Socioeconomic inequalities in sexual victimisation in a nationally representative sample of the Swedish population.

AIMS: Sexual victimisation is a key public health concern because of its physical, psychological and social consequences. Nationally representative studies exploring sexual victimisation and re-victimisation are still scarce. The aim of the current study was to explore associations of sexual victimisation with sociodemographic factors including sexual orientation in Sweden. METHODS: We used Swedish data from a national population survey linked to nationwide registers. The sample consisted of 3349 individuals aged 30-44 years, (2021 women and 1328 men). With a latent class analysis we identified groups of individuals with distinctly different experiences of sexual victimisation. Multinomial logistic regression was used to explore how common characteristics could explain latent class membership classes. RESULTS: Experiences of sexual victimisation were common: 48% of women and 13% of men had experienced sexual harassment, 47% of women and 12% of women sexual assault, 11% of women and 1% of men attempted intercourse and 8% of women and 1% of men rape. Among women four groups were identified who had distinctly different experiences of exposure to sexual victimisation such as low victimisation, sexually harassed and assaulted several times, highly sexually victimised with low re-victimisation and finally high victimisation. Both women and men who were highly sexually victimised had to a higher extent a non-heterosexual sexual identity. CONCLUSIONS: Non-heterosexual orientation is a robust indicator of a high level of sexual victimisation as well as re-victimisation among both male and female adults.

Sexual violence against women in Sweden: Associations with combined childhood violence and sociodemographic factors.

Aims: This cross-sectional, population-based study aimed to investigate the prevalence of violence polyvictimization during childhood and sexual violence in adulthood among women, and how childhood violence exposure and sociodemographic factors associate with women's risk of experiencing sexual violence in adulthood. Methods: A survey regarding lifetime experiences of sexual, physical and psychological violence was sent to a national sample of 10,000 women aged 18-74 years, of which 56% participated. Data were analysed using Chi-square analyses and logistic regression. Results: Sexual violence before 18 years of age was reported by 16.3% and rape/attempted rape in adulthood by 10.2% of the women. In univariate analyses, sexual, physical, and psychological violence during childhood was associated with rape/attempted rape in adulthood (odds ratio 4.5, confidence interval 3.2-6.2; odds ratio 2.5, confidence interval 1.3-4.6; and odds ratio 2.5, confidence interval 1.8-3.2, respectively). Associations were stronger for combined exposure to sexual and physical (odds ratio 5.5, confidence interval 2.5-12.3), sexual and psychological (odds ratio 9.2, confidence interval 6.7-12.8) or sexual, physical, and psychological violence (odds ratio 14.1, confidence interval 10.4-19.2) during childhood. Rape/attempted rape after 18 years of age was more common among women who were single, those with college-level education and those who had been unemployed or had received social welfare payments. Most associations remained relatively unchanged when including all exposure and background variables in multivariate analyses. Conclusions: Although several of the sociodemographic factors studied showed significant associations, multiple exposure to violence during childhood was found to be the most potent risk factor for sexual violence in adulthood among adult women.

Lifetime experiences of violence against women and men in Sweden.

Aims: The aims of this cross-sectional study were to examine the prevalence of lifetime exposure to sexual, physical and psychological violence among a representative sample of women and men in Sweden, and to analyze if there were gender differences regarding the types of violence the participants were exposed to and by whom it was perpetrated. Methods: A survey containing questions about lifetime experiences of sexual, physical and psychological violence was sent to a national sample of 10,000 women and 10,000 men aged 18-74; 56.8% of the women and 46.5% of the men agreed to participate. Results: Sexual violence in childhood was reported by 26.4% of women and 22.1% experienced sexual violence in adulthood. Among men, 11% disclosed experiences of sexual violence in childhood and 4.5% in adulthood. Physical violence was experienced by 39.3% of women in childhood and by 18.8% as adults, often by a present or former partner. Among men, 59.3% were exposed to physical violence during childhood, often by a peer, and 20.4% as adults. Psychological violence in childhood was experienced by 58.1% of women in childhood and by 21.8% in adulthood. Among male respondents, 69.2% reported experiences of physiological violence in childhood, often by a peer, and 9.4% in adulthood. Conclusions: Lifetime violence exposure is common in the Swedish population. Though it affects both women and men, the patterns of type of violence and perpetrators are different. The results suggest that violence prevention early in life is important to target.

