Possibilities and hindrances for prevention of intimate partner violence: perceptions among professionals and decision makers in a Swedish medium-sized town.

BACKGROUND: Intimate partner violence (IPV) is a major public health problem, but few evidence-based prevention programs have yet been implemented. PURPOSE: This study explored the perceptions and beliefs of local-level decision makers, social and health-care professionals, and representatives from the police force regarding the possibilities and hindrances for prevention of IPV. METHOD: An explorative qualitative approach was used, and participants were strategically selected for focus group discussions. The participants, 19 men and 23 women, were professionals or decision makers within health-care services, social welfare, municipal administration, the police force, local industry, and local politicians in a Swedish town of 54,000 inhabitants. The focus group discussions were audio recorded, transcribed verbatim, and thematically analyzed. A manifest content analysis was performed on the text. RESULTS: Preschools, schools, sports associations, workplaces, and the mass media were suggested as possible arenas for prevention measures. The proposed activities included norm building and improved social support structures. Hindrances were conceptualized as societal beliefs and attitudes, shame, silence, gender inequality, the counteracting influence of the media, and lack of resources. The participants demonstrated closeness and distance to IPV, expressed as acceptance or referral of responsibility to others regarding where and by whom prevention measures should be executed. CONCLUSION: This study gave new insights in the prevailing perceptions of professionals and decision makers of a medium-sized Swedish town, which can be a useful knowledge in future preventive work and contribute to bridge the gap between research and practice.

Exploring consequences of sickness absence - a longitudinal study on changes in self-rated physical health.

Women experience sickness absence more often than men, but few studies have addressed the possibility that the sick-leave period itself could be regarded as an exposure with possible positive or negative consequences on health. The aim was to explore the association between experience of sickness absence and self-rated physical health. Interview data from population samples in 1990 and 1995 of women born in 1935, 1945, 1955 and 1965 (n=231) were used. 'Any sick-leave' and 'Long sick-leave' were used as exposure measures and analyzed in relation to change in self-rated physical health with multivariate logistic regression, adjusting for age and prior sickness absence. Separate analyses were performed for women with psychiatric disorders (DSM-III-R) and different level of domestic responsibility. The proportion reporting good health at baseline and follow up were lower when experienced sickness absence compared to those who had not. For women exposed to long sick-leave, the OR for remained poor health were 4.1 (95% CI 1.1-15.4), and for women with psychiatric disorders, the OR for a change from poor to good health was 9.9 (1.7-58.5). Women with high level of domestic responsibility and exposed to long sick-leave, had increased ORs for both a positive and negative change in health. This explorative study contributes to the sparse knowledge of consequences on health of sickness absence.

Introduction: gendering socio cultural alcohol and drug research.

AIM: The gender gap in alcohol consumption and alcohol-related harm still is considerable and largely unexplained. This paper introduces four studies performed in Sweden that explore factors influencing gender differences in levels of consumption, adverse consequences and treatment. METHOD: We summarize and discuss these four studies performed within the same cultural setting, which each analyse interaction with the gender. RESULTS: Two studies focus on the individual level addressing criminal behaviour, alcohol problems and mortality, and gender identity and alcohol problems in women taking psychiatric co-morbidity into account. Two studies focus on the institutional and cultural levels addressing the handling of alcohol-related problems in primary healthcare and the effectiveness of using cultural analysis in identifying gender concerns for women. CONCLUSION: Future studies need to focus more on these complex associations to secure that treatment settings provide both genders with fair and adequate treatment of high quality and that prevention activities will start to test measures that take gender into consideration.

Decreased risk of alcohol dependence and/or misuse in women with high self-assertiveness and leadership abilities.

