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  • 1.
    Afzelius, Maria
    et al.
    Malmö University, Sweden.
    Ostman, Margareta
    Malmö University, Sweden.
    Råstam, Maria
    Lund University, Sweden; University of Gothenburg, Sweden.
    Priebe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Lund University, Sweden.
    Parents in adult psychiatric care and their children: a call for more interagency collaboration with social services and child and adolescent psychiatry2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, no 1, p. 31-38Article in journal (Refereed)
    Abstract [en]

    Background: A parental mental illness affects all family members and should warrant a need for support.Aim: To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration.Methods: Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients main diagnoses, comorbidity, children below the age of 18, and child-focused interventions.Results: Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care.Conclusions: Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.

  • 2.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics 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.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Mental health in young mothers, single mothers and their children2019In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 19, article id 112Article in journal (Refereed)
    Abstract [en]

    Background: Parenthood is a life transition that can be especially demanding for vulnerable individuals. Young maternal age and maternal single status have been reported to increase the risk for adverse outcomes for both mother and child. The aim of this study was to investigate the effect of young maternal age and maternal single status on maternal and child mental health and child development at age 3. Methods: A birth-cohort of 1723 mothers and their children were followed from birth to age 3. Sixty-one mothers (3.5%) were age 20 or younger, and 65 (4.0%) reported single status at childbirth. The mothers filled out standardized instruments and medical information was retrieved from the standardized clinical assessment of the children at Child Welfare Centers, (CWC). Results: Young maternal age was associated with symptoms of postpartum depression whereas single status was not. Young mothers were more prone to report internalizing and externalizing problems in their children, while there was no association between single status and child behavioral problems. No differences were seen on child development (CWC scores). School drop-out was, however, a more influential factor on depressive symptoms postpartum than maternal age. Conclusion: Young mothers are at increased risk for symptoms of postpartum depression which indicates the need for attention in pre- and postnatal health care programs. Single mothers and their children were not found to be at increased risk for adverse outcomes. The importance of schooling was demonstrated, indicating the need for societal support to encourage adolescents to remain in school.

  • 3.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health 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.
    Oreland, Lars
    Uppsala University, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Comasco, Erika
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 122017In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 48, no 4, p. 584-596Article in journal (Refereed)
    Abstract [en]

    An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on preadolescence behavior. Data from 889 children and mothers from a birth cohort were used. An adversity score was created by combining maternal symptoms of depression, psychosocial risk and childrens experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament, social functioning, and maternal sense of coherence. The l/ l genotype of the serotonin transporter linked polymorphic region was associated with lower internalizing scores, but not mainly related to the level of adversity. An easy temperament was associated with resilience for children exposed to high adversity. Social functioning was found to be promotive independent of the risk level. The results support a multiple-level model of resilience indicating effects, though small, of both biological and psychosocial factors.

  • 4.
    Aho, Nikolas
    et al.
    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.
    Proczkowska Björklund, Marie
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health 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.
    Peritraumatic reactions in relation to trauma exposure and symptoms of posttraumatic stress in high school students2017In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 8, no 1, article id 1380998Article in journal (Refereed)
    Abstract [en]

    Background: Exposure to traumatic events is clearly associated with a diversity of subsequent mental health problems, with posttraumatic stress disorder (PTSD) as the most prevalent disorder. Epidemiologically, trauma exposure rates are more prevalent than PTSD, indicating that most trauma victims do not develop PTSD. More knowledge is needed to understand the development of the different posttraumatic pathways including the significance of pretraumatic, peritraumatic and posttraumatic risk factors. Objective: To study peritraumatic reactions in relation to trauma exposure and symptoms of posttraumatic stress and to enhance our understanding of peritraumatic reactions as mediators between trauma and later symptomatology. Method: The study was composed of a representative community sample of 5332 second year high school students (mean age 17.3 years) who completed the Juvenile Victimization Questionnaire (SAQ/JVQ), Trauma Symptom Checklist for Children (TSCC) and answered questions about peritraumatic reactions. Mediation effects of peritraumatic reactions on the trauma exposure relationship to symptoms was tested using the PROCESS macro for SPSS. Results: Traumatic events are common (84.1%) and are accompanied in three-quarters of the students with at least one form of peritraumatic reaction. Peritraumatic reactions, especially peritraumatic dissociative reactions, mediate the relationship between trauma exposure and symptoms, and gender moderates the effect of peritraumatic dissociation. This moderating effect was found to be larger for boys than for girls, indicating gender differences in response to trauma. Conclusions: The results indicate the need to screen for peritraumatic reactions as early as possible after a traumatic event in order to identify those at risk for PTSD.

