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  • 1.
    Lundell, Inger Wallin
    et al.
    Sophiahemmet University.
    Eulau, Louise
    Sophiahemmet University.
    Bjarneby, Frida
    Westerbotn, Margareta
    Sophiahemmet University.
    Women's Experiences with Healthcare Professionals after Suffering from Gender-Based Violence: An Interview Study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. 949-957Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: This study sought to describe how women in Mexico who have suffered from gender-based violence experience their encounters with healthcare professionals.

    BACKGROUND: Gender-based violence is a worldwide problem. Previous studies have described that women feel they are not being cared for appropriately during their encounters with healthcare professionals. This study was conducted in Mexico, which has a high rate of gender inequality.

    DESIGN: A descriptive, qualitative study was conducted.

    METHODS: Face-to-face interviews were conducted with seven women. An inductive content analysis was used to analyse the interviews.

    RESULTS: The analyses resulted in four categories: Feelings of guilt about being abused, Feelings of being unimportant, Feelings of taking time and Feelings of being insecure/secure. The women emphasised the importance of healthcare professionals taking time out of their busy schedules for them. When they treated the women with respect and genuine interest, the women felt secure. When the healthcare professionals did not meet these expectations, feelings of frustration and mistrust were elicited.

    CONCLUSIONS: Feelings of being listened to and safety were considered important aspects in a positive encounter, whereas feeling a lack of time or interest often led to negative experiences such as frustration with and distrust of the healthcare system. These results imply that healthcare professionals may have deficiencies with regard to how these women are treated because these women do not feel that they receive the proper support.

  • 2. Tinglöf, Soile
    et al.
    Högberg, Ulf
    Wallin Lundell, Inger
    Sophiahemmet University.
    Skoog Svanberg, Agneta
    Exposure to violence among women with unwanted pregnancies and the association with post-traumatic stress disorder, symptoms of anxiety and depression2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 2, p. 50-53Article in journal (Refereed)
    Abstract [en]

    Aim

    The objective was to examine lifetime exposure to violence, physical and sexual, among women seeking termination of pregnancy (TOP) and its association with socio-demographic factors, PTSD, symptoms of anxiety and depression.

    Design

    The design of the study was a Swedish multi-centre study targeting women requesting TOP.

    Methods

    All women requesting TOP with a gestational length less than 12 pregnancy weeks were approached for participation in the study. The questionnaire comprised the following research instruments: Screen Questionnaire-Post traumatic Stress Disorder (SQ-PTSD) and Hospital Anxiety and Depression Scale (HADS). The response rate was 57% and the final sample was 1514 women. Descriptive and analytic statistics were applied.

    Results

    Lifetime exposure to violence was common among women seeking abortion. Exposure to violence was associated with low education, single marital status, smoking and high alcohol consumption. Exposure to violence was associated with the occurrence of signs of PTSD and symptoms of anxiety and depression. Among those having PTSD, all had been exposed to sexual violence and almost all had been exposed to physical violence, while for those with symptoms of anxiety and depression almost half had been exposed to either physical or sexual violence.

    Conclusion

    Exposure to physical and sexual abuse was common among women requesting TOP, and was strongly associated with the occurrence of PTSD, symptoms of anxiety and depression. This underscores the importance for health professionals to recognize and offer support to those women exposed to violence.

  • 3.
    Wallin Lundell, Inger
    Sophiahemmet University.
    Induced Abortions and Posttraumatic Stress - Is there any relation?: A Swedish multi-centre study2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers, and there is lack of knowledge about the relationship between posttraumatic disorder (PTSD) and induced abortion. Aims: To study and compare PTSD, posttraumatic stress symptoms (PTSS) and anxiety- and depressive symptoms among women seeking abortion, allowing for demographic variables. Further aims were to assess risk factors and to assess PTSD and PTSS following induced abortion in relation to experienced care at the clinic. Methods: This was a multi-centre cohort study targeting women who requested an induced abortion at the outpatient clinics of the gynaecology and obstetrics departments of six public hospitals in Sweden. All women who requested an induced abortion before the end of gestational week 12 were approached for participation. PTSD, PTSS, anxiety- and depressive symptoms, personality traits and women’s perceptions of abortion care were measured by means of questionnaires. Measurements were made at the first visit before the abortion as well as three- and six-months thereafter. Data collection was performed from September 2009 to January 2011. Results: 1,514 women filled out the questionnaire before the abortion. Abortion-seeking women did not suffer from PTSD to a greater extent than the general Swedish female population. Few women (51/720) developed PTSD or PTSS after the abortion, 11 did so due to trauma experience related to the abortion. Women at risk of posttraumatic stress were more likely to be young, having anxiety- or depressive symptoms and personality traits related to neuroticism. Furthermore, women with PTSD or PTSS were more likely to perceive certain aspects of the abortion care as deficient. Conclusions: The vast majority of women coped well with the induced abortion. Few developed posttraumatic stress post abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Young women and women with mental distress are vulnerable groups that need to be paid attention to in abortion care. These women are at risk for negative experiences of the abortion care, and may be at risk of PTSD or PTSS post abortion

  • 4.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress.2016Conference paper (Other academic)
  • 5.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress.2016Conference paper (Other academic)
  • 6.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress2016Conference paper (Other academic)
  • 7.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Nyberg, Sigrid
    Sundström Poromaa, Inger
    Sydsjö, Gunilla
    Östlund, Ingrid
    Skoog Svanberg, Agneta
    Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study2013In: BMC Women's Health, E-ISSN 1472-6874, Vol. 13, p. 52-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

    METHODS: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups.

    RESULTS: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

    CONCLUSION: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

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    Wallin_140307
  • 8.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress2015In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 3, p. 211-222Article in journal (Refereed)
    Abstract [en]

    Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.

  • 9.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Ekselius, Lisa
    Georgsson, Susanne
    Sophiahemmet University.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Skoog Svanberg, Agneta
    Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study2017In: BMC Women's Health, E-ISSN 1472-6874, Vol. 17, no 1, article id 96Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion.

    METHODS: A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion.

    RESULTS: Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2-5.6) and 2.9 (CI 95% 1.3-6.6), respectively.

    CONCLUSION: High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.

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  • 10.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Ekselius, Lisa
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    Neuroticism-related personality traits are associated with post-abortion posttraumatic stress2014In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102Article in journal (Refereed)
  • 11.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Moby, Lena
    Nyberg, Sigrid
    Sydsjö, Gunilla
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Östlund, Ingrid
    Skoog Svanberg, Agneta
    The prevalence of posttraumatic stress among women requesting induced abortion2013In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, no 6, p. 480-8Article in journal (Refereed)
    Abstract [en]

    Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime- and point prevalence of PTSD were 7% (95% confidence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.

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    Wallin Lundell 140311
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