge can help the clinician to understand better the breadth of feelings their client is experiencing and thus can help the clinician better to be able to suggest appropriate treatment.

  • 21.
    Nilsson, Doris
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Gustafsson, Per. E
    Hälsa och familje medicin Umeå.
    Larsson, Jessica
    Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Child and Adolescent Habilitation.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Evaluation of the Linköping Youth Life experience Scale2010In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 198, no 10, p. 768-774Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate the psychometric properties of a newly developed instrument for potentially traumatic life events, the Linköping Youth Life Experience Scale (LYLES), and determine the benefits of including adverse childhood circumstances (ACCs) as factors in the evaluation. In addition, we wanted to investigate the difference between interpersonal and noninterpersonal traumatic events, the impact of ACCs, and the cumulative effects of these events on self-reported symptoms of dissociation, depression, and anxiety. Adolescents from the normative population (n = 188) answered the questionnaire LYLES and also the Dissociation-Questionnaire-Sweden and Hospital Anxiety and Depression Scale. The results showed that LYLES was stable, with test-retest r = 0.79 and kappa item per item ranging between k = 0.44 and 1.0. ACCs contributed independently to the explanation of symptoms explaining them better than potentially traumatic events alone, particularly for boys where the impact of ACCs exceeded the impact of events. The conclusions are that LYLES displayed satisfactory psychometric properties and that ACCs seem to be a valuable addition to an instrument to evaluate potentially traumatic events.

  • 22.
    Nilsson, Doris
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Gustafsson, Per E
    Umeå University, Sweden .
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Lifetime Polytraumatization in Adolescence and Being a Victim of Bullying2012In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 200, no 11, p. 954-961Article in journal (Refereed)
    Abstract [en]

    The purposes of this study were to examine the mental health consequences of having been a victim of bullying and to investigate whether the impact of bullying was dependent on the co-occurrence of other potentially traumatic events, noninterpersonal traumas, interpersonal traumas, as well as adverse childhood circumstances. less thanbrgreater than less thanbrgreater thanA community sample of participants (n = 462; 216 males and 246 females) aged 15 to 20 years completed the self-administered Linkopings Youth Life Experience Scale about lifetime exposure to a range of traumatic and other adverse events and circumstances and the Trauma Symptom Checklist for Children (TSCC). The results showed that those who reported being a victim of bullying reported significantly higher scores on all TSCC clinical scales as well as significantly more other traumatic and adverse family exposures. Multiple linear regression analyses indicated that the impact of bullying on mental health was explained, to a considerable degree, by the accumulation of other adverse and traumatic exposures, particularly in the females.

  • 23.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Gustafsson, Per, E
    Umeå University.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Polytraumatization and Trauma Symptoms in Adolescent Boys and Girls: Interpersonal and Noninterpersonal Events and Moderating Effects of Adverse Family Circumstances2012In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 27, no 13, p. 2645-2664Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate the cumulative effect of interpersonal and noninterpersonal traumatic life events (IPEs and nIPEs, respectively) on the mental health of adolescents and to determine if the adverse impacts of trauma were moderated by adverse family circumstances (AFC). Adolescents (mean age 16.7 years) from the normative population (n = 462) completed the questionnaire, the Linköping Youth Life Experience Scale (LYLES), together with Trauma Symptom Checklist for Children (TSCC). The lifetime accumulation of interpersonal, noninterpersonal, and AFC was independently related to trauma-related symptoms in both boys and girls. The number of AFCs moderated the mental health impact of both IPEs and nIPEs in boys but not in girls. Cumulative exposure to both interpersonal and noninterpersonal traumatic events is important for the mental health of adolescents, and, at least for boys, family circumstances seem to be relevant for the impact of trauma. Our results suggest that broader approaches to the study, prevention, and treatment of trauma, including consideration of cumulative exposure, different types of trauma, and additional social risk factors, could be fruitful.

  • 24.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Gustafsson, Per E.
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    The psychometric properties of the Trauma Symptom Checklist for Young Children in a sample of Swedish children2012In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 3, article id 18505Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the psychometric properties of the Swedish version of Trauma Symptom Checklist for Young Children (TSCYC).

    Method: The study was composed of a total of 629 children - 296 girls and 333 boys - aged 311, from a nonclinical population who were rated by their caretakers (26 of whom performed a re-test after 2 weeks) in addition to 59 children from a clinical population with known experience of sexual and/or physical abuse. The caretakers from the normal population completed the TSCYC and Lifetime Incidence of Traumatic Events Scale-parent scale (LITE-P) and the clinical-sample caretakers completed TSCYC. The psychometric properties of the TSCYC were examined, including reliability and validity.

    Results: The reliability (Cronbach’s alpha) of the TSCYC, total scale, was α=0.93 (normative group) and α=0.96 (clinical group). For the clinical scales, this ranged between α=0.550.88 and 0.770.93, respectively. Test-retest for the total scale was r0.77. Regarding criterion-related validity, the clinical groups scored significantly higher than the normative group, and within the normative group significant relationships were found between exposure to traumatic events and TSCYC scores. Confirmatory factor analysis testing of the construction of the TSCYC indicated significant loadings on the original scales.