  • 5.
    Annerbäck, Eva-Maria
    et al.
    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. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Centre for Clinical Research in Sörmland, Sörmland County Council, Uppsala University, Eskilstuna, 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.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Child physical abuse: factors influencing the associations between self-reported exposure and self-reported health problems: a cross-sectional study2018In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 12, article id 38Article in journal (Refereed)
    Abstract [en]

    Background

    Child physical abuse (CPA) is an extensive public health problem because of its associations with poor health outcomes. The aim of this study was to examine which of the background factors of CPA committed by a parent or other caregiver relates to self-reported poor health among girls and boys (13; 15 and 17 years old): perpetrator, last year exposure; severity and frequency; socioeconomic load and foreign background.

    Methods

    In a cross-sectional study in a Swedish county (n = 8024) a path analysis was performed to evaluate a model where all background variables were put as predictors of three health-status variables: mental; physical and general health problems. In a second step a log linear analysis was performed to examine how the distribution over the health-status categories was different for different combinations of background factors.

    Results

    Children exposed to CPA reported poor health to a much higher extent than those who were not exposed. In the path analysis it was found that frequency and severity of abuse (boys only) and having experienced CPA during the last year, was significantly associated with poor health as well as socioeconomic load in the families. Foreign background was significantly negatively associated with all three health indicators especially for girls. Neither mother nor father as perpetrator remained significant in the path analysis, while the results from the log linear analyses showed that mother-abuse did in fact relate to poor general health and mental as well as physical health problems among boys and girls. Father-abuse was associated with poor mental health if severe abuse was reported. Poor mental health was also associated with mild father-abuse if exposure during the last year was reported.

    Conclusion

    Despite the limitations that cross-sectional studies imply, this study provides new knowledge about factors associated with poor health among physically abused children. It describes details of CPA that have significant associations to different aspects of poor health and thus what needs to be addressed by professionals within mental health providers and social services. Understanding how different factors may contribute to different health outcomes for exposed children is important in future research and needs further studies.

  • 6.
    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.

  • 7.
    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.

  • 8.
    Fredlund, Cecilia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. 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, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    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.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    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.
    Pribe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden.
    Adolescents motives for selling sex in a welfare state - A Swedish national study2018In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 81, p. 286-295Article in journal (Refereed)
    Abstract [en]

    In addition to money or other compensation, other motives for selling sex may be important in a welfare country such as Sweden. The aim of this study was to carry out an exploratory investigation of adolescents motives for selling sex in a population-based survey in Sweden. A total of 5839 adolescents from the third year of Swedish high school, mean age 18.0 years, participated in the study. The response rate was 59.7% and 51 students (0.9%) reported having sold sex. Exploratory factor analysis and hierarchical cluster analysis were used to identify groups of adolescents according to underlying motives for selling sex. Further analyses were carried out for characteristics of selling sex and risk factors. Three groups of adolescents were categorized according to their motives for selling sex: Adolescents reporting; 1) Emotional reasons, being at a greater risk of sexual abuse, using sex as a means of self-injury and having a non-heterosexual orientation. 2) Material but no Emotional reasons, who more often receive money as compensation and selling sex to a person over 25 years of age, and 3) Pleasure or no underlying motive for selling sex reported, who were mostly heterosexual males selling sex to a person under 25 years of age, the buyer was not known from the Internet, the reward was seldom money and this group was less exposed to penetrative sexual abuse or using sex as a means of self-injury. In conclusion, adolescents selling sex are a heterogeneous group in regard to underlying motives.

    The full text will be freely available from 2021-05-05 00:01
  • 9.
    Fredlund, Cecilia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. 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.
    Svedin, Carl Göran
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences.
    Pribe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    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.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. 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.
    Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health2017In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury.

  • 10.
    Jonsson, Linda
    et al.
    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.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Psykiatriska kliniken inkl beroendekliniken.
    Priebe, Gisela
    Lund Univ, Sweden.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health 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.
    Online sexual abuse of adolescents by a perpetrator met online: a cross-sectional study2019In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 13, no 1, article id 32Article in journal (Refereed)
    Abstract [en]

    Background

    The current study aimed at exploring adolescents’ experiences of online sexual contacts leading to online sexual abuse by a perpetrator whom the victim had first met online. Associations with socio demographic background, experience of abuse, relation to parents, health and risk behaviors were studied.

