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  • 1.
    Carlsson, Emma
    et al.
    School of Health Sciences, Department of Natural Science and Biomedicine, Jonköping University, Jönköping, Sweden, Division of Medical Diagnostics, Ryhov County Hospital, Jönköping, Sweden.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Faresjo, Maria
    School of Health Sciences, Department of Natural Science and Biomedicine, Jonköping University, Jönköping, Sweden, Division of Medical Diagnostics, Ryhov County Hospital, Jonköping, Sweden.
    Psychological stress in children may alter the immune response2014In: Journal of Immunology, ISSN 0022-1767, E-ISSN 1550-6606, Vol. 192, no 5, p. 2071-2081Article in journal (Refereed)
    Abstract [en]

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

  • 2.
    Ernersson, Åsa
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sepa Frostell, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    An obesity provoking behaviour negatively influences young normal weight subjects' Health Related Quality of Life and causes depressive symptoms2010In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 11, no 4, p. 247-252Article in journal (Refereed)
    Abstract [en]

    In many parts of the world the prevalence of a sedentary lifestyle in combination with high consumption of food has increased, which contributes to increased risk for becoming overweight. Our primary aim was, in an intervention, to examine the influence on health related quality of life (HRQoL) and mood in young normal weight subjects of both sexes, when adopting an obesity provoking behaviour by increasing the energy intake via fast food and simultaneously adopting a sedentary lifestyle. A secondary aim was to follow-up possible long-term effects on HRQoL and mood 6 and 12 months after this short-term intervention.

    In this prospective study, 18 healthy normal weight subjects (mean age 26 ± 6.6 years), mainly university students were prescribed doubled energy intake, and maximum 5000 steps/day, during 4 weeks. An age and sex matched control group (n = 18), who were asked to have unchanged eating habits and physical activity, was recruited. Before and after the intervention questionnaires including Short Form-36, Hospital Anxiety Depression scale, Center of Epidemiological Studies Depression scale, Sense of Coherence and Mastery scale were completed by the subjects in the intervention group and by the controls with 4 weeks interval. Six and 12 months after the intervention the subjects underwent the same procedure as at baseline and the controls completed the same questionnaires.

    During the intervention, subjects in the intervention group increased their bodyweight and developed markedly lower physical and mental health scores on Short Form-36 as well as depressive symptoms while no changes appeared in the controls. The increase of depressive symptoms was associated with increases of energy intake, body weight and body fat. When followed up, 6 and 12 months after the intervention, physical and mental health had returned completely to baseline values, despite somewhat increased body weight.

    In conclusion, adopting obesity provoking behaviour for 4 weeks decreases HRQoL and mood in young normal weight subjects. The effect is temporary and when followed up 6 and 12 months after the short-term intervention no remaining influence is found.

  • 3. Frodi, Ann
    et al.
    Dernevik, M
    Sepa, Anneli
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Philipsson, J
    Bragesjö, M
    Current attachment representations of incarcerated offenders varying in degree of psychopathy2001In: Attachment & Human Development, ISSN 1461-6734, E-ISSN 1469-2988, Vol. 3, no 3, p. 269-283Article in journal (Refereed)
    Abstract [en]

    The present study sought to examine the current mental representations of early attachment relationships in 24 psychopathic criminal offenders, incarcerated in a forensic psychiatric hospital or a medium-security prison. The participants had been assessed on Hare's Psychopathy Checklist, Revised: Screening Version (PCL-R, sv, 1997) and scored either high or low. They were interviewed with the Main and Goldwyn Adult Attachment Interview (1998) and completed the EMBU, a Swedish self-report questionnaire tapping memories of the parent's rearing techniques. The results pointed to an extensive over-representation of individuals who were dismissing of attachment and attachment-related experiences (close to three times as many as in the normal population), no secure individuals, and with the remainder being either unclassifiable or unresolved with regard to severe early abuse/trauma. In addition, an examination of the EMBU data revealed an association between a higher psychopathy score and a family constellation of a rejecting father and an emotionally very warm (idealized) mother. The discussion will focus on the unique discourse of the dismissing individuals and on clinical implications.

  • 4.
    Hallin, A-L
    et al.
    Department of Psychology, Lund University, Lund.
    Bengtsson, H
    Department of Psychology, Lund University, Lund.
    Sepa Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Cognition, Development and Disability. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Stjernqvist, K
    Department of Psychology, Lund University, Lund.
    The effect of extremely preterm birth on attachment organization in late adolescence2012In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 38, no 2, p. 196-203Article in journal (Refereed)
    Abstract [en]

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

  • 5.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Maternal Influence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair2013In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 132, no 5, p. E1333-E1340Article in journal (Refereed)
    Abstract [en]

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

  • 6.
    Karlén, Jerker
    et al.
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Cognition, Development and Disability. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Cortisol in hair measured in young adults - a biomarker of major life stressors?2011In: BMC Clinical Pathology, ISSN 1472-6890, E-ISSN 1472-6890, Vol. 11, no 1, p. 12-Article in journal (Refereed)
    Abstract [en]