    Conclusion: The Swedish version of TSCYC appears to be a screening instrument with satisfactory psychometric qualities for identifying symptoms after trauma in young children. The instrument can also be recommended to clinicians for screening purposes in a European context.

  • 25.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Jonsson, Mattias
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Health Sciences.
    Self-reported attachment style, trauma exposure and dissociative symptoms among adolescents2011In: Attachment & Human Development, ISSN 1461-6734, E-ISSN 1469-2988, Vol. 13, no 6, p. 579-595Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze whether self-reported attachment style (measuring avoidance and anxiety) among adolescents was associated with dissociative symptoms, in addition to self-reported potentially traumatic experiences. A group consisting of 462 adolescents completed three self-assessment questionnaires: Linkoping Youth Life Experience Scale (LYLES), Experiences in Close Relationships, modified version (ECR) and Dissociation Questionnaire Sweden (Dis-Q-Sweden). Self-reported attachment style had a stronger association with dissociative symptoms than self reported traumas. It was also found that scores on a dissociation questionnaire correlated strongly with scores on self-reported attachment style in adolescence. Discussion concerns reasons why self-reported attachment style is an important factor that may influence dissociative symptoms during adolescence.

  • 26.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Johansson, Erika
    Linköping University, Department of Behavioural Sciences and Learning.
    Larsson, Katarina
    Linköping University, Department of Behavioural Sciences and Learning.
    Näslund, Johan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    The experience of internal and external supporting objects from the perspective of six young women who have lost a parent to cancer: An interpretative phenomenological analyisis2017In: Annals of Psychiatry and Treatment, Vol. 2, no (2), p. 24-32Article in journal (Refereed)
    Abstract [en]

    Background: Adolescents losing a parent are a risk group for future complications in their ongoing live such as higher rate of mortality, self- harm and other mental health problems. There is a lack of knowledge in what, how and when to offer help as well as no concluding theoretical model to understand the whole process of losing a parent. The objective of this study was to examine how the relationships of some young people are affected by the loss of a parent to cancer during their teenage years.

    Method: Six women aged between 18 and 25 participated in the study. An Interpretative Phenomenological Analysis (IPA) method was used.

    Result: The theme of loneliness was cemented with the two main themes, into loneliness and out of loneliness and sub-themes such as, cancer comes along, silence, hold on to and miss, those closest, the supporters, independence, closeness and distance.

    Conclusion: The parent who has died lives on as an inner object and the support from the remaining parent is viewed very important. The process to be back on track seems diverse and continues for a long time and outside help needs to tune in with this.

  • 27.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Lejonclou, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Jonsson, Mattias
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Somatoform dissociation among Swedish adolescents and young adults: The psychometric properties of the Swedish versions of the SDQ-20 and SDQ-52015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 2, p. 152-160Article in journal (Refereed)
    Abstract [en]

    Background: Somatoform dissociation is supposed to be a vital aspect of the general concept of dissociation. The Somatoform Dissociation Questionnaire-20 (SDQ-20) and the brief version SDQ-5 are self-report instruments constructed to identify somatic dissociation. Aim: In the present study, the psychometric qualities of the Swedish version of the SDQ-20 and its brief version, the SDQ-5, were examined among adolescents and young adults. Reliability and concurrent validity were investigated. Methods: A total of 512 adolescents and young adults participated in the study: 461 adolescents from a non-clinical sample and 50 adolescents and young adults from a clinical eating disorder outpatient unit. They completed the self-report instruments the SDQ-20, the SDQ-5 (part of SDQ-20), the Linköping Youth Life Experience Scale (LYLES, a trauma history scale) and the Dissociation Questionnaire-Sweden (Dis-Q-Sweden). Results: Both internal consistency and test-retest reliability of the Swedish version of SDQ-20 were good in both the non-clinical (α = 0.83) and the clinical groups (α = 0.84); the reliability for the SDQ-5 was, however, lower (non-clinical α = 0.50, clinical α = 0.64). Significant differences were found between the clinical and non-clinical groups on both somatoform and psychoform dissociation. Correlations between the Dis-Q-Sweden, SDQ-20 and SDQ-5 were generally high. The criterion and convergent validity was acceptable for both scales but somewhat better for SDQ-20 than for SDQ-5. Conclusion: The advantage with both the SDQ-20 and the SDQ-5 is that they are short questionnaires, but the results suggests that SDQ-20 is preferable based on the higher-quality psychometric properties of the SDQ-20.

  • 28.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Lejoonclou, Annika
    Region Östergötland.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Psychoform and somatoform dissociation amongindividuals with eating disorders2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: This study analyzed the prevalence of psychoform and somatoform dissociation among individuals with the whole spectrum of eating disorder diagnoses and compared it with ratings from a non-clinical group. The relationship between dissociation and severity of eating disturbance was examined as well as differences between the eating disorder diagnosis groups in extent of dissociation. The validity of a new structural dissociation interview suitable for eating disorder patients was analyzed.