    Methods

    The participants were a representative national sample of 5175 students in the third year of the Swedish high school Swedish (M age = 17.97). Analyses included bivariate statistics and stepwise multiple logistic regression models.

    Results

    In total 330 (5.8%) adolescents had gotten to know someone during the preceding 12 months for the purpose of engaging in some kind of sexual activity online. Thirty-two (9.7%) of those, the index group, had felt that they had been persuaded, pressed or coerced on at least one occasion. Sexual interaction under pressure was seen as constituting sexual abuse. These adolescent victims of online sexual abuse, the index group, did not differ with respect to socio-demographic background from the adolescents without this experience, the reference group. The index group had significantly more prior experiences of different kind of abuse, indicating that they belong to a polyvictimized group. More frequent risk behavior, poorer psychological health, poorer relationships with parents and lower self-esteem also characterized the index group. Online sexual abuse, without experiences of offline abuse, was associated with a poorer psychological health, at least at the same level as offline sexual abuse only.

    Conclusions

    The study made clear the importance of viewing online sexual abuse as a serious form of sexual abuse. Professionals meeting these children need to focus not only on their psychological health such as symptoms of trauma and depression but also need to screen them for online behavior, online abuse and other forms of previous abuse.

  • 11.
    Jonsson, Linda
    et al.
    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.
    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.
    Barn utsatta för sexuella övergrepp på nätet2017Report (Other academic)
    Abstract [sv]

    Denna fördjupningsrapport fokuserar på barns erfarenheter av sexuella övergrepp på nätet. Rapporten baseras på den tredje epidemiologiska undersökningen om ungdomars sexuella beteenden och erfarenheter på Internet. Unga sex och Internet – i en föränderlig värld är en enkätstudie från 2014 där 5 839 elever i gymnasiets tredje år deltog. Deltagarna tillfrågades om erfarenheter av olika övergrepp av sexuell karaktär på nätet såsom nätgrooming, sexuella övergrepp och sexuella övergreppsbilder.

    Resultaten i denna rapport är nya och unika. De ska tolkas med försiktighet då det behövs mer studier inom området. Dock visar resultaten tydliga mönster, som vi till viss del känner igen från både nationell och internationell forskning samt kliniska erfarenheter vi fått ta del av.

    Såväl de ungdomar som blivit nätgroomade (23,2 %) som de som blivit utsatta för sexuella övergrepp över nätet senaste året (32 ungdomar av de 330 ungdomar som hade haft sex på nätet) uppvisade en tämligen likartad bild av utsatthet för andra sexuella övergrepp, känslomässig och fysisk misshandel, känslomässig och fysisk mobbning samt olika former av självskadebeteenden. Till detta kommer att de rapporterade en sämre känslomässig relation till sina föräldrar under uppväxten även om de sociodemografiskt inte skiljde sig från andra ungdomar med få undantag.

    Ett viktigt resultat från studien är att vi har kunnat konstatera att dokumentation i form av fotografering och filmning av sexuella övergrepp påverkar den psykiska hälsan negativt. Även osäkerheten om det skett eller inte är förknippad med en ytterligare försämrad psykisk ohälsa jämfört med när övergrepp inte dokumenterats. För de barn/ungdomar vars bilder spritts ökar den psykiska ohälsan ytterligare.

    Bilden som målas upp är att denna grupp av ungdomar har en komplex bild av traumatiska erfarenheter och ohälsa och närmast är att betrakta som polytraumatiserade.

    Forskningens uppgift är att på ett vetenskapligt sätt belysa olika fenomen i samhället och att utifrån genererade data dra slutsatser och ge rekommendationer för att som i detta fall bidra till en bättre hjälp som i detta fall till en utsatt och belastad grupp barn- och ungdomar.

    Vi kan se att dessa ungdomar behöver såväl förebyggande som rehabiliterande insatser.

    På det förebyggande planet behövs bättre kunskap om våld och andra former av övergrepp bland alla som arbetar med barn. Utan denna kunskap och professionell utveckling kommer de barn som riskerar att utsättas eller redan blivit utsatta riskera att inte upptäckas i tid, och att inte heller kunna erbjudas adekvata insatser. Detta gäller sannolikt än mer de mest utsatta, bl.a. de grupper som denna fördjupningsrapport fokuserat på.

