miun.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Thomtén, Johanna
Alternative names
Publications (10 of 32) Show all publications
Leiler, A., Bjärtå, A., Ekdahl, J. & Wasteson, E. (2019). Mental Health and Quality of Life among Asylum Seekers and Refugees Living in Refugee Housing Facilities in Sweden. Social Psychiatry and Psychiatric Epidemiology, 54(5), 543-551
Open this publication in new window or tab >>Mental Health and Quality of Life among Asylum Seekers and Refugees Living in Refugee Housing Facilities in Sweden
2019 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 54, no 5, p. 543-551Article in journal (Refereed) Published
Abstract [en]

In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing facilities for long periods. The present study aims to describe the mental health and quality of life of these individuals. 

Methods. Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF).

Results. Of the total sample, 56-58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes.

Conclusions. Individuals residing in refugee housing facilities show high levels of psychological distress and rate their quality of life as low. Asylum seekers score higher than those having received a residence permit. These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process wait time and improve conditions at the housing facilities.  

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Refugee mental health, Prevalence, Aylum seekers
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-35290 (URN)10.1007/s00127-018-1651-6 (DOI)000468889500003 ()30580381 (PubMedID)2-s2.0-85059004802 (Scopus ID)
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-07-08
Rondung, E., Ekdahl, J. & Sundin, Ö. (2019). Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty.. Birth, 46(1), 61-68
Open this publication in new window or tab >>Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty.
2019 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 46, no 1, p. 61-68Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although many pregnant women experience fear, worry, or anxiety relating to the upcoming birth, little is known regarding the psychological mechanisms contributing to these experiences. In this study, we wanted to take a first step in trying to identify mechanisms of potential interest. The objective of this cross-sectional study was thus to investigate pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance as potential mechanisms predicting fear of birth among pregnant women.

METHODS: A sample of 499 pregnant women, recruited in antenatal health care settings in 2 Swedish regions, completed the Fear of Birth Scale, along with measurements of the mechanisms of interest. Linear and logistic hierarchical regression analyses were used to investigate the extent to which pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance predicted fear of birth, both as a continuous and a dichotomous measure.

RESULTS: Logistic regression analysis showed high levels of pain catastrophizing and intolerance of uncertainty to be the best predictors of fear of birth, OR 3.49 (95% CI 2.17-5.61) and OR 3.25 (95% CI 2.00-5.27), respectively. Positive beliefs about worry and cognitive avoidance were both correlated with fear of birth as a continuous measure, but did not contribute to the logistic regression model.

CONCLUSIONS: Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.

Keywords
fear of birth, intolerance of uncertainty, pain catastrophizing
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34319 (URN)10.1111/birt.12368 (DOI)000459794300007 ()29954044 (PubMedID)2-s2.0-85061577739 (Scopus ID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-08-07Bibliographically approved
Baylis, R., Thomtén, J., Haines, H. & Rubertsson, C. (2019). Women's experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth. Women and Birth
Open this publication in new window or tab >>Women's experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Fear of Birth is common in pregnant women and associated with negative physical and mental health. There is a clear comorbidity with anxiety and depression. Internet-delivered Cognitive Behaviour Therapy has been suggested as a treatment option for Fear of Birth and a randomized controlled trial comparing internet-delivered Cognitive Behaviour Therapy with midwifery led counselling as standard care has been conducted. Objective: The aim of this study was to describe women's experiences of guided internet-delivered Cognitive Behaviour Therapy for Fear of Birth and to describe the content of their fear. Methods: The present study is a qualitative, follow-up interview study following the randomized controlled trial, the U-CARE Pregnancy Trial. In total 19 women allocated to internet-delivered Cognitive Behaviour Therapy for Fear of Birth were interviewed by telephone. A semi-structured interview guide was used and the transcripts were analyzed with thematic analysis. Results: The women's descriptions of Fear of Birth differed, however their fear was most often associated with fear of losing control, fear for the baby's life or health or own life threatening events. The experiences of internet-delivered Cognitive Behaviour Therapy for Fear of Birth varied, some women were positive to its flexibility although most women preferred a face-to face meeting. The treatment did not pin-point their fears, it was challenging to maintain motivation and to work with the treatment in solitude. Conclusions: Women's descriptions of Fear of Birth varied. Most women undergoing internet-delivered Cognitive Behaviour Therapy would have preferred a face-to-face meeting which they imagined would have soothed their fear. Internet-delivered Cognitive Behaviour Therapy for Fear of Birth may be an alternative for some women. 