    Method: Sixty individuals with eating disorder completed three self-report questionnaires: Dissociation Questionnaire Sweden, Somatoform Dissociation Questionnaire and Eating Disorder Examination Questionnaire. The ratings were compared with the scores in a female non-clinical group (N = 245). Twenty patients with eating disorder diagnoses were interviewed with the Interview for Dissociative Disorders and Trauma Related Symptoms. The validity of the interview was tested by comparing the ratings on the interview subscales with the scores on the Dissociation questionnaires and the Somatoform Dissociation Questionnaire.

    Results: Participants with eating disorders reported a higher extent of both psychoform and somatoform dissociation compared with the non-clinical individuals. Analyses also showed a correlation between degree of dissociation and severity of eating disorder symptoms. No differences in dissociation were found between the ED subgroups. Participants reporting more dissociation got higher ratings on the interview, indicating convergent validity.

    Discussion: Eating disorders seem to be associated with presence and severity of dissociative symptoms. The extent of dissociation needs to be assessed for these individuals as treatment may benefit from a focus on such symptoms in order to increase its effect.

  • 29.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nordenstam, Carin
    Uppsala Univ, Natl Ctr Disaster Psychiat, Akad Sjukhuset, SE-75185 Uppsala, Sweden.
    Green, Sara
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Wetterhall, Annika
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Lundin, Tom
    Uppsala Univ, Natl Ctr Disaster Psychiat, Akad Sjukhuset, SE-75185 Uppsala, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Child and Adolescent Psychiatry in Norrköping.
    Acute stress among adloescents and female rape victims measured by ASC-Kids: A pilot study2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 7, p. 539-545Article in journal (Refereed)
    Abstract [en]

    Background: Rape is considered a stressful trauma and often with durable consequences. How the aftermath of rape is for young adolescents' girls considering acute stress is an overlooked field and remains to be studied. Aims: In this study, we wanted to investigate acute stress among adolescent victims of rape and the psychometric properties of the Acute Stress Checklist for Children (ASC-Kids). Methods: A clinical sample (n = 79) of raped girls, 13-17 years old who had turned to a special rape victim unit for treatment, answered the ASC-Kids. ASC-Kids was also given to a group of minor stressed, non-raped adolescents in the same age range (n = 154) together with the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD RI), and the Sense of Coherence Scale 13 (SOC-13). Results: The scores from the groups were compared and showed significant differences in mean values on all the diagnostic criteria of acute stress disorder. In the clinical group, 36.7% obtained full ASD criteria. ASC-Kids could discriminate well between groups. Cronbach's alpha was found to be excellent, and the correlation between the UCLA PTSD RI and ASC-Kids found to be good; both ASC-Kids and UCLA PTSD RI had a good and moderate negative correlation with SOC-13. Conclusion: Adolescent female rape victims were shown to have a very high level of acute stress, and the ASC-Kids was found to have sound psychometrics and can be a valuable screening instrument to support clinicians in their assessments of an indication of adolescents after potentially stressful events such as rape.

  • 30.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Nordås, Elvira
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Priebe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Department of Psychology, Lund University, Lund, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Child physical abuse: High school students’ mental health and parental relations depending on who perpetrated the abuse2017In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 70, p. 28-38Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to contribute to the research of child physical abuse (CPA) by examining if there were any differences in high school students’ mental health (in this study symptoms of depression and anxiety, self-esteem and sense of coherence) and/or, in how they perceive their parents, depending on whether or not they had been subjected to CPA during childhood. In addition, if high school students reported different mental health and/or, relationships with their parents, depending on if their mother, father or both parents were the perpetrators of CPA.

    A representative national sample of high school students (N = 3288, data collected 2009) participated in the study. Participants completed the following: questions about CPA and alleged perpetrators, the Hopkins Symptom Checklist, Rosenberg Self-Esteem Scale, the Sense of Coherence Scale and Parental Bonding Instrument.

    The results showed students who reported experiences of CPA were more likely to report symptoms of mental illness and negative perceptions of their parents’ parenting. However, there were no mental health differences depending on whether their mother, father or both parents were the perpetrators of CPA. Still, there were differences in perceived parenting indicating that mothers’ parenting was perceived as more negative when mothers only or both parents were perpetrators of the abuse than when only fathers were perpetrators.

  • 31.
    Nilsson, Doris
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Evaluation of the Swedish version of Dissociation Questionnaire (DIS-Q), Dis-Q-Sweden, Among Adolescents2006In: Journal of Trauma & Dissociation, ISSN 1529-9732, Vol. 7, no 3, p. 65-89Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the psychometric properties of the Swedish version of the Dissociation Questionnaire in a normative adolescent population and also to investigate dissociative symptoms associated with trauma including sexual and physical abuse. A normative sample of 449 adolescents between the ages of 12 and 19 and a clinical group of 74 adolescents with known experiences of trauma, sexual and/or physical abuse was given Dis-Q-Sweden. A mixed group of 22 abused and non-abused adolescents who answered Dis-Q-Sweden was also interviewed by using the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability concerning both internal consistency and test-retest stability. Validity was tested in several ways (criterion, predictive, construct and concurrent) and found to be satisfactory. Significant differences for the total sum scores of Dis-Q-Sweden were found between the normative group and the clinical group with known sexual abuse (p < 0.001). The prevalence of dissociative symptoms (cut-off score > 2.5) was 2.3% in the normative group and 50% in the clinical group. Dis-Q-Sweden has proven to be a screening instrument with good psychometric properties and has proven to be able to capture dissociative symptoms in adolescents with self-reported trauma and known trauma (sexual abuse).