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

  • 7.
    Koch, Felix-Sebastian
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Body Dissatisfaction Measured with a Figure Preference Task and Self-Esteem in 8 Year Old Children: a Study within the ABIS-Project2008In: Clinical Medicine Insights: Pediatrics, ISSN 1179-5565, Vol. 2, p. 13-26Article in journal (Refereed)
    Abstract [en]

    Body dissatisfaction has been related to low self-esteem and depression in adolescents. With regard to the current world wide rise in childhood obesity and common stigmatization of adults and children with obesity, easy to use and cost effective measurements of body dissatisfaction would be helpful in epidemiological research. In the current study, detailed data on body measurements with regard to perceived and ideal body size and body dissatisfaction, as measured with the figure preference task, are presented for a population based sample of 3837 children. Perceived body size correlations to weight, body mass index [BMI], and waist circumference were between 0.41 and 0.54; and to height between 0.12 and 0.21. Odds ratios for lower self-esteem increased with increase in body dissatisfaction. Gender differences in body dissatisfaction were present but not found in relation to self-esteem. It is concluded that the figure preference task yields valuable information in epidemiological studies of children as young as 7.5 years of age. It is argued, that the figure preference task is an additional measurement which theoretically relates to psychological stress in childhood.

  • 8.
    Koch, Felix-Sebastian
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Parents’ psychological stress over time may affect children’s cortisol at age 82010In: Journal of Pediatric Psychology, ISSN 0146-8693, E-ISSN 1465-735X, Vol. 35, no 9, p. 950-959Article in journal (Refereed)
    Abstract [en]

    Objective: To study possible relations between parents’ psychological stress, children’s selfesteem and children’s saliva cortisol levels with regard to a mild stressor (drawing a blood sample).

    Method: Parenting stress and serious life events at birth, age 1, age 2, age 5 and age 8, and children’s self-esteem at age 8 were assessed. 82 paired saliva samples just before and 30 minutes after a children’s blood was drawn were analyzed.

    Results: Repeated measure general linear models indicated a relation between higher parenting stress at age 1 (p=0.03) and at age 8 (p<0.01), and elevated cortisol levels. No relation was found for serious life events. Lack of self-esteem in the domain of mental well-being was related to elevated cortisol levels (p=0.02).

    Conclusion: Parenting stress related to elevated cortisol levels of their children cross-sectionally and longitudinally and may be used as an indicator for children’s psychological stress in epidemiological studies.

  • 9.
    Koch, Felix-Sebastian
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Parenting stress over time and children’s self-esteem at age 8Manuscript (Other academic)
    Abstract [en]

    Parenting stress and other kinds of psychological stress were measured longitudinally from birth and related to children’s self-esteem at age 8. 3837 children answered a Swedish instrument assessing self-esteem in 5 domains. Generalized linear models showed a relation between parenting stress and lower self-esteem in all domains (e.g., cross-sectional for domain mental well-being: Odds ratio=1.76, p<.001 and longitudinal from age 1: Odds ratio=1.38, p<.001). This relation was not explained by other factors, such as serious life events, the child’s temperament or socioeconomy, and it was proposed that interventions aimed at reducing parenting stress could help children even long term.

  • 10.
    Koch, Felix-Sebastian
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Faculty of Health Sciences.
    Psychological Stress and Obesity2008In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 153, no 6, p. 839-844Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether there is a relationship between psychological stress in the family and obesity in 5- to 6-year-old children.

    Study design: A total of 7443 Swedish families reported on psychological stress across 4 domains as part of the prospective All Babies in Southeast Sweden-project (ABIS). Domains assessed included serious life events, parenting stress, lack of social support, and parental worries. These variables were summarized in cross-sectional and longitudinal composite measures of psychological stress. Logistic regression models were used to calculate odds ratios for childhood obesity for psychological stress.

    Results: A total of 4.2% of the children were obese according to age-adjusted international standards. Children from families that reported stress in at least 2 of the 4 domains assessed had significantly higher adjusted odds ratios (OR) for obesity, both cross-sectionally (OR, 2.1; 95% CI, 1.3-3.5; P < .01.) and longitudinally (OR, 2.6; 95% CI, 1.3-5.4, P < .01).

    Conclusion: Psychological stress in the family may be a contributing factor for childhood obesity. This finding underscores how important it is to give children with obesity and their families psychological and social support in addition to recommendations about changing life style.

