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Ut ur ensamheten: Hälsa och liv för kvinnor som varit utsatta för sexuella övergrepp i barndomen och som deltagit i självhjälpsgrupp
Nordic Council of Ministers, Nordic School of Public Health NHV.
2009 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Bakgrund och syfte: Könsrelaterat våld ses som ett globalt folkhälsoproblem och som den mest genomgripande, men minst uppmärksammade kränkningen mot mänskliga rättigheter. Prevalensen i Sverige har skattats till 10 % med ett troligt stort mörkertal. Sexuella övergrepp kan påverka både fysisk och psykisk hälsa negativt och utsatta kvinnor söker för många olika symtom utan att nämna övergreppen. Det övergripande syftet med denna avhandling var att öka kunskapen om kvinnor som varit utsatta för sexuella övergrepp under uppväxten och nu sökt sig till självhjälpsgrupper, rörande hälsa, personliga resurser, relationer och omständigheter kring övergreppen, samt hur de upplevt att delta i självhjälpsgrupp (SHG). Metod: Avhandlingen bygger på fyra delstudier (I – IV) och har både kvantitativ och kvalitativ forskningsansats. Delstudie I (n=81) syftade till dels att mäta Känsla av Sammanhang, KASAM, hos kvinnorna, dels att analysera sambandet mellan KASAM-värde och frågor i ett formulär som konstruerats för delstudie I och II. Delstudie II (n=87) syftade till att mäta psykiska och psykosomatiska symtom (SCL-90-R) hos kvinnorna samt förekomsten av posttraumatiska stressymtom (IES-R). Delstudie III (n=10) hade både kvantitativ och kvalitativ ansats och syftade till att undersöka om och hur kvinnorna verbalt uttryckte outtalad skam via kodord i intervjuer. I den kvalitativa delstudie IV (n=17) intervjuades kvinnorna om upplevelsen av att ha deltagit i en självhjälpsgrupp och om det medfört några förändringar i hälsa, livssituationer och relationer. Resultat: Kvinnorna uppgav attdet vanligaste skälet för att delta i en självhjälpsgrupp var att vilja tala med andra kvinnor med liknande erfarenheter, följt av att få hjälpa varandra. Medelvärdet på KASAM var 104,1 med de lägsta värdena för dem som inte mindes hur många år de varit utsatta (I). De hade en dålig psykisk hälsa och signifikant sämre än en jämförelsegrupp bestående av kvinnliga psykiatriska patienter med olika diagnoser. Resultaten från IES-R visade att 57,5 % av kvinnorna hade värden som indikerade risk för post traumatisk stress (PTSD). I delstudie III framkom att kvinnorna använde kodord som indikerade skambenägenhet. Affekten skam påverkade deras hälsa, syn på sig själva och relationer negativt. Kvinnorna beskrev i delstudie (IV) att självhjälpsgrupperna fungerat som en väg ut ur ensamhet, att deras självbilder förändrats positivt, att symtom som t.ex. depression och ångest minskat samt minskade PTSD-symtom. Dessa förändringar kan indikera att kvinnorna har uppnått empowerment. Konklusion: Problematiken kring sexuella övergrepp som sker under uppväxten är komplext. Att tänka hälsopromotivt – t.ex. genom ett helhetsperspektiv kring hälsa samt delaktighet – kring denna problematik är av vikt för dem som utsatts för övergrepp ocsom behöver adekvat hjälp att bearbeta detta. Detta är också viktigt för professionella behandlare för att kunna ge rätt hjälp. En av hälsopromotionens grundstenar, empowerment, tycks ha uppnåtts i de deltagarstyrda självhjälpsgrupperna. Men självhjälpsgrupper ska endast ses som ett komplement till professionell vård. Därför behöver kunskaper spridas och utvecklas i de sektorer där man möter problematiken. En ökad kunskap bör kunna leda till ökad benägenhet att undersöka om sexuella övergrepp ligger bakom de symtom kvinnor uppvisar. Det är den grund som krävs för att kunna erbjuda en adekvat och rättvis vård