  • 32.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Kunskapsöversikt om stöd och behandling för barn som utsatts för sexuella övergrepp och fysisk misshandel2017Report (Other academic)
    Abstract [sv]

    Denna översikt är inte vad man brukar kalla en systematisk litteraturöversikt utan en översikt i huvudsak baserad på tidigare kunskapsöversikter och metaanalyser. Det innebar att enstaka artiklar och studier kan ha förbisetts beroende på de sökord som har använts i de olika översiktsartiklarna och metaanalyserna. Vi har dock så långt det är möjligt letat i andra sammanställningar och organisationers hemsidor för att minimera risken för att viktiga instrument och evidensbaserade interventioner missats.

    Det som framkommit i denna kunskapsöversikt är att när något barn eller ungdom varit utsatt för ett trauma så är det viktigt att det tidigt finns ett gott omhändertagande för att lindra och om möjligt förhindra en negativ utveckling av den psykiska hälsan som följd av att ha varit utsatt för ett potentiellt trauma. I vissa fall och kanske framförallt när det gäller potentiella trauman som inte innehåller våld eller sexuella övergrepp kan det kanske räcka med en kortare men evidensbaserad tidig intervention. Forskning visar att det för ungefär hälften av de traumatiserade barnen sker en spontanläkning de första tre månaderna av posttraumatisk stress, för att sedan plana ut, men att det efter 6 månader inte längre är troligt att symtomen försvinner utan intervention (Hiller et al., 2016).

    Genom screening och annan bedömning bör man kunna avgöra om barnet eller ungdomen behöver någon ytterligare behandling, förslagsvis då en av de evidensbaserade behandlingar som finns, och vid mer komplex traumatisering en behandling anpassad för detta ändamål.

    Det är dock viktigt att betona att en del barn och ungdomar kan behöva behandling omedelbart, till exempel när allvarliga symtom utvecklas snabbt. Observera också att tidsintervallet inom 4 veckor avser tid efter traumahändelsen, inte tid efter avslöjande eller anmälan. Våld och sexuella övergrepp består inte sällan av många händelser över tid. Utsatta barn berättar ofta att de utsatts en lång tid efteråt. Vid avslöjandet kan de redan ha utvecklat symtom som kräver behandling direkt.

    För att kunna ge rätt insats/behandling, både tidigt och senare, efter ett eller flera potentiella trauman, är det viktigt med validerade mätinstrument för screening av traumaerfarenheter och symtom, men även för bedömning av mer allvarlig problematik/diagnoser. Detta är något som framkommit mycket tydligt under arbetet med denna kunskapsöversikt. Då det många gånger är psykologiska begrepp och symtom som inte så lätt låter sig identifieras, operationaliserar man det man vill mäta med frågor som besvaras av den som berörs. Man försöker identifiera hur en person mår, vilka symtom den har etc. genom ett frågeformulär som används regelbundet bland t.ex. barn och ungdomar. Efter att ha studerat formulärets kvaliteter (att det mäter vad det utger sig för att mäta och att det är stabilt över tid) har man utvecklat ett standardiserat instrument för att mäta ett visst symtom. Det är i detta sammanhang också viktigt att påpeka att de mätinstrument man använder även är undersökta i det land de används.

    Sammanfattning av Bedömningsinstrument

    I denna översikt finns såväl skattnings- och bedömningsinstrument som mäter förekomsten av trauma som instrument som mäter symtom och beteendeproblem som kan förknippas med traumatiska händelser. Instrumenten kan vara i form av intervjuer, mer eller mindre kliniska/diagnostiska eller utformade som självsvarsformulär.

    Barn och unga är givetvis en viktig källa då det gäller information omkring deras egna erfarenheter och posttraumatiska reaktioner och de rapporterar sina erfarenheter (Bernstein et al., 1997) och sina symtom tillförlitligt (Hamby, Finkelhor, Ormod & Turner, 2005). Dessutom rapporterar de mer symtom än vad andra gör å deras vägnar (Nader, 2008). Då det gäller överensstämmelsen mellan hur olika informanter rapporterar barns erfarenhet av potentiellt traumatiska händelser så har den visat sig inte vara särskilt god (Tingskull, Svedin, Agnafors, deKeyser, Sydsjö & Nilsson, 2013) varför vi med ledning av ovanstående rekommenderar att använda självsvarsformulär för de barn och ungdomar som själva kan hantera dessa.

