Assessing the use of clinical guidelines against domestic violence in southern Sweden: A mixed-methods study

BACKGROUND AND AIM

Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use.

METHODS

A survey was distributed to first-line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically.

RESULTS

73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program.

CONCLUSION

This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence.

Risk for mental illness following exposure to violence and threats among newly arrived refugees

OBJECTIVE

There is an association between pre-migration exposure to threats and violence, and the risk for mental illness among newly arrived refugees (NAR). The aim of this study is therefore to investigate the effect of pre-migration violent and threatening experiences on the mental health of NAR in Sweden. The participants were recruited between February 2015 and February 2016, undergoing the naturalisation process in Sweden. In total, 681 questionnaires were returned (response rate of 39.5%).

RESULTS

The results showed that almost 50% of the sample were at risk for mental illness. Analysis of pre-migration exposure to violence or threats, and risk for mental illness, showed a significant odds ratio for violence as well as for threats. Analysing men and women separately resulted in a significant odds ratio for women for pre-migration threats. For men, pre-migration violence and threats were significantly associated with the risk for mental illness. The host society receiving NAR must screen for mental illness and be prepared to provide support and care for refugees who were exposed to violence or threats, and who are subsequently at risk for mental illness. This must be considered in order to improve health and subsequently the social integration of refugees.

Correction to: Perceptions and effects of COVID-19 related information in Denmark and Sweden - a web-based survey about COVID-19 and social media

[This corrects the article DOI: 10.1007/s10389-021-01539-5.].

Does country-level gender equality explain individual risk of intimate partner violence against women? A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) in the European Union

Background

Gender equality is widely accepted as an important explanatory factor for the occurrence of intimate partner violence (IPV) against women. However, the relationship is not straightforward, as high country-level gender equality is not always associated with lower IPV prevalence. We apply ‘multilevel analysis of individual heterogeneity and discriminatory accuracy’ (MAIHDA) to (i) quantify the extent to which the country of residence determines individual risk of IPV and (ii) investigate the association between country-level gender equality and individual experience of IPV, and to which extent this association explains the observed between-country differences.

Methods

Using data from the 2012 European Union Agency for Fundamental Rights survey on violence against women we applied MAIHDA to analyse experiences of physical and sexual IPV among 42 000 women living in the EU. We fitted three consecutive models, and calculated specific individual contextual effects (measures of association) as well as the general contextual effects (measures of variance) and the discriminatory accuracy (DA).

Results

Our findings show that the relationship between experiences of IPV and country-level gender equality is weak and heterogeneous. The general contextual effect is small and the DA is low, indicating that country boundaries are rather irrelevant for understanding the individual risk of IPV.

Conclusions

Findings from the present study do not imply that that gender equality is unimportant in relation to IPV, but rather that information on country of residence or country-level gender equality does not discriminate very well with regards to individual experiences of IPV in cross-national comparisons.

Perceptions and effects of COVID-19 related information in Denmark and Sweden - a web-based survey about COVID-19 and social media

Aim

Extensive COVID-19 information can generate information overload and confusion. Denmark and Sweden adopted different COVID-19 management strategies.

Aim

This study aimed to compare search strategies, perceptions and effects of COVID-19 information, in general and specifically in social media, in residents in Denmark and Sweden.

Subject and methods

Quantitative data from a sample of respondents (n = 616) from Denmark and Sweden on an international web-based survey was analysed using descriptive and analytical statistics.

Results

The results showed similarities between the countries regarding preferred and trusted information sources, use of (social) media, and psychosocial and behavioural effects of such information. Traditional media and social media were frequently used for COVID-19 information. Especially health authorities and researchers were trusted sources, representing the dominant medico-political discourse. There were no differences in negative effect and social behaviour. Residents in Denmark experienced significantly more positive effects than residents in Sweden.

Conclusion

Summarily, the study showed similarities and small differences among residents in both countries related to usage patterns, perceptions and effects of COVID-19 information from (social) media, despite diverging strategies.

An Extended Home Visit Programme Within the Swedish Child Healthcare System for First-Time Parents in Scania, Sweden: A Study Protocol