  • 11.
    Ludvigsson, Johnny
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Ludvigsson, Mikael
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Screening for prediabetes in the general child population: maternal attitude to participation2001In: Pediatric Diabetes, ISSN 1399-543X, Vol. 2, no 4, p. 170-174Article in journal (Refereed)
    Abstract [en]

    Screening to predict serious diseases in the general population has been regarded as unethical as it is supposed to make people anxious. Therefore we have evaluated whether mothers become anxious when their babies participate in a project to predict diabetes in the general child population. Out of 21 700 newborn children, 16 300 (75%) entered the ABIS project (All Babies in South-east Sweden). The parents (usually the mothers) answered a questionnaire at the child's birth and then again after 1 yr. A total of 10 868 representative birth questionnaires had been analyzed. To the question, 'How do you feel when you know that your child is participating in this study?', only 2.5% of mothers of children with type 1 diabetes in the family answered 'more anxious/much more anxious', and even fewer (1.5%) of the mothers in the general population (p < 0.01). A total of 52.5% of the general population answered 'calmer/more reassured' (29.3% 'calmer' and 23.2% 'much calmer'), while 43.3% felt unaffected. Those 1.5% of mothers who reported becoming more anxious were more likely to be in an unstable social situation (unemployed, p < 0.001; born abroad, p < 0.001; low education, p < 0.001).

    At the 1-yr follow-up, 4948 unselected questionnaires had been analyzed. Only 1.2% of the mothers felt 'more anxious', while the overwhelming majority felt either unaffected (58.7%) or calmer (38.6%). At this follow-up, most of those who had felt 'more anxious' at birth did not feel that way any longer, and none of those with diabetes in the family.

    We conclude that large-scale screening studies for the prediction of diabetes in the general population can be performed without causing increased anxiety. A few parents, most often found in the group with known social problems, might need extra information and support.

  • 12.
    Marild, Karl
    et al.
    Karolinska University Hospital.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ludvigsson, Jonas F
    Karolinska Institute.
    Psychological stress and coeliac disease in childhood: a cohort study2010In: BMC GASTROENTEROLOGY, ISSN 1471-230X, Vol. 10Article, review/survey (Refereed)
    Abstract [en]

    Background: Psychological stress has previously been associated with several immunological diseases, e. g. inflammatory bowel disease. Through questionnaire data from the ABIS study (All Babies In southeast Sweden) we examined the association between psychological stress in the family and biopsy-proven coeliac disease (CD) in the child. Methods: We used serious life event, parenting stress, and parental worries as measures of psychological stress. Data were collected when the child was 1 and 2.5 years old in some 11,000 and 8,800 children, respectively. CD was confirmed through small intestinal biopsy (with villous atrophy), and the diagnosis was validated through patient chart data. Results: Serious life event in the family in the childs first 1 or 2.5 years after childbirth was not associated with future CD in the child (Odds Ratio (OR) = 0.45; 95% Confidence Interval (CI) = 0.01-2.65; P = 0.72; and OR = 1.21; 95% CI = 0.43-3.05; P = 0.64, respectively). Neither did we see any association between CD and parenting stress at age 1 year and at 2.5 years (OR = 0.40; 95% CI = 0.01-2.38; P = 0.73 and OR = 0.74; 95% CI = 0.01-4.56; P = 1.00, respectively). Among children exposed to parental worries at 2.5 years, no child had a diagnosis of CD before end of follow-up, compared to 25/8082 (0.3%) among non-exposed children (OR = 0.00; 95% CI = 0.00-2.34; P = 0.64). There was no association between the combined measures of stress and CD. Conclusion: This study found no association between psychological stress and later development of CD in Swedish children. However, we cannot rule out that the lack of such an association is due to limited statistical power.

  • 13.
    Mörelius, Eva-lotta
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Örtenstrand, Annika
    Karolinska Institutet.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding2015In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 91, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    AIM:

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

    STUDY DESIGN:

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

    SUBJECTS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 14.
    Mörelius, Evalotte
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Örtenstrand, Annika
    Karolinska institutet, Stockholm.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kan hud-mot-hud vård dygnet runt påverka det för tidigt födda barnets kortisolvärden?2014Conference paper (Other academic)
  • 15.
    Nygren, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Koch, Felix-Sebastian
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Faculty of Health Sciences.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study2015In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, no 6, p. 1188-1197Article in journal (Refereed)
    Abstract [en]

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

  • 16.
    Nygren, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Koch, Felix-Sebastian
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Frostell, Anneli Sepa
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Serious life events across childhood and mental health problems in early adolescence: The moderating role of family climate. Results from the ABIS population-based longitudinal study2015Manuscript (preprint) (Other academic)
    Abstract [en]

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

  • 17.
    Nygren, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Adult attachment and parenting stress among parents of toddlers2012In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 30, no 3, p. 289-302Article in journal (Refereed)
    Abstract [en]

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

  • 18.
    Nygren, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Health Sciences.
    Sepa Frostell, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Linköping University, Department of Behavioural Sciences and Learning, Cognition, Development and Disability. Linköping University, Faculty of Arts and Sciences.
    Family psychological stress early in life and development of type 1 diabetes: The ABIS prospective study2013In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 100, no 2, p. 257-264Article in journal (Refereed)
    Abstract [en]

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

  • 19.
    Palmstierna, Peder
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Longitudinal associations between child sleep, parental sleep, andparenting stressManuscript (preprint) (Other academic)
    Abstract [en]

    This study investigates a possible model for the relationship between child and parental sleep and parenting stress. We performed post-hoc statistical analyses of longitudinal parent questionnaire data, gathered at regular visits to well-child clinics in south-east Sweden or later at home from unselected parents of about 10,000 children at ages 1, 3 and 5 years old, as part of ABIS (All Babies In Southeast Sweden).