Prevalence and Correlates of Sexual, Physical, and Psychological Violence Against Women and Men of 60 to 74 Years in Sweden.

Past-year sexual, physical, and psychological violence against women and men aged 60 to 74 years was studied. The data derived from a nationally representative survey on violence in which approximately 2,800 women and men aged 60 to 74 years in Sweden participated. Women were significantly more likely to have been subjected to at least one form of violence in the past year. The prevalence of sexual violence as well as systematic and repeated psychological violence was found to be significantly higher for women than for men. Sexual violence was the most common form of violence against women. Systematic and repeated psychological violence was the most common form of violence against men. Additional gender differences were found in relation to victim characteristics. While associations among women were found between violence victimization and sociodemographic characteristics, health as well as social capital, only health-related characteristics were found to be associated with past-year violence victimization among men. Among women, economic problems, posttraumatic stress disorder (PTSD) symptoms, lack of trust in other people, and not having anyone to talk to were associated with violence victimization. Poor psychological health and an at-risk consumption of alcohol were found to be associated with violence victimization among men. The results highlight the importance of research on violence victimization to assess gender differences also when inquiring into the situation among persons in older generations. The results also indicate practical implications for caring professions; the need to inquire into the experiences of violence among older persons and to pay particular attention to these characteristics when encountering women and men in this age interval.

Experiences of sexual violence among women seeking services at a family planning unit in Sweden.

Background: Experiences of sexual violence among women can lead to ill health and increase the risk of lifetime co-occurrence of violence. Identifying risk factors and victims facilitates development of effective programmes for treatment and prevention of additional violence. The primary aim of this study was to assess the prevalence and correlates of sexual violence experiences among women seeking care at a family planning unit in Sweden. A secondary aim was to examine associations between sexual violence and other types of violence. Methods: Women (n = 1226) seeking services at a family planning unit, Uppsala University Hospital, Sweden, answered a questionnaire and were interviewed about experiences of sexual violence. Bivariate associations were examined using the chi-square test. Results: Experiences of sexual violence were reported by 27% of the participants, of which 57% were exposed when they were younger than 18 years old. Women with experiences of sexual violence were more likely to have lower education (P = 0.024), were students or without occupation (P = 0.037), and were not in a current relationship (P < 0.001). Women with experiences of non-partner sexual violence were more likely to have experiences of intimate partner violence (P < 0.001). Conclusion: Prevalence of sexual violence was high among the respondents. Many women were young when they were exposed to violence, and lifetime co-occurrence of violence was common among women with experiences of non-partner sexual violence.

[Having been exposed to violence increases the risk of health problems later in life]. / Att ha varit utsatt för våld ökar risken för ohälsa senare i livet - Kunskap om våldets förekomst och konsekvenser behövs i hela vården - anamnesen bör innefatta fråga om våld.

Violence is a common problem in society worldwide, and recent research has shown links to various signs of ill-health among victims. In a Swedish population based study, 46 per cent of women and 38 per cent of men had, at some point, been subjected to severe sexual, physical or emotional violence. The respondents were also asked about their present health. The study showed a significant over-representation of respondents subjected to serious violence in all ill-health indicators (PTSD, depression, psychosomatic symptoms, self-harm behaviour, risky alcohol intake, low self-rated physical health and heart attacks in the older age group). Several other Swedish studies have addressed abuse and future health. In a study among young people attending youth clinics the last year prevalence of sexual, physical and emotional violence was high, as expected. Young women were to a higher extent than young men exposed to sexual (14 and 4 per cent, respectively) and emotional violence (33 and 18 per cent respectively) and young men more to physical violence than young women (27 and 18 per cent respectively). Those who had been exposed to more than two types of violence were significantly more likely to resort to self-harm behaviour and suicide ideation and rated their psychological wellbeing lower than others. In one study the violence victimization and self-reported physical and mental ill-health among young women belonging to a sexual minority and heterosexual young women was assessed. Being subjected to two or more types of violence was significantly more frequent among the minority women compared to heterosexual women. However all victimized women had significantly higher risk for ill-health in all outcomes (PTSD, sleeping difficulties, and recurrent bowel problems). The impact of being subjected to more than one type of violence has been shown to be even more strongly linked to mental ill-health also in adult patients. Hence, research supports that violence victimisation is associated with various symptoms and conditions for which people seek medical care. Therefore questions about violence victimization should routinely be included in the medical history.