Background: The Swedish Child Healthcare (CHC) system aims to provide equal and fair health care for all children and families in Sweden. Currently in Sweden, the CHC offers every family two home visits during the child's 1st year of life. During 2019, an extended home visit programme, called Grow Safely, was started in the region of Scania for first-time parents. The aim of the extended home visit programme was to provide support for first-time parents in order to improve the overall health of the child and family and contribute to better conditions for equal health. Instead of two home visits during the 1st year, a subsample of first-time parents would receive six visits during the child's first 15 months. These six visits would be conducted by CHC nurses and social workers, midwives, and dental assistants. In the present paper, we describe a research project related to the regional extended home visit programme; the project aims to illuminate the experiences of the participants and to investigate the perceived benefits of the programme in relation to improved health, social and emotional interaction between parent and child, and attitudes toward authorities and surrounding society. Method/Analysis: In order to evaluate the introduction of the intervention, three qualitative interview studies and one quantitative study with follow-up questionnaires will be conducted. Since the research project also comprises studies focusing on the implementation and expectations of politicians, civil servants, organizational managers, and professionals working within the programme, interviews within these fields will be conducted. Discussion: Sweden has a well-established CHC programme, but improvements are always possible. Previous research has shown that home visits are an effective tool to improve both the child's physical and mental health as well as the parents' well-being. However, this kind of intervention involves a significant investment from all organizations involved in the home visits; hence, it is important that the intervention is evaluated. The research project described in the present paper intends to examine the impact of the intervention, and its findings will aid decisionmakers in determining the future of the home visit programme.

For Whom Does Hate Crime Hurt More? A Comparison of Consequences of Victimization Across Motives and Crime Types

Hate crimes have been found to have more severe consequences than other parallel crimes that were not motivated by the offenders' hostility toward someone because of their real or perceived difference. Many countries today have hate crime laws that make it possible to increase the penalties for such crimes. The main critique against hate crime laws is that they punish thoughts. Instead, proponents of hate crime laws argue that sentence enhancement is justified because hate crimes cause greater harm. This study compares consequences of victimization across groups of victims to test for whom hate crimes hurt more. We analyzed data that were collected through questionnaires distributed to almost 3,000 students at Malmö University, Sweden, during 2013. The survey focused on students' exposure to, and experiences of, hate crime. A series of separate logistic regression analyses were performed, which analyzed the likelihood for reporting consequences following a crime depending on crime type, perceived motive, repeat victimization, gender, and age. Analyzed as one victim group, victims of hate crime more often reported any of the consequences following a crime compared with victims of parallel non-hate-motivated crimes. And, overall victims of threat more often reported consequences compared with victims of sexual harassment and minor assault. However, all hate crime victim groups did not report more consequences than the non-hate crime victim group. The results provide grounds for questioning that hate crimes hurt the individual victim more. It seems that hate crimes do not hurt all more but hate crimes hurt some victims of some crimes more in some ways.

Prevalence of intimate partner violence against women in Sweden and Spain: A psychometric study of the 'Nordic paradox'

The high prevalence of intimate partner violence against women (IPVAW) in countries with high levels of gender equality has been defined as the “Nordic paradox”. In this study we compared physical and sexual IPVAW prevalence data in two countries exemplifying the Nordic paradox: Sweden (N = 1483) and Spain (N = 1447). Data was drawn from the European Union Agency for Fundamental Rights Survey on violence against women. To ascertain whether differences between these two countries reflect true differences in IPVAW prevalence, and to rule out the possibility of measurement bias, we conducted a set of analyses to ensure measurement equivalence, a precondition for appropriate and valid cross-cultural comparisons. Results showed that in both countries items were measuring two separate constructs, physical and sexual IPVAW, and that these factors had high internal consistency and adequate validity. Measurement equivalence analyses (i.e., differential item functioning, and multigroup confirmatory factor analysis) supported the comparability of data across countries. Latent means comparisons between the Spanish and the Swedish samples showed that scores on both the physical and sexual IPVAW factors were significantly higher in Sweden than in Spain. The effect sizes of these differences were large: 89.1% of the Swedish sample had higher values in the physical IPVAW factor than the Spanish average, and this percentage was 99.4% for the sexual IPVAW factor as compared to the Spanish average. In terms of probability of superiority, there was an 80.7% and 96.1% probability that a Swedish woman would score higher than a Spanish woman in the physical and the sexual IPVAW factors, respectively. Our results showed that the higher prevalence of physical and sexual IPVAW in Sweden than in Spain reflects actual differences and are not the result of measurement bias, supporting the idea of the Nordic paradox.

Is Women's Fear of Crime Fear of Sexual Assault? A Test of the Shadow of Sexual Assault Hypothesis in a Sample of Swedish University Students

Prior research shows that women's higher fear of crime compared with men can largely be explained by women's fear of rape. Whether women's higher fear can also be explained by fear of nonviolent sexual harassment has not been explored. This study tested the shadow of sexual assault hypothesis in a sample of almost 3,000 Swedish university students. Our results confirm previous tests of the shadow thesis on the effect of fear of rape. In addition, we show that fear of sexual harassment also explained differences in fear between men and women. Based on the findings, we recommend that strategies to reduce sexual violence should focus on the entire continuum of violence against women.