    När det gäller att screena för erfarenheter av potentiellt traumatiska händelser traumaformulär så kan man välja att använda kortare formulär som på så sätt tidsmässigt är lättare att administrera (LITE, LYLES) eller längre och mer omfattande formulär som JVQ som ger en mer allsidig bild av barnets utsatthet. För mindre barn finns då föräldraversioner av såväl LITE som LYLES.

    Symtomformulär finns med olika inriktning och i huvudsak ser vi översatta formulär som mäter akut stress, symtom relaterade till traumaupplevelser, som posttraumatiskt stressyndrom samt formulär som mäter dissociativa symtom. Här finns flera att välja på men det som är mest allsidigt och mest använt i Sverige är TSCC och TSCYC vars nackdelar är att de inte är fria att användas utan kostnad och behörighet. För akut stress finns ASC-kids. Beträffande dissociation så finns flera formulär att välja på men tre som är relativt lättadministrerade är Dis-Q-Sweden (självsvar), CDC (föräldrasvar) samt SDQ-20 vid misstanke om somatoform dissociation.

    Vid behov av vidare diagnostik finns en rad kliniska standardiserade intervjuer men där kanske K-SADS-PL eller M.I.N.I. KID är de mest använda i klinisk praxis med barn och ungdomar.

    För forskning så är det också angeläget att använda internationellt erkända formulär om man vill jämföra traumaförekomst eller symtom efter potentiellt traumatiska upplevelser med undersökningar från andra länder.

    För framtiden ser vi behov av att fler instrument översätts till andra språk då Sverige idag är ett multikulturellt samhälle med stort inflöde av unga människor med annan språklig bakgrund, traumatiska erfarenheter samt traumarelaterade symtom. Det finns också behov av att översätta eller utveckla ett kortare kombinerat instrument för screening av såväl traumahistoria som symtom.

    Sammanfattning av tidig intervention

    Att tidigt kunna ge stöd och hjälp vid upplevda potentiella trauman såväl naturkatastrofer, trafikolyckor som vid våld och sexuella övergrepp måste anses som viktigt.

    Att kunna identifiera barn som riskerar att utveckla posttraumatisk stress kan spela en viktig roll när det gäller att minska risken för att utveckla kvarstående svårigheter efter potentiellt traumatiska händelser. Detta är något som framkommer i alla dessa studier. Ingen studie rapporterar skadlig inverkan vid de tidiga interventionerna. Således hittar man positiva tendenser även om inte man inte alltid får signifikanta symtomreduktioner när det gäller posttraumatisk stress. De flesta av studierna har interventioner som bara är en gång, vissa 1–2 och ibland endast en information via webben och en broschyr. Den intervention som framstår som den mest välgjorda studien var metoden Child and Family Traumatic Stress Intervention (CFTSI) (metoden beskrivs i kapitlet om tidig intervention) som visade på bäst resultat med signifikant symtomreduktion på flera utfallsmått och även posttraumatisk stress efter 4 sessioner. Denna metod har även i en icke randomiserad studie (n=114, 5-8 sessioner) vid för- och eftermätning visat på signifikanta resultat och metoden är också bedömd av CEBC som ha ett lovande vetenskapligt stöd (nivå 3).

    Det som i denna kunskapsöversikt samstämmigt framkommit i alla studierna är att screena för risk samt ge psykoedukation om trauma och hur man kan reagera efter en traumatisk händelse samt information om vad som kommer att ske.

    De svagheter vi kan se är att i stort sett inga interventioner vänder sig till barn under 6–7 års ålder samt att de flesta interventioner vänder sig till barn som varit utsatt för kroppsligt trauma såsom bilolyckor. Få vänder sig till barn som upplevt interpersonella trauman.

    För framtiden ser vi ett behov av att i Sverige utvärdera och implementera såväl CFTSI som den modell ”Efter barnförhöret” som utvecklats av Elfström, Landberg och Olofsson (2017).

    Sammanfattning av Behandling

    Det framkommer tydligt från studierna i denna kunskapsöversikt att psykologiska behandlingar för barn och ungdom som exponerats för potentiella trauman hjälper. De hjälper för barn och ungdomar som varit utsatt för våld och eller sexuella övergrepp. Det finns också flera studier som visar att det är viktigt att också välja behandling utefter barnets erfarenheter, behov och förutsättningar såsom ålder, typ av övergrepp/trauma, vad man söker för och vilket problem man tycker att man har. De komponenter som förkommer i alla de behandlingar som visar på stark evidens är: Psykoedukation om trauma och prevalens, och vad trauma kan få för inverkan (impact) och om behandlingen; träning i känsloregleringsstrategier (t.ex. avslappning, identifikation av känslor, kognitiv koping, imaginär exponering, in vivo exponering, kognitivt processande och problemlösning).

    Av den ovanstående genomgången blir det tydligt att det också finns mer evidens för vissa behandlingar än andra ibland beroende på att det finns fler studier av en viss sorts behandling och färre eller mycket små av en annan typ.