    Parent-rated child sleep quality and parenting stress as measured by Swedish Parenting Stress Questionnaire at ages 1, 3 and 5 years; and self-reported parental sleep quality at ages 3 and 5 were dichotomised into poor/not poor sleep and high/not high stress. Odds ratios for the interrelationships between measures were obtained first by cross-tabulation two by two, then by logistic regression including all concurrent and preceding measures. The association of child sleep quality with parenting stress observed at age 3 with crosstabulation was non-significant with logistic regression, whereas the associations of child sleep quality with parental sleep quality and of parental sleep quality with parenting stress remained strong at all ages with odds ratios of about 16-20 or 4.5, respectively (p < 0.001). All measures also showed stability over time, especially parenting stress. Child temperament rating and social support dissatisfaction showed strong associations to sleep/stress measures but including them in logistic regressions did not influence the above relationships. Our data support a model where the associations between poor child sleep and high parenting stress, within and between age groups, is mainly explained by poor parental sleep.

  • 20.
    Palmstierna, Peder
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Parent perceptions of child sleep: a study of 10 000 Swedish children2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 12, p. 1631-1639Article in journal (Refereed)
    Abstract [en]

    Aim: To gather normative data on parent-reported child sleep and investigate what influences it.

    Methods: Subjective sleep report data on night wakings, sleep quality, bedtime and risetime were gathered from parents of around 10 000 children from birth to age 5 in a cohort questionnaire study. The data were analysed for trends, and sleep measures were compared with background factors such as child temperament, foreign origin, family situation, parents age and education and night feedings.

    Results: The population trends were towards improved sleep with increasing age. Individual sleep patterns show some stability. Reports of frequent night wakings and low sleep quality (LSQ) were strongly associated with each other within and between the age groups (odds ratio [OR] 2.8-60.2, p < 0.001). Perception of poor child sleep was influenced by child temperament at ages 1 and 3 (OR 2.2-4.4, p < 0.001), foreign origin at age 1 (OR 2.1-2.3, p < 0.001), and to some extent, parents age and education at ages 1-3 (OR 1.4-2.1, p < 0.05 or stronger), but not by single parent status or infant night feedings. Reporting multiple or unspecific causes of night wakings was associated with reporting LSQ (OR 1.8-4.7, p < 0.05 or stronger).

    Conclusion: With increasing age, fewer wakings, improved sleep quality and a more uniform sleep schedule seem normal. However, frequent wakings and low quality sleep at early ages seem surprisingly stable. A difficult temperament and foreign origin were associated with lower quality sleep and more frequent wakings in early ages, whereas being a single parent was not. Finally, night feeding does not seem to condition children to frequent wakings.

  • 21.
    Sepa, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    The Stress Hypothesis: Implications for the induction of diabetes-related autoimmunity in children?2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Second to Finland, Sweden has the world’s highest incidence of type 1 diabetes. Experiences of serious life events have retrospectively been shown to constitute a risk factor for the development of this disease, probably via the biological stress response. Parenting stress and maternal attachment insecurity are other important sources of stress in early childhood.

    Psychological stress increases the need for insulin and may induce insulin resistance, which might add extra pressure on the insulin-producing beta cells in the pancreas (beta-cell stress).

    The aim of the current thesis was to propose and start investigating a stress hypothesis – namely that psychological stress may induce insulin resistance leading to beta-cell stress, which could trigger an autoimmune reaction towards beta-cells in genetically predisposed children. When all the beta cells have been destroyed, insulin can no longer be produced in the body and type 1 diabetes becomes manifest.

    Methods: Families from the prospective population-based ABIS-project, which follows approximately 17 000 children, participated in the empirical studies of the current thesis. The mothers completed questionnaires, including various measures of psychological stress (e.g. parenting stress and experiences of serious life events) and socio-demographic background, at the birth of the child and when the child was 1 as well as 2.5 years of age. Maternal attachment insecurity was assessed with the Adult Attachment Interview. Blood samples drawn from the children at 1 and 2.5 years of age were analyzed for type 1 diabetes-related autoantibodies towards Tyrosine phosphatase (IA-2) and Glutamic Acid Decarboxylase (GAD).

    Findings and Conclusions: Parenting stress and experiences of serious life events like divorce and maternal exposure to violence were associated with the induction of diabetes-related autoimmunity in early childhood, possibly via insulin resistance and beta-cell stress. The risk of developing diabetesrelated autoimmunity after parental divorce or mothers’ exposure to violence was about threefold. None of the results were explained by any of the potential confounding factors analyzed. These results support and strengthen the stress hypothesis, which warrants further investigation.

    Mothers’ attachment insecurity was not associated with the induction of diabetes-related autoimmunity in their infants. However, this lack of association was perhaps due to methodological constraints.

    The vast majority of the parents were calmed or unaffected concerning their participation in the ABIS-project, suggesting that large-scale medical screening-projects in the general population are not in themselves a cause for worry and can be performed without causing increased anxiety.