Keywords
Cognitive Behavioral Therapy, Fear of Birth, iCBT, Women's experiences
National Category
Psychology
Identifiers
urn:nbn:se:miun:diva-36674 (URN)10.1016/j.wombi.2019.05.006 (DOI)
Available from: 2019-07-09 Created: 2019-07-09 Last updated: 2019-07-09Bibliographically approved
Bjärtå, A., Leiler, A., Ekdahl, J. & Wasteson, E. (2018). Assessing Severity of Psychological Distress Among Refugees With the Refugee Health Screener, 13-Item Version. Journal of Nervous and Mental Disease, 206(11), 834-839
Open this publication in new window or tab >>Assessing Severity of Psychological Distress Among Refugees With the Refugee Health Screener, 13-Item Version
2018 (English)In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 206, no 11, p. 834-839Article in journal (Refereed) Published
Abstract [en]

The recent inflow of refugees to Sweden has put pressure on health care as well as revealing a need for methods regarding assessment of refugees' mental health status. The present study investigated the use of the Refugee Health Screener (RHS; Hollifield et al., 2013) to distinguish among severity levels of symptoms of psychological distress in refugees. Refugees residing in asylum accommodations (n = 510) were screened with RHS-13, together with screeners for depression, anxiety, and posttraumatic stress disorder (PTSD). Risk for mild, moderate, or severe levels of depression, anxiety, or/and PTSD was used as screening proxy. Receiver operating characteristic analysis rendered cutoff scores of 11, 18, and 25, for mild, moderate, and severe symptoms, respectively. Evaluated against each symptom scale separately, cutoffs performed well. Cutoff 11, previously identified by Hollifield et al. (2016), was also confirmed. However, utilization of additional cutoffs could improve refugee mental health by guiding clinical decision making.

Keywords
Refugee mental health, screening instrument, symptom severity levels
National Category
Psychology
Identifiers
urn:nbn:se:miun:diva-35042 (URN)10.1097/NMD.0000000000000886 (DOI)000449644500002 ()30256332 (PubMedID)2-s2.0-85055612622 (Scopus ID)
Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2019-08-06Bibliographically approved
Engman, L., Flink, I., Ekdahl, J., Boersma, K. & Linton, S. (2018). Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain. European Journal of Pain, 22(8), 1388-1398
Open this publication in new window or tab >>Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain
Show others...
2018 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 8, p. 1388-1398Article in journal (Refereed) Published
Abstract [en]

Background

Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.

Methods

One hundred and seventeen women, 18–35 years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.

Results

Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.

Conclusions

Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.

Significance

In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.

National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-33649 (URN)10.1002/ejp.1227 (DOI)000441435800002 ()2-s2.0-85045933115 (Scopus ID)
Available from: 2018-05-17 Created: 2018-05-17 Last updated: 2019-03-26Bibliographically approved
Rondung, E., Ternström, E., Hildingsson, I., Haines, H. M., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2018). Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.. JMIR mental health, 5(3), Article ID e10420.
Open this publication in new window or tab >>Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.
Show others...
2018 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 5, no 3, article id e10420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care.

OBJECTIVE: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth.

METHODS: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale.

RESULTS: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03).

CONCLUSIONS: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).

Keywords
anxiety, cognitive behavioral therapy, fear of birth, internet-based, pregnancy
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34318 (URN)10.2196/10420 (DOI)000449378200001 ()30097422 (PubMedID)2-s2.0-85052907128 (Scopus ID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-03-27Bibliographically approved
Rondung, E., Ekdahl, J., Hildingsson, I., Rubertsson, C. & Sundin, Ö. (2018). Heterogeneity in childbirth related fear or anxiety. Scandinavian Journal of Psychology, 59(6), 634-643
Open this publication in new window or tab >>Heterogeneity in childbirth related fear or anxiety
Show others...
2018 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 59, no 6, p. 634-643Article in journal (Refereed) Published
Abstract [en]

Many pregnant women experience fear, worry or anxiety relating to the upcoming childbirth. The aim of this cross-sectional study was to investigate possible subgroups in a sample of 206 pregnant women (mean age 29.4 years), reporting fear of birth in mid-pregnancy. Comparisons were made between nulliparous and parous women. In a series of cluster analyses, validated psychological instruments were used to cluster women based on their psychological profiles. A five-cluster solution was suggested, with the clusters characterized by: overall low symptom load, general high symptom load, medium symptom load with high performance-based self-esteem, blood- and injection phobic anxiety, and specific anxiety symptoms. Nulliparous women were more likely to report clinically relevant levels of blood- and injection phobia (OR = 2.57, 95% CI 1.09–6.01), while parous women more often reported previous negative experiences in health care (OR 1.93, 95% CI 1.09–3.39) or previous trauma (OR 2.90, 95% CI 1.58–5.32). The results indicate that women reporting fear of birth are a heterogeneous group. In order to individualize treatment, psychological characteristics may be of greater importance than parity in identifying relevant subgroups. 