    Det finns i dagsläget ett mycket starkt stöd för TF-KBT baserat på minst 17 randomiserade studier som styrker TF-KBT:s effektivitet. Behandlingen har kortfattat beskrivits i detta dokument. Dock ska man beakta att TF-KBT vänder sig till barn som fyllt 6 år och som har ett bättre utvecklat språk och har större kognitiva förmågor än yngre barn. När det gäller yngre barn (under 6 år) så bör leken få en större plats. Child and Parent Psychotherapy (CPP) är en behandling som visat sig vara troligen effektiv. Även denna behandling är kortfattat beskriven i detta dokument och rekommenderas till mindre barn som bevittnat våld. Även EMDR kan ges till mycket små barn Kognitiv integrerad behandling vid Barnmisshandel (KIBB) är ytterligare en behandling för barn 6 år och äldre och där det beslutats att barnet ska fortsättta leva med den som utövat våldet. KIBB har de ingredienser som de väletablerade behandlingarna har men har fortfarande för få och för små studier.

    Således är det TF-KBT som kan sägas vara den behandling som bör rekommenderas i första hand när det gäller sexuella övergrepp. Vid fysisk misshandel rekommenderas KIBB om barnet ska fortsätta leva med den som utsatt barnet, i annat fall TF-KBT. För yngre barn rekommenderas CPP och EMDR.

    För ungdomar som uppvisar mer komplex traumatisering rekommenderas IITCT som innehåller alla plus fler ingredienser som de väletablerade behandlingarna gör.

    Det är viktigt att se var i vårdkedjan de olika behandlingarna kommer in alltifrån exponering av ett potentiellt trauma, screening/risk, bedömning, behandling som sätts in efter ca 4 veckor eller om det behövs mer komplexbehandling. För de svenska Barnahusen syns det som en viktig uppgift att till alla barn erbjuda screening av trauma och symtom samt tidig intervention. Även bedömning för fortsatt terapi är en viktig uppgift samt tillförsäkra och ha rutiner för att de barn som bedöms ha ett behov av fortsatt behandling också erhåller detta allt i enlighet med FN’s konvention om barns rättigheter.

    Det visar sig således att vi idag har en god kunskap om vad som är effektivt när det gäller arbete med barn och trauma men inför framtiden ser vi ett behov av att denna kunskap implementeras samt att barn oavsett var man bor i Sverige får ett likartat bemötande baserad på forskning (evidens) och beprövad erfarenhet (framtida evidens).

    Vi har i denna genomgång inte hittat terapiformer som anpassats eller utvecklats för barn med olika typer av funktionsnedsättningar.

  • 33.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Trauma Symptom Checklist for Children: Manualsupplement2010Other (Other academic)
  • 34.
    Nilsson, Doris
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Symboldrama, a Psychotherapeutic Method for Adolescents with Dissociative and PTSD Symptoms: A Pilot Study2010In: Journal of Trauma & Dissociation, ISSN 1529-9732, E-ISSN 1529-9740, Vol. 11, no 3, p. 308-321Article in journal (Refereed)
    Abstract [en]

    A total of 15 clinically referred adolescents who had been sexually or physically abused participated in this pilot study of the use of symboldrama psychotherapy. Symboldrama is a psychotherapeutic method that uses imagery as the major psychotherapeutic tool. All adolescents reported to be suffering from a high level of dissociative symptoms and other symptoms such as anxiety, depression, posttraumatic stress, and anger after their traumas. The objective of the study was to test the hypothesis that symboldrama psychotherapy in addition to psycho-education of the non-offending parent would significantly reduce the reported symptoms. Before treatment, the participants answered three questionnaires: (a) the Life Incidence of Traumatic Events Scale, (b) the Trauma Symptom Checklist for Children, and (c) the Dissociation Questionnaire-Swedish version. After treatment, the participants once again filled out the Trauma Symptom Checklist for Children and the Dissociation Questionnaire-Swedish version. The scores from before and after treatment were compared, and the results showed that the symptoms had been statistically significantly reduced.

  • 35.
    Nilsson, Doris
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Wadsby, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry .
    Svedin, Carl Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry .
    The psychometric properties of the Trauma Symptom Checklist For Children (TSCC) in a sample of Swedish children2008In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 32, no 6, p. 627-636Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the psychometric properties of the Swedish version of the Trauma Symptom Checklist for Children (TSCC) and to study traumatic symptoms in a normative group of Swedish children and adolescents. Method: A normative group of 728 children and adolescents age 10-17 and a clinical group of 91 children and adolescents known to have experienced sexual abuse participated in the study. A test-retest procedure was conducted with 79 participants from the normative group. Results: Good reliability such as internal consistency (Cronbach's alpha) for the total scale .94 (ranging in the clinical scales .78-.83) and test-retest for the total scale r = .81 (ranging in the clinical scales .67-.81) were found. The confirmatory 6-factor analysis explained 50.7% of the variance. Other validity measures such as concurrent validity and criterion related validity were also shown to be satisfactory. The normative sample of Swedish children and adolescents showed lower means on the subscales than has been reported in previous studies from a number of other countries. Conclusion: The Swedish version of TSCC has been shown to be a screening instrument with satisfactory psychometric qualities that is capable to identify trauma symptoms among children and adolescents who have themselves self-reported experiencing trauma or for whom clinicians have identified traumatic experiences. © 2008 Elsevier Ltd. All rights reserved.