AIMS: To analyse dimensions of gender identity and its association to psychiatric disorders and alcohol consumption. METHODS: The study was performed in two stages: an initial screening (n = 8335) for alcohol consumption, followed by a structured psychiatric interview (n = 1054). The Masculinity/Femininity-Questionnaire was used as an indicator of gender identity. The final study group included 836 women. RESULTS: Leadership, caring, self-assertiveness and emotionality were dimensions of gender identity found in a factor analysis. Low self-assertiveness, high emotionality and to some extent low leadership were associated with increased odds for having bipolar disorders, severe anxiety disorders and alcohol dependence and misuse. Low self-assertiveness and high emotionality were not only associated with alcohol dependence and misuse, but also with high episodic drinking. CONCLUSIONS: There was an association between some of the dimensions of gender identity and psychiatric disorders and alcohol consumption. Further attention is needed in both clinical work and research.

Moderate alcohol intake increases fibrosis progression in untreated patients with hepatitis C virus infection.

Although excessive alcohol consumption in combination with hepatitis C virus (HCV) infection is known to increase the risk of liver cirrhosis, the effect of moderate alcohol intake remains to be elucidated. The aim of this study was to evaluate the effect of moderate alcohol consumption on fibrosis progression in HCV infection. A group of 78 patients with HCV infection and moderate alcohol consumption were analysed retrospectively. All patients had undergone two liver biopsies, with a median time between biopsies of 6.3 years, and had not received any antiviral therapy. Their lifetime drinking history was recorded. All patients except one had daily alcohol consumption below 40 g of ethanol (median 4.8 g/day, interquartile range 1.1-11.6 g/day) during the period between the biopsies. The patients whose liver fibrosis had deteriorated had a higher total alcohol consumption and higher drinking frequency between the biopsies. The degree of fibrosis progression was greater in patients with a total alcohol intake and drinking frequency above the median level for the group. A multiple logistic regression analysis showed that drinking frequency and time between biopsies were independently associated with fibrosis progression. Hence, even moderate alcohol intake seems to increase fibrosis progression in HCV-infected patients. From that point of view, total abstention ought to be recommended. If this is not achieved, occasional use of alcohol is probably less harmful than daily drinking for patients with low or moderate alcohol consumption.

[The Gothenburg study of women and alcohol: low occurrence of abuse--increase appears to have abated]. / Studie i Göteborg om kvinnor och alkohol: låg förekomst av missbruk--ökningen förefaller ha avklingat.

Prevalence of alcohol dependence and abuse (ADA) was determined in a cohort of women selected by stratified random sampling from the general population in Gothenburg. A questionnaire was administered to 3,130 women and 399 were interviewed. Questions were asked about social background, living conditions, family and working life. Volume and frequency of alcohol intake were recorded, and diagnoses were made according to DSM-III. We found that the one-year prevalence of ADA was 1.5 percent and the life time prevalence 3.3 percent. In a follow-up five years after base-line, the prevalence of ADA was unchanged, while indicators of high alcohol consumption and high episodic drinking showed reduced levels of problem drinking.

[The Gothenburg study of women and alcohol: problems during childhood and adolescence important risk factors]. / Studie i Göteborg om kvinnor och alkohol: problem under barn- och ungdomsåren en stor riskfaktor.

This is a part of longitudinal study concerning women and alcohol in Gothenburg. The aim was to find out more about risk factors for alcohol dependence and abuse (ADA) among women in the general population, as well as social conditions and life style among these women. Several indicators of dissatisfactory childhood conditions, and particularly sexual abuse before age 13, were related to ADA in adulthood. Early substance abuse, such as having been intoxicated before age 15 and having used narcotics before 18, was strongly related to future ADA. Our findings point to the need of paying attention to mental health problems in childhood and youth, and to prevent early use of alcohol and drugs.

Drinking patterns among Swedish women: results from a 5-year follow-up of a population-based study.