    List of papers
    1. Screening for prediabetes in the general child population: maternal attitude to participation
    Open this publication in new window or tab >>Screening for prediabetes in the general child population: maternal attitude to participation
    2001 (English)In: Pediatric Diabetes, ISSN 1399-543X, Vol. 2, no 4, p. 170-174Article in journal (Refereed) Published
    Abstract [en]

    Screening to predict serious diseases in the general population has been regarded as unethical as it is supposed to make people anxious. Therefore we have evaluated whether mothers become anxious when their babies participate in a project to predict diabetes in the general child population. Out of 21 700 newborn children, 16 300 (75%) entered the ABIS project (All Babies in South-east Sweden). The parents (usually the mothers) answered a questionnaire at the child's birth and then again after 1 yr. A total of 10 868 representative birth questionnaires had been analyzed. To the question, 'How do you feel when you know that your child is participating in this study?', only 2.5% of mothers of children with type 1 diabetes in the family answered 'more anxious/much more anxious', and even fewer (1.5%) of the mothers in the general population (p < 0.01). A total of 52.5% of the general population answered 'calmer/more reassured' (29.3% 'calmer' and 23.2% 'much calmer'), while 43.3% felt unaffected. Those 1.5% of mothers who reported becoming more anxious were more likely to be in an unstable social situation (unemployed, p < 0.001; born abroad, p < 0.001; low education, p < 0.001).

    At the 1-yr follow-up, 4948 unselected questionnaires had been analyzed. Only 1.2% of the mothers felt 'more anxious', while the overwhelming majority felt either unaffected (58.7%) or calmer (38.6%). At this follow-up, most of those who had felt 'more anxious' at birth did not feel that way any longer, and none of those with diabetes in the family.

    We conclude that large-scale screening studies for the prediction of diabetes in the general population can be performed without causing increased anxiety. A few parents, most often found in the group with known social problems, might need extra information and support.

    Keywords
    attitudes, children, ethics, prediction, screening, type 1 diabetes
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13628 (URN)10.1034/j.1399-5448.2001.20405.x (DOI)
    Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2009-08-19
    2. Could parenting stress and lack of support/confidence function as mediating mechanisms between certain environmental factors and the development of autoimmunity in children? – A study within ABIS
    Open this publication in new window or tab >>Could parenting stress and lack of support/confidence function as mediating mechanisms between certain environmental factors and the development of autoimmunity in children? – A study within ABIS
    2002 (English)In: Annals of the New York Academy of Science, ISSN 0077-8923, Vol. 958, p. 431-435Article in journal (Refereed) Published
    Abstract [en]

    Despite extensive research, the etiology of type 1 diabetes is still to a large extent unknown. We would like to propose psychoimmunology as one possible pathway. Psychological mechanisms are directly linked to hormonal and nervous signals, which increase the need for insulin and affect the immune system. Disparate factors of social, environmental, and medical character have been associated with the onset of type 1 diabetes or with the autoimmune process leading to the disease—for instance, parental age, maternal infections, delivery mood, need for neonatal intensive care, and low socioeconomic status. Our results, based on the analyses of 4337 nonselected newborn children and their mothers, show that all these risk factors were also associated with psychological mechanisms (defined as lack of social support/confidence and high parenting stress). These results support the hypothesis of psychological mechanisms as mediating variables between a number of disparate risk factors and the development of type 1 diabetes.

    Keywords
    type 1 diabetes, children, psychological factors, etiology
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13629 (URN)10.1111/j.1749-6632.2002.tb03019.x (DOI)
    Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2009-08-21
    3. Psychosocial correlates of parenting stress, lack of support and lack of confidence/security
    Open this publication in new window or tab >>Psychosocial correlates of parenting stress, lack of support and lack of confidence/security
    2004 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, Vol. 45, no 2, p. 169-179Article in journal (Refereed) Published
    Abstract [en]

    The purpose of the current study was to identify important correlates of parenting stress, frequently conceptualized as a mediator of suboptimal family function, and of social support and confidence/security, often regarded as buffers. Potential correlates of these concepts were assessed in questionnaires at delivery and at one year, in a sample of 16,000 families in Sweden. Predictors (1) of parenting stress were parental dissatisfaction and poor child sleeping patterns; (2) of lack of support included lack of confidence/security, parents born abroad, single motherhood, and maternal health problems; and (3) of lack of confidence/security were lack of support and serious life events. Mothers lacking social support or confidence/security exhibited significantly higher stress. Although parenting stress is a complex phenomenon certain risk factors can be emphasized, such as sleep problems which appear more important than child health problems. These risk factors can be used both in efforts to prevent stress and in studies of stress effects.