Prevalence of intimate partner violence among women seeking termination of pregnancy compared to women seeking contraceptive counseling.

OBJECTIVE: To estimate the prevalence of intimate partner violence (IPV) among women seeking termination of pregnancy (TOP) in comparison to women seeking contraceptive counseling. DESIGN: Case-control study. SETTING: Family planning unit, Uppsala University Hospital. POPULATION: Women seeking TOP (n = 635) and women seeking contraceptive counseling (n = 591) answered a self-administered questionnaire regarding experience of IPV. In addition, the women were interviewed by specially trained staff. METHOD: Comparisons were made between the two groups and between those who had previously undergone TOP and those who had never done so with experience of IPV as the main outcome measure. Multivariate logistic regression was used to adjust for age, education and occupation. RESULTS: In total, 29% of women seeking TOP and 22% of women seeking contraceptive counseling reported experience of violence. Women seeking TOP were more likely to report physical violence [adjusted odds ratio (aOR) = 1.6, 95% confidence interval (CI) 1.2-2.1] and experience of violence during the past year (aOR = 2.3, 95% Cl 1.1-4.8). Women who had ever undergone TOP were also more likely to report IPV compared with women with no history of TOP (aOR = 1.7, 95% CI 1.3-2.3). Among women with repeated TOP, 51% reported experience of IPV. CONCLUSION: Women seeking TOP reported to a greater extent experience of IPV. However, women seeking contraceptive counseling also had a high prevalence of violent experiences. These results stress the importance of caregivers approaching both groups of women with questions about IPV to identify exposed women and offer them help.

Prevalence of violence exposure in women with premenstrual dysphoric disorder in comparison with other gynecological patients and asymptomatic controls.

OBJECTIVE: The aim of the present study was to estimate prevalence rates of physical, emotional and sexual abuse in women with premenstrual dysphoric disorder (PMDD) in comparison with gynecological outpatients and asymptomatic healthy control subjects. DESIGN: Cross-sectional study. SETTINGS: Departments of obstetrics and gynecology in three different Swedish hospitals. POPULATION: Fifty-eight women meeting strict criteria for PMDD, a control group of 102 women seeking care at the gynecological outpatient clinic (ObGyn controls) and 47 asymptomatic healthy control subjects were included in this study. METHODS: The Swedish version of the Abuse Assessment Screen was used to collect information on physical and sexual abuse, and the screening instrument was administered as a face-to-face interview. MAIN OUTCOME MEASURES: Previous and ongoing physical and sexual abuse. RESULTS: Any lifetime abuse (physical, emotional or sexual) was reported by 31.0% of PMDD patients, by 39.2% of ObGyn controls and by 21.3% of healthy controls. The ObGyn controls reported physical and/or emotional abuse significantly more often than PMDD patients as well as healthy controls (p<0.05). Lifetime sexual abuse was reported significantly more often by ObGyn controls than by healthy controls (p<0.05). CONCLUSIONS: Patients with PMDD appear not to have suffered physical, emotional or sexual abuse to a greater extent than other gynecological patients or healthy control subjects. However, exposure to violence was common in all groups of interviewed women, and for the individual patient these experiences may contribute to their experience of symptoms.

Gendered patterns of high violence exposure among Swedish youth.

OBJECTIVE: The WHO describes violence as a global public health problem. In contrast to domestic violence, violence against youth has been little explored. Our aims were to investigate the prevalence and gender differences in relation to emotional, physical and sexual abuse among young men and women attending youth health centers in Sweden, the current adverse effects of the abuse and the perpetrators of the abuse. DESIGN: Cross-sectional study. SETTING: Nationally representative youth health centers in Sweden. POPULATION AND METHODS: In total, 2,250 women and 920 men aged 15-23 years answered a validated questionnaire about emotional, physical and sexual abuse. RESULTS: A total of 33% (CI: 31-35) of the young women and 18% (CI: 16-21) of the young men had been exposed to emotional abuse during the past year. For physical abuse, 18% (CI: 17-20) of the women and 27% (CI: 24-30) of the men stated that they had been abused during the past year. The gender differences for sexual abuse were pronounced, with 14% (CI: 12-15) of the young women and 4.7% (CI: 3.3-6.0) of the men stating that they had been abused during the past 12 months. The young women reported more severe adverse effects from all types of abuse and were more often abused by a person close to them. CONCLUSIONS: The exposure to violence among young people is alarming and presents prominent gender differences, and should be taken into serious consideration as it is a matter of health, democracy and human rights.