The aims of this study were to: (1) document women's alcohol use over a 5-year period; (2) compare different measures of alcohol consumption such as high alcohol consumption (HAC) and high episodic drinking (HED); (3) to follow the incidence and course of alcohol dependence and abuse (ADA). The study is part of a longitudinal general population-based study, Women and Alcohol in Göteborg. From a stratified random sample of 479 respondents, 399 were interviewed in the first wave (1989/90). In the second wave (1995/96), 386 of the 479 women were available for a follow-up interview. The 12-month prevalence of ADA was 1.3% in both waves. In the longitudinal analysis the 5-year cumulative incidence of ADA was 0.1%. Two new cases of ADA were found. The prevalence of HAC and HED decreased in women of all ages except HED in women born in 1955. We conclude that the 12-month prevalence of ADA remained the same at the 5-year follow-up and that, in contrast to what has been found in some other studies, there was an overall decrease in HAC and in HED.

Alcoholism and depression in a Swedish female population: co-morbidity and risk factors.

OBJECTIVE: Our aims were to study associations between depressive disorders and alcohol dependence/abuse (ADA) in a female population-based sample, and to identify risk indicators common to both depressive disorders and ADA. METHOD: Three hundred and sixteen women in a stratified randomized sample were interviewed face to face. They were asked about their childhood/adolescence and alcohol habits. Clinical lifetime diagnoses according to DSM-III-R were made. Depressive disorders includes different mood disorders. RESULTS: Half the women with ADA also had a depressive disorder, and 25% of the women with depressive disorders also had ADA. Alcohol intoxication before the age of 15 and psychological and/or psychiatric problems before the age of 18 years increased the risk for ADA and depressive disorders in our study. CONCLUSION: Our results support previous findings of an association between depressive disorders and ADA, beginning early in life.

[Risky alcohol drinking surveyed at a GP unit. Secondary prevention of alcohol problems in primary care patients]. / Riskbruk av alkohol kartlagt på vårdcentral. Sekundärprevention av alkoholproblem hos primärvårdspatienter.

This article describes an implementation of secondary prevention of alcohol abuse at a GP unit in southern Gothenburg, Sweden. During several periods between 1994 and 1996, screening for alcohol problems was performed using either AUDIT or a 4-item instrument called SWAG. In one part of the study, screening was simultaneously carried out using gamma-GT and MCV. The main object of screening efforts was to stimulate interest for alcohol-related conditions, and this goal was reached. The staff was trained in treatment techniques such as motivational interviewing (MI), bio-feedback using gamma-GT and delivery of concise information. Simple methods to determine level of motivation were used for treatment stratification. Some doctors reported that they had insufficient time for adequate MI treatment, and therefore a condensed model was sometimes used. A nurse-staffed treatment unit was started and successfully promoted work with alcohol problem. Attempts were made to spread these methods to other GP units in the region and this was partially successful, although support from the central primary care administration was not secured.

Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns.

AIMS: To examine the consistency and/or variability of gender differences in drinking behavior cross-culturally. DESIGN, SETTING, PARTICIPANTS: Women's and men's responses in 16 general population surveys from 10 countries, analyzed by members of the International Research Group on Gender and Alcohol. MEASUREMENTS: Comparable measures of drinking, versus abstention, typical drinking frequencies and quantities, heavy episodic drinking, intoxication, morning drinking, and alcohol-related family and occupational problems. FINDINGS: Women and men differed little in the probability of currently drinking versus abstaining, but men consistently exceeded women in typical drinking frequencies and quantities and in rates of heavy drinking episodes and adverse drinking consequences, while women were consistently more likely than men to be life-time abstainers. In older age groups, both men and women drank smaller quantities of alcohol and were more likely to stop drinking altogether, but drinking frequencies did not change consistently with age. CONCLUSIONS: A theoretical synthesis proposes that gender roles may amplify biological differences in reactions to alcohol, and that gender differences in drinking behavior may be modified by macrosocial factors that modify gender role contrasts.

Sick-leave in women with alcohol dependence or abuse: effects of additional psychiatric disorders.