  • 36.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Ängarne-Lindberg, Teresia
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Children who lose a parent suddenly: what kind of assistance do they feel provides relief?: a content analysis study of children and their parents2016In: Child Care in Practice, ISSN 1357-5279, E-ISSN 1476-489X, Vol. 22, no 2, p. 197-209Article in journal (Refereed)
    Abstract [en]

    There are few studies that have investigated children and adolescents’ own perceptions of early intervention following the death of a parent, and even fewer that focus on children and adolescents who have lost a parent suddenly. The aim of this study was to use interviews to identify what children and the surviving parent perceived to be helpful or unhelpful in terms of the interventions they received when a parent died suddenly. The children and young people in the study had received help from a team whose work involves early intervention for children and adolescents affected by the sudden death of a parent. Fourteen adolescents and 15 parents were interviewed for this purpose. The interview material was analysed using qualitative content analysis. The results identified one theme (perception of support), two categories (feeling confident and secure; and receiving help to bring about order), and six subcategories (a feeling of being noticed and attended to; a feeling that they knew what they were doing; a feeling of being able to hand over; a feeling of being in a free zone; a feeling of recovery and inner order; and a feeling of clarity and structure).

  • 37.
    Svedin, Carl Göran
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Nilsson, Doris
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Lindell, Charlotta
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Traumatic experiences and dissociative symptoms among Swedish adolescents: A pilot study using Dis-Q-Sweden2004In: Nordic Journal of Psychiatry, ISSN 0803-9488, Vol. 58, no 5, p. 349-355Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the occurrence of dissociative symptoms in relation to reported traumatic experiences among adolescents. A normative sample of 216 adolescents and a clinical sample of 30 cases with a history of traumatization were given the Swedish translation of Dissociation Questionnaire, DIS-Q. The results showed that 8.8% of the adolescents reported scores above the cut-off score of 2.5 on the Dis-Q-Sweden, with a female-male ratio of 2.6:1. In the normative sample, 53 (24.5%) of the adolescents reported one or more trauma experiences. The adolescents who self-reported trauma experiences in the normative sample scored higher on the total Dis-Q-Sweden scores and on three of the four subscales compared to the adolescents with no such experiences. The clinical group exhibited significantly higher Dis-Q-Sweden scores than the normative sample on every scale, with 60% above the cut-off score. The study confirms the results from earlier studies that adolescents with a history of trauma exhibit more dissociative symptoms in this study according to Dis-Q-Sweden. The impact of trauma qualities and background factors on the development of dissociative symptoms need to be studied further.

  • 38.
    Thulin, Johanna
    et al.
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Kjellgren, Ceclia
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Children’s disclosure of physical abuse: the process of disclosing and the responses from social welfare workers2019In: Child Care in Practice, ISSN 1357-5279, E-ISSN 1476-489XArticle in journal (Refereed)
    Abstract [en]

    Children experiencing physical abuse by their parents are left with several difficult decisions. The present study aims at exploring the process of disclosing the abuse and the responses from social welfare workers from a child perspective, in a Swedish context. Data was obtained from in depth interviews with 15 children with a history of child physical abuse. A qualitative content analysis was conducted in order to capture the children's experiences. Disclosing abuse was described as a process including several judgements from the child. Children describe their everyday life before disclosing, with an escalation of violence making them think they have to act in order to prevent further abuse. They made several well-thought decisions and selected a trustworthy recipient. The decision to disclose was often made out of fear, but the fear could remain after the disclosure, not knowing what will happen next. Children seem to lose control over how their abuse narratives are handled after disclosing. The recipient and social welfare worker was acting but not informing or consulting the child. Children emphasize the importance of trustworthy and competent adults when disclosing physical abuse. Ethical issues and implications for practice are discussed.

    Practitioner messages

    • Disclosure is to be seen as a process, including several judgements by the child.

    • Children emphasize the importance of trustworthy and competent adults when choosing to disclose physical abuse.

    • Social welfare workers should inform and include children in their decision making.

  • 39.
    Thulin, Johanna
    et al.
    Linnéuniveristet, Sweden.
    Kjellgren, Ceclia
    Linnéuniversitetet, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Children's experiences with an intervention aimed to prevent further physical abuse2019In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206, Vol. 24, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Although many children across cultures are victims of physical abuse, few treatment models target these children and their parents. In Sweden, Combined Parent–Child Cognitive Behavioural Therapy for families at risk for child physical abuse has been successfully used according to pretreatment and posttreatment studies. However, few studies have explored how physically abused children experience treatment. This study includes 20 physically abused children aged 9–17 who completed Combined Parent–Child Cognitive Behavioural Therapy. Children had a positive overall impression of the treatment and highlighted addressing the abuse, as well as processing their experiences as particularly essential. Children described a positive transformation in their family life as a result of treatment, including violence cessation and bonding among family members. Children experienced the intervention as inclusive and child‐friendly. The implications of the promising findings are discussed.