Keywords
anxiety, fear, childbirth, pregnancy, cluster analysis, blood- and injection phobia
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34320 (URN)10.1111/sjop.12481 (DOI)000449851300009 ()30176051 (PubMedID)2-s2.0-85053239503 (Scopus ID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-03-27Bibliographically approved
Leiler, A., Bjärtå, A., Ekdahl, J. & Wasteson, E. (2018). High levels of psychological distress among asylum seekers and refugees in Sweden. In: : . Paper presented at association of psychological Science, APS.
Open this publication in new window or tab >>High levels of psychological distress among asylum seekers and refugees in Sweden
2018 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

In 2015 there was an unforeseen increase of refugees worldwide. In order to face the high rates of psychological distress refugees suffer, the AMIR-project created a model for early assessment and intervention of mental health among refugees. Previous research might not be applicable to the groups seeking asylum in Europe from 2015, so as a first step, a study aiming to estimate the prevalence of mental health problems was conducted.  

Methods. Five hundred and ten refugees participated at open screenings conducted at refugee housing facilities. Of the participants, 367 were asylum seekers and 143 had received a residence permit. Instruments included measures of depressive symptoms, anxiety, risk of having PTSD and quality of life.

Preliminary results. A high percentage of individuals (56-58.4%) reported clinically significant levels of depression, anxiety and risk of having PTSD. Prevalence estimates were significantly higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated significantly with mental health outcomes.

Conclusions. Individuals residing in refugee housing facilities show high levels of psychological distress. Asylum seekers are worse off than those having received a residence permit. Actions should be taken to improve conditions in housing facilities, to shorten the time awaiting the asylum decision and to provide psychosocial support to help individuals manage their distress during the time of waiting.

Key words: Refugee – asylum seeker – mental health – quality of life - prevalence

National Category
Psychology
Identifiers
urn:nbn:se:miun:diva-35121 (URN)
Conference
association of psychological Science, APS
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2018-12-10Bibliographically approved
Ekdahl, J., Flink, I., Engman, L. & Linton, S. J. (2018). Vulvovaginal pain from a fear-avoidance perspective: a prospective study among female university students in Sweden. International Journal of Sexual Health, 30(1), 49-59
Open this publication in new window or tab >>Vulvovaginal pain from a fear-avoidance perspective: a prospective study among female university students in Sweden
2018 (English)In: International Journal of Sexual Health, ISSN 1931-7611, E-ISSN 1931-762X, Vol. 30, no 1, p. 49-59Article in journal (Refereed) Published
Abstract [en]

Objectives: To examine how fear-avoidance influences vulvovaginal pain and sexual function over time.

Method: At baseline and at 10-month follow-up, self-report measures for sexual- and fear avoidance factors were obtained from 483 female university students with and without self-reported vulvovaginal pain.

Results: individuals with pain at both times reported lower sexual function, and higher levels of fear-avoidance compared to the pain-free group. Fear-avoidance beliefs predicted the occurrence of vulvovaginal pain at follow up and the level of pain intensity.

Conclusion: The results points to the relevance of the components of the fear-avoidance model in vulvovaginal pain over time.

Keywords
vulvovaginal pain, fear-avoidance, catastrophizing, sexual function, sexual satisfaction
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-32172 (URN)10.1080/19317611.2017.1404543 (DOI)000432548400006 ()2-s2.0-85041172070 (Scopus ID)
Available from: 2017-11-28 Created: 2017-11-28 Last updated: 2019-03-26Bibliographically approved
Ternström, E., Hildingsson, I., Haines, H., Karlström, A., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2017). A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth – A study protocol. Sexual & Reproductive HealthCare, 13, 75-82
Open this publication in new window or tab >>A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth – A study protocol
Show others...
2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 75-82Article in journal (Refereed) Published
Abstract [en]

Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-31379 (URN)10.1016/j.srhc.2017.06.001 (DOI)000411305800011 ()28844361 (PubMedID)2-s2.0-85021645169 (Scopus ID)
Note

Available online 15 June 2017

Available from: 2017-08-11 Created: 2017-08-11 Last updated: 2018-12-05Bibliographically approved
Organisations

Search in DiVA

Show all publications