    Keywords
    Parenting stress, social support, confidence
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13630 (URN)10.1111/j.1467-9450.2004.00392.x (DOI)
    Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2009-08-21
    4. Psychological stress may induce diabetes-related autoimmunity in infancy
    Open this publication in new window or tab >>Psychological stress may induce diabetes-related autoimmunity in infancy
    Show others...
    2005 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 28, no 2, p. 290-295Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE— In retrospective studies, a number of disparate environmental factors (including experiences of serious life events) have been proposed as trigger mechanisms for type 1 diabetes or the autoimmune process behind the disease. Psychosocial stress in families may affect children negatively due to a link to hormonal levels and nervous signals that in turn influence both insulin sensitivity/insulin need and the immune system. Our aim was to investigate whether psychological stress, measured as psychosocial strain in families, is associated with diabetes-related autoimmunity during infancy.

    RESEARCH DESIGN AND METHODS— The first 4,400 consecutive 1-year-old children from a large prospective population-based project participated in the study. Parents completed questionnaires at birth and at 1 year, including various measures of psychosocial stress (e.g., parenting stress) and sociodemographic background. Blood samples drawn from the children at 1 year were analyzed for type 1 diabetes–associated autoantibodies toward tyrosine phosphatase and GAD. Antibodies toward tetanus toxoid were used as non–diabetes-related control antibodies.

    RESULTS— Psychosocial factors, i.e., high parenting stress (odds ratio 1.8 [95% CI 1.2–2.9], P < 0.01), experiences of a serious life event (2.3 [1.3–4.0], P < 0.01), foreign origin of the mother (2.1 [1.3–3.3], P < 0.001), and low paternal education (1.6 [1.1–2.3], P < 0.01) were associated with diabetes-related autoimmunity in the child, independent of family history of diabetes.

    CONCLUSIONS— Psychological stress, measured as psychosocial strain in the family, seems to be involved in the induction, or progression, of diabetes-related autoimmunity in the child during the 1st year of life.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13631 (URN)10.2337/diacare.28.2.290 (DOI)
    Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2017-12-13Bibliographically approved
    5. Mothers’ attachment insecurity and diabetes-related autoantibodies in their infants
    Open this publication in new window or tab >>Mothers’ attachment insecurity and diabetes-related autoantibodies in their infants
    2004 (English)In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 1037, p. 110-113Article in journal (Refereed) Published
    Abstract [en]

    Psychological stress may, via hormonal levels, increase insulin resistance. The aim of this study was to investigate whether mothers' attachment insecurity is associated with the induction or progression of diabetes-related autoimmunity in early childhood. Adult attachment interviews were conducted with 18 mothers of infants who were positive, and 32 mothers of infants who were negative, for glutamic acid decarboxylase, selected from ABIS, a large prospective population-based project. The proportion of children with insecure mothers was larger, but not significantly so, in the autoantibody-positive group than in the negative group. If an association exists between maternal attachment insecurity and diabetes-related autoimmunity during infancy, it does not appear to be strong.

    Keywords
    attachment insecurity, children, psychosocial factors, type 1 diabetes, beta cell autoantibodies
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13632 (URN)10.1196/annals.1337.016 (DOI)
    Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2017-12-13
    6. Mothers' experiences of serious life events increase the risk of diabetes-related autoimmunity in their children
    Open this publication in new window or tab >>Mothers' experiences of serious life events increase the risk of diabetes-related autoimmunity in their children
    2005 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 28, no 10, p. 2394-2399Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE—Stressful life events have been shown to constitute a risk factor for type 1 diabetes during childhood. Our aim was to investigate in the general child population (i.e., irrespective of genetic risk for type 1 diabetes) whether mothers’ experiences of serious life events, such as divorce and violence, were associated with diabetes-related autoimmunity in their children at age 2.5 years.

    RESEARCH DESIGN AND METHODS—The study cohort was comprised of the first 5,986 consecutive children and their families from the prospective population-based All Babies in Southeast Sweden project for whom 2.5-year study data were available. Data were drawn from parental questionnaires that included questions about experiences of serious life events and the blood samples taken from the children when the children were age 2.5 years. The blood samples were analyzed for diabetes-related autoantibodies against tyrosine phosphatase and GAD.

    RESULTS—Mothers’ experiences of divorce (odds ratio 3.6, 95% CI 1.4–9.6, P < 0.05) and violence (2.9, 1.0–7.8, P < 0.05) were associated with diabetes-related autoimmunity in the children, independent of a family history of type 1 diabetes.

    CONCLUSIONS—The results support the ß-cell stress hypothesis and suggest that maternal experiences of serious life events such as divorce and violence seem to be involved in the induction or progression of diabetes-related autoimmunity in children at age 2.5 years, independent of family history of type 1 diabetes.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13633 (URN)10.2337/diacare.28.10.2394 (DOI)
    Available from: 2004-03-26 Created: 2004-03-26 Last updated: 2017-12-13
  • 22.
    Sepa, Anneli
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Frodi, Ann
    Linköping University, Department of Behavioural Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Could parenting stress and lack of support/confidence function as mediating mechanisms between certain environmental factors and the development of autoimmunity in children? – A study within ABIS2002In: Annals of the New York Academy of Science, ISSN 0077-8923, Vol. 958, p. 431-435Article in journal (Refereed)
    Abstract [en]

    Despite extensive research, the etiology of type 1 diabetes is still to a large extent unknown. We would like to propose psychoimmunology as one possible pathway. Psychological mechanisms are directly linked to hormonal and nervous signals, which increase the need for insulin and affect the immune system. Disparate factors of social, environmental, and medical character have been associated with the onset of type 1 diabetes or with the autoimmune process leading to the disease—for instance, parental age, maternal infections, delivery mood, need for neonatal intensive care, and low socioeconomic status. Our results, based on the analyses of 4337 nonselected newborn children and their mothers, show that all these risk factors were also associated with psychological mechanisms (defined as lack of social support/confidence and high parenting stress). These results support the hypothesis of psychological mechanisms as mediating variables between a number of disparate risk factors and the development of type 1 diabetes.