    Barn och unga måste tidigt få kunskap om vad ett sexuellt övergrepp är, vilka rättigheter man har och vad man kan göra om man blir drabbad. Skolan är en utmärkt plats att genomföra denna typ av utbildning. Vi kan se ett behov av en förändrad, moderniserad, sexualundervisning med fokus på relationer, ömsesidighet och respekt för att stärka barn och ungdomars sexuella integritet.

    Kunskap om våld och andra övergrepp mot barn behöver integreras i samtliga utbildningar som riktar sig till personer som kommer att arbeta med barn och ungdomar. Detta sker lämpligast genom att ämnet införs i respektive examinationsordningar. Det är också angeläget att fortbilda redan anställd personal inom rättsväsende, socialt arbete, hälso- och sjukvård och skola om våld och sexuella övergrepp mot barn.

    Utsatta barn/och ungdomar vänder sig oftast till kompisar och andra jämnåriga för att prata om övergreppen och för att få ett initialt stöd (Svedin et al., 2015; Landberg et al., 2015). Därför måste det till stora satsningar vad gäller kunskap om kompisstöd, vad man t.ex. ska göra om en kompis utsatts. Redan idag finns bra framtaget material (se www.dagsattprataom.se) som behöver spridas vidare till bland annat ungdomsmottagningar och skolan.

    Erfarenheterna från intervjuer med ungdomar i EU-projektet SPIRTO (Jonsson et al, 2015c) visar att främsta anledningen till att unga undviker att prata med sina föräldrar om vad de gör på nätet är för att de upplever att föräldrarna kan för lite. Unga efterlyser kunskapsspridning till föräldrar och lärare och andra som arbetar med barn om nätet. Hur nätet fungerar som källa till information och glädje såväl som till de risker som finns på nätet.

    Förövarna behöver hjälp och behandling för att minska risken att de utsätter nya barn. Därför är det ytterst viktigt med behandlingsenheter spridda i landet som alla har möjlighet att kontakta.

    Resultaten gällande det markant allvarliga hälsoläget för de barn som drabbats av övergrepp på nätet av sexuell karaktär ställer krav på skola, hälso- och sjukvård samt rättsväsende. De drabbade barnen måste prioriteras genom att få snabba utredningar från både polis och socialtjänst följt av möjlighet till bra stöd och behandling. Precis som i huvudrapporten från 2015 (Svedin et al., 2015), finns det anledning att understryka att om barn och ungdomars psykosociala ohälsa är så nedsatt som här framkommer, måste samhället säkerställa att de erbjuds professionellt stöd och hjälp. Många kan behöva högspecialiserad vård. Detta gäller en stor del av de barn och unga som utsatts för våld eller andra övergrepp och är extra angeläget för en polyviktimiserad grupp som den som denna rapport fokuserar på.

    I framtiden behövs fler studier med olika metodik för att få en bättre bild och en djupare förståelse för hur övergrepp på nätet av sexuell karaktär påverkar de drabbade barnen.

  • 12.
    Jonsson, Linda
    et al.
    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.
    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.
    Pribe, Gisela
    Department of Psychology, IKV, Lund University, Lund, Sweden.
    Fredlund, Cecilia
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. 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.
    Zetterqvist, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. 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.
    Similarities and differences in the functions of nonsuicidal self-injury (NSSI) and sex as self-injury (SASI)2019In: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, no 1, p. 120-136Article in journal (Refereed)
    Abstract [en]

    Differences and similarities were studied in the functions of two different self-injurious behaviors (SIB): nonsuicidal self-injury (NSSI) and sex as self-injury (SASI). Based on type of SIB reported, adolescents were classified in one of three groups: NSSI only (n = 910), SASI only (n = 41), and both NSSI and SASI (n = 76). There was support for functional equivalence in the two forms of SIB, with automatic functions being most commonly endorsed in all three groups. There were also functional differences, with adolescents in the SASI only group reporting more social influence functions than those with NSSI only. Adolescents reporting both NSSI and SASI endorsed the highest number of functions for both behaviors. Clinical implications are discussed, emphasizing the need for emotion regulation skills.