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2009. , p. 80
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2009:1
Keywords [sv]
Sexuella övergrepp på barn; psykis k hälsa; PTSD; skam; salutogenes; självhjälpsgrupper; folkhälsa; hälsopromotion; empowerment.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3659ISBN: 978-91-85721-51-1 (print)OAI: oai:DiVA.org:norden-3659DiVA, id: diva2:785246
Public defence
2009-01-16, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2015-02-02Bibliographically approved
List of papers
1. 'Disgust, disgust beyond description'- shame cues to detect shame in disguise, in interviews with women who were sexually abused during childhood.
Open this publication in new window or tab >>'Disgust, disgust beyond description'- shame cues to detect shame in disguise, in interviews with women who were sexually abused during childhood.
2006 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 13, no 1, p. 100-9Article in journal (Refereed) Published
Abstract [en]

Shame is a recurrent theme in the context of sexually abused women. Sexual abuse is taboo and shameful, and so is shame. Shame affects the development of a person and relationships, and is mentally painful. It is often covert. One aim of the present study was to explore whether and how women exposed to sexual abuse during childhood verbally express unacknowledged overt and covert shame, when interviewed about their physical and mental health, relations and circumstances relating to the sexual abuse. Another aim was, if shame was present, to describe the quality of the shame expressed by the women. A mainly qualitative approach with semi-structured interviews was used. Ten women attending self-help groups for women who were sexually abused during childhood were recruited as informants. The interviews were analysed for verbal expressions of shame by identifying code words and phrases, which were first sorted into six shame indicator groups and then categorized into various aspects of shame. The frequency of the code words and phrases was also counted. The findings clearly reveal that the affect of shame is present and negatively influences the lives of the informants in this study. It was possible to sort the code words and phrases most often mentioned into the indicator groups 'alienated', 'inadequate' and 'hurt', in the order of their frequency. It is obvious that shame affects the lives of this study's informants in negative ways. One important clinical implication for professionals in health care and psychiatric services is to acknowledge both sexual abuse and shame in order to make it possible for patients to work through it and thereby help them psychologically to improve their health.

Keywords
affect; health; qualitative method; self-help group; sexual abuse; shame
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3656 (URN)10.1111/j.1365-2850.2006.00927.x (DOI)16441400 (PubMedID)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved
2. Sense of coherence in women with a history of childhood sexual abuse
Open this publication in new window or tab >>Sense of coherence in women with a history of childhood sexual abuse
2005 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 14, no 2, p. 127-133Article in journal (Refereed) Published
Abstract [en]

Women with a history of childhood sexual abuse experience a range of difficulties. The aim of the present study is to examine the personal resources of women with such a history measured using the SOC scale. The relationships of SOC to other factors were analysed. Eighty-one women who participated in self-help groups were questioned using the 29-item version of the SOC scale. The SOC mean score for the whole group was 104.1 (range 58–187). The women who had a more than ten-year duration of sexual abuse had a low SOC score (M = 96.8) but those who did not remember the number of years of duration had an even lower score (M = 94.4). In a first step of multiple regression analysis of childhood sexual abuse characteristics and SOC total score, only duration of sexual abuse was entered and accounted for 10.3 per cent of the variance. In a second step of multiple regression analysis, relationship to fellow workers was a significant predictor of SOC and contributed to 31.7 per cent of the variance

Keywords
childhood sexual abuse; sense of coherence; SOC scale; self-help group
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3657 (URN)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved
3. Psychological distress among women who were sexually abused as children
Open this publication in new window or tab >>Psychological distress among women who were sexually abused as children
2013 (English)In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 22, no 3, p. 269-278Article in journal (Refereed) Published
Abstract [en]

One of the aims of the study was to investigate how participants in self-help groups (SHG) for women (n = 87) who had been sexually abused in childhood rated their mental health and to what extent they were at risk of developing posttraumatic stress disorder (PTSD). A further aim was to investigate the relationship between the ratings of mental health, occurrence of PTSD, women's interpersonal relationships, reasons for participating in an SHG and characteristics of the childhood sexual abuse (CSA). The participants completed questionnaires regarding their personal relationships, reasons for joining a group, abuse characteristics, mental health (Symptom Checklist-90-Revised) and PTSD (Impact of Event Scale-Revised). The women showed poor mental health, and more than half of them were at risk of developing PTSD. Lack of social support and feelings of shame correlated with poor mental health, whereas guilt did not. Relationships with female friends had a positive association. Further research is needed to determine whether participating in an SHG could provide adequate social support and reduce feelings of shame, thereby contributing to the healing process in the aftermath of CSA.

Keywords
childhood sexual abuse; mental health; PTSD; shame; self-help group; public health
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3658 (URN)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved

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