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Maathz P, Flink IK, Engman L, Ekdahl J. Psychological Inflexibility as a Predictor of Sexual Functioning Among Women with Vulvovaginal Pain: A Prospective Investigation. Pain Med 2020; 21:3596-3602. [PMID: 32186737 PMCID: PMC7770233 DOI: 10.1093/pm/pnaa042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Persistent vulvovaginal pain affects many women and often has adverse effects on sexual functioning. Psychological inflexibility related to pain is associated with distress and functional disability across different types of chronic pain conditions, but little is known about the role of psychological inflexibility in vulvovaginal pain. The present study examines psychological inflexibility related to pain as a predictor of sexual functioning over time among women with vulvovaginal pain. Methods Questionnaires including measures of psychological inflexibility, pain severity, and sexual functioning were administered to female university students at two points in time. One hundred thirty women with vulvovaginal pain responded to the questionnaire at baseline and at follow-up after 10 months. A multiple regression model was used to explore psychological inflexibility and pain severity as predictors of sexual functioning at follow-up. Results Higher levels of psychological inflexibility and more severe pain at baseline were associated with poorer sexual functioning 10 months later. In analysis adjusting for baseline levels of sexual functioning, psychological inflexibility was the only significant predictor of sexual functioning at follow-up. Conclusions The findings provide preliminary evidence that psychological inflexibility is associated with sexual adjustment over time among women with vulvovaginal pain and point to the relevance of further examinations of the psychological inflexibility model in the context of vulvovaginal pain.
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Affiliation(s)
- Pernilla Maathz
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Ida K Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Linnea Engman
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
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Leiler A, Bjärtå A, Ekdahl J, Wasteson E. Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden. Soc Psychiatry Psychiatr Epidemiol 2019; 54:543-551. [PMID: 30580381 DOI: 10.1007/s00127-018-1651-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION 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 and improve conditions at the housing facilities.
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Affiliation(s)
- Anna Leiler
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden.
| | - Anna Bjärtå
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
| | - Elisabet Wasteson
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
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Rondung E, Ekdahl J, Sundin Ö. Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty. Birth 2019; 46:61-68. [PMID: 29954044 DOI: 10.1111/birt.12368] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
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Rondung E, Ekdahl J, Hildingsson I, Rubertsson C, Sundin Ö. Heterogeneity in childbirth related fear or anxiety. Scand J Psychol 2018; 59:634-643. [DOI: 10.1111/sjop.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Ingegerd Hildingsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Nursing; Mid Sweden University; Sweden
| | - Christine Rubertsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Health Sciences; Faculty of Medicine; Lund University; Sweden
| | - Örjan Sundin
- Department of Psychology; Mid Sweden University; Sweden
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Rondung E, Ternström E, Hildingsson I, Haines HM, Sundin Ö, Ekdahl J, Karlström A, Larsson B, Segeblad B, Baylis R, Rubertsson C. Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10420. [PMID: 30097422 PMCID: PMC6109226 DOI: 10.2196/10420] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 02/05/2023] Open
Abstract
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).
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Affiliation(s)
- Elisabet Rondung
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Helen M Haines
- Department of Rural Health, The University of Melbourne, Victoria, Australia
| | - Örjan Sundin
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | | | | | - Birgitta Segeblad
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Rebecca Baylis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Faculty of Medicine, Lund university, Lund, Sweden
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Engman L, Flink IK, Ekdahl J, Boersma K, Linton SJ. Avoiding or enduring painful sex? A prospective study of coping and psychosexual function in vulvovaginal pain. Eur J Pain 2018; 22:1388-1398. [PMID: 29635880 DOI: 10.1002/ejp.1227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- L Engman
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - I K Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - J Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - K Boersma
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - S J Linton
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Larsson B, Karlström A, Rubertsson C, Ternström E, Ekdahl J, Segebladh B, Hildingsson I. Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial. Women Birth 2017; 30:460-467. [DOI: 10.1016/j.wombi.2017.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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Ternström E, Hildingsson I, Haines H, Karlström A, Sundin Ö, Ekdahl J, Segeblad B, Larsson B, Rondung E, Rubertsson C. A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth - A study protocol. Sex Reprod Healthc 2017; 13:75-82. [PMID: 28844361 DOI: 10.1016/j.srhc.2017.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/04/2017] [Accepted: 06/13/2017] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Science, Mid Sweden University, Sundsvall, Sweden.
| | - Helen Haines
- Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
| | - Annika Karlström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | | | - Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Research and Development Centre, Sundsvall Hospital, Sundsvall, Sweden.
| | - Elisabet Rondung
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Otterstedt OE, Otterstedt JEA, Ekdahl J, Backman J, Andersson CH. Fine colloidal silica as reinforcing filler in polyurethane polymers. J Appl Polym Sci 1987. [DOI: 10.1002/app.1987.070340720] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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