  • 23.
    Sepa, Anneli
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Frodi, Ann
    Linköping University, Department of Behavioural Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Mothers’ attachment insecurity and diabetes-related autoantibodies in their infants2004In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 1037, p. 110-113Article in journal (Refereed)
    Abstract [en]

    Psychological stress may, via hormonal levels, increase insulin resistance. The aim of this study was to investigate whether mothers' attachment insecurity is associated with the induction or progression of diabetes-related autoimmunity in early childhood. Adult attachment interviews were conducted with 18 mothers of infants who were positive, and 32 mothers of infants who were negative, for glutamic acid decarboxylase, selected from ABIS, a large prospective population-based project. The proportion of children with insecure mothers was larger, but not significantly so, in the autoantibody-positive group than in the negative group. If an association exists between maternal attachment insecurity and diabetes-related autoimmunity during infancy, it does not appear to be strong.

  • 24.
    Sepa, Anneli
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Frodi, Ann
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Mothers' experiences of serious life events increase the risk of diabetes-related autoimmunity in their children2005In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 28, no 10, p. 2394-2399Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE—Stressful life events have been shown to constitute a risk factor for type 1 diabetes during childhood. Our aim was to investigate in the general child population (i.e., irrespective of genetic risk for type 1 diabetes) whether mothers’ experiences of serious life events, such as divorce and violence, were associated with diabetes-related autoimmunity in their children at age 2.5 years.

    RESEARCH DESIGN AND METHODS—The study cohort was comprised of the first 5,986 consecutive children and their families from the prospective population-based All Babies in Southeast Sweden project for whom 2.5-year study data were available. Data were drawn from parental questionnaires that included questions about experiences of serious life events and the blood samples taken from the children when the children were age 2.5 years. The blood samples were analyzed for diabetes-related autoantibodies against tyrosine phosphatase and GAD.

    RESULTS—Mothers’ experiences of divorce (odds ratio 3.6, 95% CI 1.4–9.6, P < 0.05) and violence (2.9, 1.0–7.8, P < 0.05) were associated with diabetes-related autoimmunity in the children, independent of a family history of type 1 diabetes.

    CONCLUSIONS—The results support the ß-cell stress hypothesis and suggest that maternal experiences of serious life events such as divorce and violence seem to be involved in the induction or progression of diabetes-related autoimmunity in children at age 2.5 years, independent of family history of type 1 diabetes.

  • 25.
    Sepa, Anneli
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Frodi, Ann
    Linköping University, Department of Behavioural Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Psychosocial correlates of parenting stress, lack of support and lack of confidence/security2004In: Scandinavian Journal of Psychology, ISSN 0036-5564, Vol. 45, no 2, p. 169-179Article in journal (Refereed)
    Abstract [en]

    The purpose of the current study was to identify important correlates of parenting stress, frequently conceptualized as a mediator of suboptimal family function, and of social support and confidence/security, often regarded as buffers. Potential correlates of these concepts were assessed in questionnaires at delivery and at one year, in a sample of 16,000 families in Sweden. Predictors (1) of parenting stress were parental dissatisfaction and poor child sleeping patterns; (2) of lack of support included lack of confidence/security, parents born abroad, single motherhood, and maternal health problems; and (3) of lack of confidence/security were lack of support and serious life events. Mothers lacking social support or confidence/security exhibited significantly higher stress. Although parenting stress is a complex phenomenon certain risk factors can be emphasized, such as sleep problems which appear more important than child health problems. These risk factors can be used both in efforts to prevent stress and in studies of stress effects.

  • 26.
    Sepa, Anneli
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Ludvigsson, Johnny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Psychological stress and the risk of diabetes-related autoimmunity: A review article2006In: Neuroimmunomodulation, ISSN 1021-7401, E-ISSN 1423-0216, Vol. 13, no 5-6, p. 301-308Article in journal (Refereed)
    Abstract [en]

    The β cell stress hypothesis suggests that any phenomenon that induces insulin resistance, and thereby extra pressure on the β cells, should be regarded as a risk factor for type 1 diabetes (T1D). Psychological stress decreases insulin sensitivity and increases insulin resistance and may hence be important in the development/onset of T1D. The aim of the current review article was to evaluate existing empirical evidence concerning an association between psychological stress and development/onset of T1D as well as diabetes-related autoimmunity. Ten retrospective case-control studies were found. Nine studies showed a positive association between stress and development/onset of T1D in children, adolescents or adults. One study did not find an association between stress and development/onset of T1D. An association between stress and diabetes-related autoimmunity was found at 1 and 2- 3 years of age in a large epidemiological study of the general population. The hypothesis that psychological stress (via β cell stress or direct influence on the immune system) may contribute to the induction or progression of diabetes-related autoimmunity has gained some strong initial support, but is in need of further empirical verification. It seems much clearer that stress can precipitate manifest T1D, although the biological mechanisms are still not known. Copyright © 2006 S. Karger AG.