The study objective was to assess sick-leave among women investigated in a general population survey of alcohol dependence/abuse (ADA). A total of 399 women, selected by stratified random sampling, were interviewed and diagnosed according to DSM-III-R. Data on sick-leave were obtained by linkage with the Social Insurance records. The study found that women with ADA but without other psychiatric disorders had an increased number of annual sick-leave spells--1.82 compared with 1.47 in the reference population-whereas the mean duration was similar. Women with ADA and other psychiatric disorders had 2.38 annual spells, but also considerably longer spells (mean 16.54 days vs 9.70). Socio-economic differences were large, with the less privileged groups having both more and longer spells. Stepwise multiple regression showed that both ADA and other psychiatric disorders contributed to high sick-leave incidence and duration, as, to a lesser extent, did low education and low social group (the last variable only affected duration of the spells). The frequency of disability pension/long sickness spells was higher in women with ADA (odds ratio of 2.95). We concluded that there is a strong association between ADA and sick-leave, which increases considerably in the presence of additional psychiatric disorders.

Psychiatric disorders as a factor in sick-leave due to other diagnoses. A general population-based study.

BACKGROUND: The aim was to analyse the role of psychiatric disorders in sick-leave in different sick-leave diagnoses. METHOD: A stratified population-based sample of women (n = 292) in Göteborg were interviewed, and diagnoses were made according to DSM-III-R. Sick-leave data, including diagnoses, were obtained for two years. RESULTS: Women with psychiatric disorders had an increased number of sick-leave spells and sick-leave days in all the sick-leave diagnostic groups. The largest differences between the two groups of women were found in mental disorders, diseases of the locomotor system and gastro-intestinal diseases. The association between psychiatric disorders and sick-leave was strongest in older age groups. CONCLUSIONS: Unrecognised psychiatric disorders associated with an increased number of medical complaints and visits can be an important factor in the increase in sick-leave.

Sexual abuse and alcoholism in a female population.

AIMS: (1) To study the prevalence of childhood sexual abuse before the age of 18 years (CSA) and life-time sexual abuse (LSA) in a Swedish female, general population, (2) to analyse associations between CSA and life-time alcohol dependence or abuse (ADA), and (3) to identify possible confounding factors. DESIGN AND PARTICIPANTS: The study was conducted in two phases. Phase 1: an alcohol problem screening questionnaire was sent to 3130 women aged 25-65. The answers were scored. Phase 2: based on the questionnaire scores, a randomly selected stratified sample of 479 women was invited for an interview. Of these, 316 women participated in a structured face-to-face interview. SETTING: A sector of Göteborg city with 100,000 inhabitants. MEASUREMENTS: The interviews focused on substance use and on social, psychological and behavioural characteristics, including experiences of sexual abuse. Clinical psychiatric diagnoses were made according to DSM-III-R. Bivariate analyses and multivariate logistic regression analyses were performed. FINDINGS: The prevalence of CSA and LSA was 9.8% and 13.9%, respectively. CSA increased the risk for life-time ADA and anxiety, but not for depression. When potential confounding factors (e.g. early background factors, depression and anxiety) were adjusted for, CSA under 13 years of age still predicted ADA in multivariate analyses, but CSA under 18 years of age did not. CONCLUSIONS: LSA, and especially CSA under 13 years of age, are factors that should be considered in treatment of women with ADA and in psychiatric treatment of women.

Sick-leave among women and the role of psychiatric disorder.

The aim was to assess sick-leave among women in relation to psychiatric disorder. A stratified population-based sample of women in Gothenburg were interviewed and diagnoses were made according to DSM-III-R. Sick-leave data was obtained for a ten year period. Women with psychiatric disorder had higher rates of sick-leave, compared to women without such disorders, in analyses taking into account age, socio-economic status, physical health, marital status and motherhood. Presence of psychiatric and physical illness were both independently associated with higher sick-leave. Highest sick-leave was found among those with a combination of psychiatric and physical morbidity. Psychiatric disorder is an important factor in sick-leave among women, especially regarding length of absence.