An examination of the interaction between morality and self-control in offending: A study of differences between girls and boys

BACKGROUND

There is a well-documented gender difference in offending, with evidence that boys, on average, are more involved in crime than girls. Opinions differ, however, on whether the causes of crime apply to girls and boys similarly.

AIMS

Our aim is to explore crime propensity in boys and girls. Our research questions were (1) are there differences between boys and girls in moral values and self-control; (2) are these attributes similarly correlated with offending among girls and boys; and (3) is any interaction effect between morality and self-control identical for girls and boys.

METHODS

Data were drawn from the Malmö Individual and Neighbourhood Development Study, which includes 481 girls and boys aged 16-17. An 8-item self-control scale was derived from Grasmick's self-control instrument; we created a 16-item morality scale. Analysis of variance was used to test for differences in scale scores.

RESULTS

There were significant gender differences in moral values but not self-control. Moral values and self-control were significantly correlated with offending among both girls and boys. In the multiple regression analysis, the three-way interaction term used to test the interaction between gender, self-control and moral values was non-significant, indicating that the magnitude of the self-control-moral value interaction is not affected by gender.

CONCLUSIONS

Our findings indicate that effects of morality and self-control are general and apply to girls and boys similarly, so more research is needed to explain gender differences in crime prevalence. © 2018 The Authors Criminal Behaviour and Mental Health Published by John Wiley & Sons Ltd.

Country of residence, gender equality and victim blaming attitudes about partner violence: a multilevel analysis in EU

Background

Intimate partner violence against women (IPVAW) is a global and preventable public health problem. Public attitudes, such as victim-blaming, are important for our understanding of differences in the occurrence of IPVAW, as they contribute to its justification. In this paper, we focus on victim-blaming attitudes regarding IPVAW within the EU and we apply multilevel analyses to identify contextual determinants of victim-blaming attitudes. We investigate both the general contextual effect of the country and the specific association between country level of gender equality and individual victim-blaming attitudes, as well as to what extend a possible general contextual effect was explained by county level gender equality.

Methods

We analyzed data from 26 800 respondents from 27 member states of the European Union who responded to a survey on public perceptions of domestic violence. We applied multilevel logistic regression analysis and measures of variance (intra-class correlation (ICC)) were calculated, as well as the discriminatory accuracy by calculating the area under the receiver operator characteristic curve.

Results

Over and above individual characteristics, about 15% of the individual variance in the propensity for having victim-blaming attitudes was found at the country level, and country level of gender equality did not affect the general contextual effect (i.e. ICC) of the country on individual victim-blaming attitudes.

Conclusion

The present study shows that there are important between-country differences in victim-blaming attitudes that cannot be explained by differences in individual-level demographics or in gender equality at the country level. More research on attitudes towards IPVAW is needed.

Appropriate assessment of ethnic differences in adolescent use of psychotropic medication: multilevel analysis of discriminatory accuracy

OBJECTIVE

In the present study, we used a multilevel approach to investigate the role of maternal country of birth (MCOB) in predicting adolescent use of psychotropic medication in Sweden.

DESIGN

Using the Swedish Medical Birth Register we identified all 428,314 adolescents born between 1987 and 1990 and who were residing in Sweden in the year they turned 18. We applied multilevel logistic regression analysis with adolescents (level 1) nested within MCOBs (level 2). Measures of association (odds ratio) and measures of variance (intra-class correlation (ICC)) were calculated, as well as the discriminatory accuracy by calculating the area under the Receiver Operator Characteristic (AU-ROC) curve.

RESULTS

In comparison with adolescents with Swedish-born mothers, adolescents with mothers born in upper-middle, lower-middle and low-income countries were less likely to use psychotropic medication. However, the variance between MCOBs was small (ICC = 2.5 in the final model) relative to the variation within MCOBs. This was confirmed by an AU-ROC value of 0.598.

CONCLUSIONS

Even though we found associations between MCOB and adolescent use of psychotropic medication, the small ICC and AU-ROC indicate that MCOB appears to be an inaccurate context for discriminating adolescent use of psychotropic medication in Sweden.

Adolescents' utilisation of psychiatric care, neighbourhoods and neighbourhood socioeconomic deprivation: a multilevel analysis

Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS) database. The study population consists of all boys and girls aged 13–18 years (N=18,417), who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6 %). The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect) disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas), do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our understanding of adolescent mental health further research is needed to identify such contexts.

Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral

BACKGROUND

In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP) clinics.

METHODS

The analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses.

RESULTS

Results indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral.

CONCLUSIONS

This article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach programs and should be considered when developing measures and strategies intended to reach and help children with mental health problems. This might involve providing information about the availability and accessibility of health care for children and adolescents with mental health problems to families in certain neighbourhoods and with different ethnic backgrounds.