    The full text will be freely available from 2019-10-26 15:38
  • 13.
    Lindgren, Britt-Marie
    et al.
    Umea Univ, 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.
    Werko, Sophie
    Swedish Agcy Hlth Technol Assessment and Assessment, Sweden; Karolinska Inst, Sweden.
    A Systematic Literature Review of Experiences of Professional Care and Support Among People Who Self-Harm2018In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1573-8159, Vol. 22, no 2, p. 173-192Article, review/survey (Refereed)
    Abstract [en]

    Self-harm is an increasing phenomenon among young people, with potentially fatal outcomes. Patients perceptions of treatment and support are poorly documented. The aim was to synthesise the experiences of those who self-harm, with special reference to professional care and support by family, friends, and the school system. A systematic review of the literature was conducted. Following retrieval of 1,623 abstracts, 14 studies were included in the final analysis, 11 of which are reported here. Two quantitative studies as well as 1 mixed method study on self-care could not be reported on here due to word limitations. Adult people who self-harm described the importance of quality in the caring relationship and a tailored care designed for each individual. There is a need for more studies into adolescents who self-harm but of importance is the adolescents need for support from the adult world. A positive relationship between patient and healthcare professional can be crucial in motivating continued treatment of people who self-harm. A major priority is radical improvement in the attitudes of healthcare personnel.

  • 14.
    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.

  • 15.
    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.

  • 16.
    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.

  • 17.
    Quayle, Ethel
    et al.
    Univ Edinburgh, Scotland.
    Jonsson, Linda
    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.
    Cooper, Karen
    Univ Edinburgh, Scotland.
    Traynor, James
    NCA CEOP Command, England.
    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.
    Children in Identified Sexual Images - Who Are they? Self- and Non-Self-Taken Images in the International Child Sexual Exploitation Image Database 2006-20152018In: Child Abuse Review, ISSN 0952-9136, E-ISSN 1099-0852, Vol. 27, no 3, p. 223-238Article in journal (Refereed)
    Abstract [en]

    Child sexual abuse and exploitation material has drawn concern and legislative attention since the turn of the century, and the work to identify children in the images has been a prioritised task through international cooperation. The International Child Sexual Exploitation Image Database (ICSE DB) includes more than 8000 identified victims from nearly 50 countries. The database contains considerable important information about child abuse image crimes. The general aim of this study was to quantify the characteristics of children in identified illegal images from the UK ICSE DB (n = 687) with the subsidiary aim to describe differences between cases of self-taken images and those whose images had been taken by others. The analysis showed an increase in identified victims during the study years 2006-2015. Almost two-thirds were female, the majority were white and 44.3 per cent of images were self-taken (34.4% taken in a coercive and 9.9% in a non-coercive relationship). Since 2010, the number of self-taken images each year has exceeded more than 40 per cent of the total number of images in the database. Although self-taken images may be perceived as less worrisome, two-thirds were classified as coercive. This is an important argument in favour of continuing to investigate these cases under victim identification programmes. The general aim of this study was to quantify the characteristics of children in identified illegal images from the UK ICSE DB Key Practitioner Messages The ICSE DB includes more than 8000 identified victims and contains important information about child abuse image crimes. A majority of the identified victims were female and white children. Almost half of all images were self-taken and had been taken in a coercive relationship. Parents and practitioners need to recognise that even if a child sends sexual images these should be considered worrisome and therefore investigated further.

  • 18.
    Rajan, Gita
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Ljunggren, Gunnar
    Stockholm County Council, Sweden; Karolinska Institute, Sweden.
    Wandell, Per
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Wahlstrom, Lars
    Karolinska Institute, 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.
    Carlsson, Axel C.
    Karolinska Institute, Sweden; Uppsala University, Sweden.
    Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 592-598Article in journal (Refereed)
    Abstract [en]

    Background Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions. Methods Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated. Results Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 017 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1). Conclusions Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.

  • 19.
    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.

  • 20.
    Tordön, Rikard
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health 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.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    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.
    Pribe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 1, p. 16-23Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents.

    MATERIALS AND METHODS: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze.

    RESULTS: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care.

    CONCLUSIONS: Even where the protective factor 'senior educational attainment' is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.