Factors in childhood and youth predicting alcohol dependence and abuse in Swedish women: findings from a general population study.

The aim was to assess risk factors during childhood and youth for alcohol dependence/abuse (ADA) in a population-based study of Swedish women. A total of 316 women were interviewed after stratified random sampling in the general population and a screening questionnaire. The interviews focused on social, psychological and behaviour characteristics as well as on early substance use patterns. Alcohol diagnoses were made according to DSM-III-R and CIDI-SAM. Experiences of sexual abuse before the age of 13 years, a history of psychological or psychiatric problems, early deviant behaviour and an episode of alcohol intoxication before the age of 15 years were significantly associated with ADA in a logistic model. General indicators of low social class were not associated with increased risk of ADA in a multivariate analysis. Sexual abuse in childhood was the strongest predictor of ADA. This association has potential public health importance, and should be addressed in future studies on women and alcohol.

Screening for alcohol dependence and abuse in women: description, validation, and psychometric properties of a new screening instrument, SWAG, in a population study.

In this study, we have evaluated the use of a screening instrument in the first phase of a population study of female alcoholism and alcohol problems. The instrument, called SWAG (Screening, Women, and Alcohol in Göteborg), is a 13-item questionnaire. It includes a modified version of CAGE. The study sample consisted of 3,130 women. Of these, a stratified sample of 479 were invited for interview. Validation was done against interview-based clinical diagnosis according to DSM-III-R (alcohol dependence and abuse), with additional use of medical record information. SWAG had similar sensitivity and specificity used on a population sample, as previously has been found for alcohol problem screening instruments tested in clinical settings. Positive predictive value, rarely reported in studies of other alcohol screening instruments, was 40 to 50%. With logistic regression, we developed a promising set of criteria, called SWAG-L, that had similar sensitivity, specificity, and positive predictive value as the longer version SWAG-1, at the same time it consisted of only four items. CAGE had considerably lower sensitivity than SWAG. SWAG can, so far, be recommended for use in epidemiological studies. It may also prove valuable in clinical settings, although that requires a different scoring method. The question, "I have/have had alcohol problems" was the single item that best predicted alcohol dependence and abuse.

To what extent is female alcohol dependence and abuse known in the health care system? The use of multi-source information in a Swedish population survey.

In a multi-purpose two-phase general population survey of female alcoholism/alcohol problems, unknown alcohol dependence and abuse (ADA) was estimated with interviews and by search of medical and National Insurance Office records. Firstly, 3130 subjects received a screening questionnaire and, secondly, a stratified selection of 399 women were interviewed. A total of 56 subjects received a diagnosis of ADA in interview and four due to other information. Lifetime prevalence of ADA was 3.3%. A total of 63.6% of the diagnosed women 45-65 years of age, and 25.9% of the women 25-35 years of age, were known in these records. Corresponding rates for women with alcohol dependence were 71.4% and 30.8%, respectively. Record information reveals a lack of attention to ADA from several physicians.

Prevalence of female alcohol dependence and abuse in Sweden.

Data on prevalence of female alcoholism are scarce, especially outside North America. It is even more rare that prevalence is estimated using clinical interviews, as well as by utilizing multiple sources of information. Our sample consisted of five cohorts of adult women (n = 3130) in a mainly suburban area. In a first phase we screened for alcohol-related problems. In a second phase a strategic sample was interviewed (n = 399). Prevalence was calculated for clinical and CIDI-SAM diagnoses, both according to DSM-III-R, also taking medical record data into consideration. It was found that life-time prevalence of alcohol dependence and abuse was 3.27% and 12-month prevalence was 1.49%. Agreement over alcohol dependence was very high for the different diagnostic methods, but lower for alcohol abuse. Prevalence of dependency/abuse was not higher in the attrition group. The alcohol abuse concept was found to be relevant, both in epidemiological research and for clinical purposes.