  • 40.
    Thulin, Johanna
    et al.
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Kjellgren, Ceclia
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Youth Reports of Parental Strategies and sense of Coherence: Are experienced of Being Victim of Physical Abuse Reflected2018In: Young - Nordic Journal of Youth Research, ISSN 1103-3088, E-ISSN 1741-3222, p. 1-17Article in journal (Refereed)
    Abstract [en]

    This article explores adolescent’s reports of parental strategies and sense of coherence (SOC). Building on the suggested impact of child physical abuse, this study compares reports from a group of physically abused youth and a group of non-abused youth. Independent t-test, correlations and hierarchical linear regression analysis were computed. Findings indicate that parents’ use of corporal punishment could affect how youth report their parent’s parental strategies. Physically abused youth report less parental involvement and positive parenting as well as more inconsistent parenting than non-abused youth. Furthermore, physically abused youth report a significant lower SOC than non-abused youth. Being a victim of physical abuse had a unique contribution on SOC, even after controlling for other parental strategies. Taken together, the results suggest that child physical abuse affects both the youth’s inner SOC as well as their reports of parental strategies in several ways. Implications for practice are discussed in this article.

  • 41.
    Thulin, Johanna
    et al.
    Linnéuniversitetet, Växjö, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Kjellgren, Ceclia
    Linnéuniversitetet, Växjö, Sweden.
    Outcomes of CPC-CBT in Sweden Concerning Psychosocial Well-Being and Parenting Practice: Children’s Perspectives2019In: Research on social work practice, ISSN 1049-7315, E-ISSN 1552-7581, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Purpose:

    This study explores the outcome of the intervention combined parent child–cognitive behavioral therapy (CPC-CBT) for physically abused children.

    Method:

    This study includes a clinical sample of children (n = 62) referred to Child Welfare Service due to reports of child physical abuse who completed CPC-CBT. A pretest/posttest design was applied to assess changes on the Trauma Symptom Checklist for Children (TSCC) after treatment and was compared with normative values. In addition, the occurrence of corporal punishment from pre to posttest was explored.

    Results:

    Children reported a significant decrease in parental use of corporal punishment after treatment and a significant reduction in symptoms associated with trauma (decreased to normal values for TSCC). The positive changes remained at the 6-month follow-up.

    Conclusions:

    The CPC-CBT intervention seemed to decrease parental use of corporal punishment and increase the well-being of children. Clinical implications are discussed.

  • 42.
    Tingskull, Sylvia
    et al.
    Child and Adolescent Psychiatry Clinic, Karlskrona, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Agnafors, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    deKeyser, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Parent and Child Agreement on Experience of Potential Traumatic Events2013In: Child Abuse Review, ISSN 0952-9136, E-ISSN 1099-0852, Vol. 24, no 3, p. 170-181Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the agreement between parent and child report of potential traumas experienced, to look at the agreement by interpersonal versus non-interpersonal traumas and by gender. A birth cohort of 1723 children and their parents was followed from three months until 12 years after birth (South East Sweden Birth Cohort (SESBiC) study). At 12-year follow-up, 1174 children, 875 mothers and 601 fathers completed the Life Incidence of Traumatic Events (LITE) questionnaire. Cohen's kappa was used to assess the agreement between parent and child reports of traumas experienced by the child. The group was split by gender and kappa statistics were computed to determine the level of agreement between the different informants. The sample was also analysed according to the nature of the traumatic event: interpersonal or non-interpersonal. Agreement was low across most types of traumas reported between parents and children and moderate between mothers and fathers. Agreement was lower when the trauma was interpersonal. No significant discrepancies in general were found on gender. The study highlights the importance of from whom the researcher collects information. In future research, it is important to study the significance the choice of information source might have on reported symptoms and behavioural problems.

  • 43.
    Waller, Rosalind
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Tholander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    "You will have these ones!": Six women's experiences of being pressured to make a contraceptive choice that did not feel right2017In: Social Sciences, ISSN 2076-0760, E-ISSN 2076-0760, Vol. 6, no 4, article id 114Article in journal (Refereed)
    Abstract [en]

    This study aims to contribute to an understanding of women’s experiences of contraceptive counselling, and of being pressured to make a contraceptive choice that did not feel right. Six women in Sweden participated insemi-structured interviews, which were analysed through interpretative phenomenological analysis. The results were organised into three themes: (1)The normalisation process, i.e., the ways in which the women experienced using the contraceptive were being promoted as a natural part of womanhood; (2)Drawing the shortest straw, i.e., the women’s experiences of encountering insensitive caregivers; and (3) Feeling like a guinea pig,i.e., the women’s sense of not being allowed to control the situation and make their own choices. In conclusion, the experience of not being respected in the healthcare system could lead to consequences not only for women’s sense ofself-efficacy with regard to contraceptives, but also for their willingness to engage in renewed counselling. The caregivers’ communicative skills are, therefore, of prime importance.

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