Clinical aspects of childbirth-related anxiety
نویسنده
چکیده
.................................................................................................... 2 LIST OF PUBLICATIONS ............................................................................ 3 ABBREVIATIONS ........................................................................................ 4 BACKGROUND ............................................................................................. 5 1.1 Theoretical framework for anxiety ..................................................... 5 1.1.1 Emotions and cognitions ............................................................................. 5 1.1.2 Psychological framework of phobic anxiety ....................................... 6 1.1.3 Psychological framework of PTSD .......................................................... 7 1.2 Definitions and assessments ................................................................. 8 1.2.1 Definition and assessment of FOC ........................................................... 8 1.2.2 Definition and assessment of childbirth related PTSD ................... 9 1.3 Prevalence and related factors .......................................................... 10 1.3.1 Prevalence of FOC ......................................................................................... 10 1.3.2 Prevalence of childbirth-‐related PTSD ................................................ 11 1.3.3 Comorbidity of childbirth-‐related anxiety ......................................... 11 1.3.4 Aetiology, vulnerability and risk factors for severe FOC ............. 12 1.3.5 Aetiology, vulnerability and risk factors for childbirth-‐related PTSD ................................................................................................................... 13 1.4 Consequences of severe FOC and childbirth-‐related PTSD ...... 14 1.4.1 Consequences of severe FOC ................................................................... 15 1.4.2 Consequences of childbirth-‐related PTSD ......................................... 15 1.4.3 Societal consequences of severe FOC ................................................... 15 1.5 Interventions ........................................................................................... 16 1.5.1 Treatment of anxiety problems .............................................................. 16 1.5.2 Current knowledge of Internet interventions in the treatment of anxiety problems ..................................................................................... 17 1.5.3 Treatment of severe FOC and childbirth-‐related PTSD in obstetric care .................................................................................................. 19 1.5.4 Current knowledge of interventions with therapeutic elements in obstetric care ............................................................................................. 20 AIMS AND RESEARCH QUESTIONS ..................................................... 23 2.1 Aims of the thesis .................................................................................... 23 2.2 Research questions ................................................................................ 24 MATERIAL AND METHODS .................................................................. 25 3.1 Ethical approvals .................................................................................... 25 3.2 The measurements used in the studies ........................................... 25 3.3 Design, procedure and analysis ......................................................... 31 3.3.1 Prevalence of severe FOC and variables related to severe FOC and preference for CS (Study 1, Paper I) ............................................ 31 3.3.2 Cost of illness of severe FOC (Study 2, Paper II) ............................. 33 3.3.3 Treatment of severe FOC over the Internet (Studies 3 and 4, Papers III and IV) .......................................................................................... 37 3.3.4 Treatment of childbirth-‐related PTSD symptoms over the Internet (Study 5, Paper V) ...................................................................... 44 RESULTS ..................................................................................................... 50 4.1 Prevalence of severe FOC and variables related to severe FOC and preference for CS (Study 1, Paper I) ......................................... 50 4.2 Cost of illness of severe FOC (Study 2, Paper II) ........................... 51 4.3 Treatment of nulliparous women with severe FOC over the Internet (Study 3 and 4, Paper III and IV) ....................................... 55 4.4 Treatment of childbirth-‐related PTSD symptoms over the Internet (Study 5, Paper V) .................................................................. 60 GENERAL DISCUSSION ........................................................................... 67 5.1 Discussion of the main findings ......................................................... 67 5.2 Methodological considerations -‐ strengths and limitations .... 76 5.2.1 Study design: questionnaires .................................................................. 76 5.2.2 Study samples and other methodological aspects ......................... 77 5.2.3 Internet interventions ................................................................................ 78 CONCLUSIONS ........................................................................................... 83 CLINICAL IMPLICATIONS ...................................................................... 84 CONSIDERATIONS FOR FUTURE RESEARCH .................................. 85 FUNDING .................................................................................................... 85 ACKNOWLEDGEMENTS ......................................................................... 86 SUMMARY IN SWEDISH ......................................................................... 89 SUMMARY IN FINNISH ........................................................................... 91 REFERENCES ............................................................................................. 93 PAPERS I-‐V .............................................................................................. 107
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