  • 21.
    Zetterqvist, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. 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.
    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.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Priebe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    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.
    Self-reported nonsuicidal self-injury (NSSI) and sex as self-injury (SASI): Relationship to abuse, risk behaviors, trauma symptoms, self-esteem and attachment2018In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 265, p. 309-316Article in journal (Refereed)
    Abstract [en]

    This study focuses on a conceptually unexplored behavior among adolescents who report deliberately using sex as a means of self-injury. In a large high school-based sample (n = 5743), adolescents who engaged in sex as self injury (SASI, n = 43) were compared to adolescents who reported direct nonsuicidal self-injury (NSSI, n = 933) and those who reported both NSSI and SASI (n = 82). Re.sults showed that significantly more adolescents with SASI had experience of penetrating sexual abuse, as well as more sexual partners compared to those with NSSI. The SASI group also had higher levels of self-reported trauma symptoms, such as dissociation, posttraumatic stress and sexual concerns compared to those with NSSI, suggesting a distinct relationship between sexual abuse, trauma symptoms and engaging in sex as self-injury. There was no difference between the SASI and NSSI groups regarding experiences of emotional and physical abuse, self-esteem, parental care or overprotection or symptoms of depression, anxiety and anger. Adolescents who engaged in both NSSI + SASI stood out as a more severe and burdened group, with more experience of abuse, risk behaviors and impaired psychosocial health. Adolescents with traumatic experiences such as sexual abuse need to be assessed for SASI and vice versa.

  • 22.
    Åkerman, Ingrid
    et al.
    Barnafrid – Nationellt kunskapscentrum, Linköping.
    Jonsson, Linda
    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.
    Kunskapsbehov inom socialtjänsten om våld mot barn2017Report (Other academic)
    Abstract [sv]

    Syftet med den aktuella studien var att skapa ett underlag för hur ett socialtjänstnätverk i Barnafrids regi skulle kunna utvecklas. Därför undersöktes socialsekreterares uppfattning av hur de ser på den kompetens de redan har samt vad de är i behov av för vidare kunskap gällande våld och andra övergrepp mot barn. Ytterligare frågeställningar rörde vilken typ av kunskapsstöd som behövs, vilka kommunikativa lösningar kunskapen ska paketeras i samt hur de önskar att ett nätverk för socialtjänsten ska utformas. Nedan sammanfattas några huvuddrag från rapporten:

    • Det finns ett stort behov av kunskap bland svenska socialsekreterare om våld och andra övergrepp mot barn. Behovet beskrevs som något större bland socialsekreterare från mindre kommuner (< 50 000 invånare) och från socialsekreterare anställda kortare tid inom socialtjänsten (0-2 år).
    • Det behövs både generell kunskap om våld mot barn men också fördjupad kunskap inom mer specifika områden såsom nyanlända familjer, ensamkommande barn, hedersrelaterad våldsproblematik samt arbetsverktyg för risk och skyddsbedömningar.
    • Deltagarna önskade lättillgängliga manualer och guidelines som stöd i akuta eller särskilda situationer. Att kunna ta del av information via regionala konferenser/utbildningsdagar samt via en uppdaterad hemsida var prioriterat. Även kunskapspåfyllning via nationella föreläsningar var efterfrågat.
    • Mer än hälften av de svarande upplevde behov av en konsultationstelefon dit man kan ringa och få råd och stöd i svåra och komplicerade ärenden.
    • Mindre prioriterat var kunskap genom webbutbildningar, appar, frågelåda med svar via mejl och chattforum med andra verksamma.

    Sammanfattningsvis visar studien att det viktigaste är att socialsekreterare kan känna sig trygga och säkra när de utför sitt arbete. Det innebär ett arbete där barnets bästa alltid sätts i främsta rummet! Utifrån resultaten från denna studie kvarstår en hel del arbete för att uppnå det.

    Denna studie liksom tidigare undersökningar (se t.ex. Barnskyddsutredningen, 2009; Socialstyrelsen, 2016) pekar på brister och behov, såväl i grundutbildning, introduktionsutbildning som på specialistutbildning för de som ansvarar för myndighetsutövning inom den svenska sociala barn- och ungdomsvården. Personal inom socialtjänsten måste få kontinuerlig tillgång till en flora av olika former av kunskap som innebär både teoretisk och praktisk kunskap om hur man arbetar med barn som utsatts för våld. Utifrån resultaten bedömer vi också att det bland annat finns ett behov av såväl ett kunskapsbaserat socialtjänstnätverk som en konsultationstelefon. Detta är något Barnafrid – Nationellt kunskapscentrum mot våld och andra övergrepp mot barn vore en naturlig värd för i en framtid.

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