Prevalence of experiences of partner violence among female health staff: relevance to awareness and action when meeting abused women patients.

BACKGROUND: As violence against women is a prevalent phenomenon, it is quite likely that health workers have experienced such violence. Prevalence among female health staff of emotional, physical and sexual abuse inflicted by a current or previous male partner as well as awareness of violence within the family of origin or among acquaintances were studied. Whether such experiences were associated with practice and knowledge concerning care of abused women was also examinated. METHODS: Questionnaires were distributed to randomly selected female health care workers at a Swedish hospital. Response rate was 68% (588 participating). Bivariate and multivariate analyses were performed. MAIN FINDINGS: Emotional, physical and sexual abuse by a current or previous male partner was reported by 23.5%; abuse within family or among acquaintances by 22.1%. Associations between personal experience of violence and aspects of practice and knowledge in bivariate comparisons did not remain significant in binary logistic regression analyses, with one exception. Those with awareness of violence within the family or among acquaintances met abused women more frequently. Training was positively associated with all aspects of care and knowledge. CONCLUSION: The prevalence rate of intimate partner violence (23.5%) among female health staff was high and not unlike that of the Swedish female population in general. Training is of greater importance than personal experience of violence in the context of practice and knowledge when meeting abused women as patients. Hence, men's violence against women should be included in professional education and in in-service training.

Abuse in women and men with and without functional gastrointestinal disorders.

We aimed to investigate the history of abuse in childhood and adulthood and health-related quality of life (HRQL) in women and men with FGID in the general adult population. A cross-sectional study in a random population sample (n = 1,537, 20-87 years) living in Osthammar municipality, Sweden, in 1995 was performed. Persons with FGID (n = 141) and a group of abdominal symptom-free controls (SSF, n = 97) were selected by means of a validated questionnaire assessing gastrointestinal symptoms (the ASQ). Abuse, anxiety and depression (the HADS) and HRQL (the PGWB) were measured. Women with FGID had a higher risk of having a history of some kind of abuse, as compared with the SSF controls (45% vs.16%, OR = 2.0, 95% CI: 1.01-3.9; SSF = 1), in contrast to men (29% vs. 24% n.s.). Women with a history of abuse and FGID had reduced HRQL 91 (95% CI 85-97) as compared with women without abuse history 100 (95% CI 96-104, P = 0.01, "healthy" = 102-105 on PGWB). Childhood emotional abuse was a predictor for consulting with OR = 4.20 (95% CI: 1.12-15.7.7). Thus, previous abuse is common in women with FGID and must be considered by the physician for diagnosis and treatment of the disorder.

Midwives' experiences of routine antenatal questioning relating to men's violence against women.

OBJECTIVE: to describe and use the experience gained by antenatal-care midwives who routinely questioned pregnant women about personally experienced violence. DESIGN: qualitative, using focus-group discussions. SETTING: antenatal care in a city in south-central Sweden. STUDY POPULATION: 21 midwives. DATA COLLECTION AND ANALYSIS: the midwives participated in any one of five focus-group discussions held by the same moderator and observer. The discussions were audiotaped, transcribed verbatim and analysed using qualitative content analysis. FINDINGS: the importance of routine questioning about violence was emphasised in all groups. Midwives felt they had failed in their duty when women were not questioned. The two main obstacles to such questioning were the delicacy of the subject and the routine of inviting the partner to all visits. The perceived delicacy underlined the need to devise a natural setting for the questioning. The midwives wanted to connect questions about abuse with related subjects routinely established in early pregnancy. As the partner was invited to every visit, it was not practicable to establish a procedure whereby the assessment was connected with a particular visit. Other obstacles included the following: time constraints, oversight, a preconceived notion of who might be a victim of abuse and language difficulties. The midwives emphasised the importance of training, easy access to support for abused women, and personal counselling for midwives. They described their role as raising awareness of the problem of male violence, reducing the shame of being abused, informing, giving emotional support and mediating help. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in order to ensure that the establishment of experience of violence is a routine enquiry in antenatal care, midwives must have a reasonable opportunity of carrying out such questioning. A routine that offers each woman a private consultation will ease the questioning and save time and distress.