  • 27.
    Sepa, Anneli
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Wahlberg, Jeanette
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Vaarala, Outi
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Frodi, Ann
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Psychological stress may induce diabetes-related autoimmunity in infancy2005In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 28, no 2, p. 290-295Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE— In retrospective studies, a number of disparate environmental factors (including experiences of serious life events) have been proposed as trigger mechanisms for type 1 diabetes or the autoimmune process behind the disease. Psychosocial stress in families may affect children negatively due to a link to hormonal levels and nervous signals that in turn influence both insulin sensitivity/insulin need and the immune system. Our aim was to investigate whether psychological stress, measured as psychosocial strain in families, is associated with diabetes-related autoimmunity during infancy.

    RESEARCH DESIGN AND METHODS— The first 4,400 consecutive 1-year-old children from a large prospective population-based project participated in the study. Parents completed questionnaires at birth and at 1 year, including various measures of psychosocial stress (e.g., parenting stress) and sociodemographic background. Blood samples drawn from the children at 1 year were analyzed for type 1 diabetes–associated autoantibodies toward tyrosine phosphatase and GAD. Antibodies toward tetanus toxoid were used as non–diabetes-related control antibodies.

    RESULTS— Psychosocial factors, i.e., high parenting stress (odds ratio 1.8 [95% CI 1.2–2.9], P < 0.01), experiences of a serious life event (2.3 [1.3–4.0], P < 0.01), foreign origin of the mother (2.1 [1.3–3.3], P < 0.001), and low paternal education (1.6 [1.1–2.3], P < 0.01) were associated with diabetes-related autoimmunity in the child, independent of family history of diabetes.

    CONCLUSIONS— Psychological stress, measured as psychosocial strain in the family, seems to be involved in the induction, or progression, of diabetes-related autoimmunity in the child during the 1st year of life.

  • 28. Stechova, Katerina
    et al.
    Bohmova, Kristyna
    Vrabelova, Zuzana
    Sepa, Anneli
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Stadlerova, Gabriela
    Zacharovova, Klara
    Faresjö, Maria
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    High T-helper-1 cytokines but low T-helper-3 cytokines, inflammatory cytokines and chemokines in children with high risk of developing type 1 diabetes2007In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 23, no 6, p. 462-471Article in journal (Refereed)
    Abstract [en]

    Background. Type 1 diabetes (T1D) is suggested to be of T-helper (Th)1-like origin. However, recent reports indicate a diminished interferon (IFN)-γ secretion at the onset of the disease. We hypothesize that there is a discrepancy in subsets of Th-cells between children with a high risk of developing T1D, children newly diagnosed with T1D and healthy children. Methods. Peripheral blood mononuclear cells (PBMC) were collected from children at high risk for T1D (islet cells antibodies [ICA] ≥ 20 IJDF-U), those newly diagnosed and healthy children carrying the HLA-risk gene DQB1*0302 or DQB1*0201 and DQA1*0501. Th1- (IFN-γ, tumour necrosis factor [TNF]-β, interleukin [IL]-2), Th2- (IL-4,-5,-13), Th3- (transforming growth factor [TGF-β], IL-10) and inflammatory associated cytokines (TNF-α, IL-1α,-6) and chemokines (monocyte chemoattractant protein [MCP]-1,-2,-3, Monokine unregulated by IFN-γ [MIG], Regulated on Activation, Normal T-cell Expressed and Secreted [RANTES], IL-7,-8,-15) were detected in cell-culture supernatants of PBMC, stimulated with glutamic acid decarboxylase 65 (GAD65) and phytohaemagglutinin (PHA), by protein micro array and enzyme linked immunospot (ELISPOT) technique. Results. The Th1 cytokines IFN-γ and TNF-β, secreted both spontaneously and by GAD65- and mitogen stimulation, were seen to a higher extent in high-risk children than in children newly diagnosed with T1D. In contrast, TNF-α and IL-6, classified as inflammatory cytokines, the chemokines RANTES, MCP-1 and IL-7 as well as the Th3 cytokines TGF-β and IL-10 were elevated in T1D children compared to high-risk children. Conclusion. High Th-1 cytokines were observed in children with high risk of developing TID, whereas in children newly diagnosed with T1D Th3 cytokines, inflammatory cytokines and chemokines were increased. Thus, an inverse relation between Th1-like cells and markers of inflammation was shown between children with high risk and those newly diagnosed with T1D. Copyright © 2007 John Wiley & Sons, Ltd.

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