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Skapa rum. Ung femininitet, kroppslighet och psykisk ohälsa: genusmedveten hälsofrämjande intervention.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Clinical Sciences. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Create space. Young femininity, body and mental health : a gender sensitive and health promoting intervention. (English)
Abstract [en]

Mental health problems among young people, girls and young women in particular, are a serious public health problem. Gendered patterns of mental illness are seen in conjunction with stress-related problems such as anxiety, depression, and psychosomatic complaints. Intervention models tailored to the health care situation are therefore in need of development and evaluation. The overall aim of this thesis is to develop knowledge and understanding for young women’s mental health, stress-related, and bodily problems from a psychosomatic and gender theory perspective, and to evaluate a gender sensitive physiotherapeutic intervention model consisting of a stress management course for young women with stress-related problems.

The thesis consists of four studies. The overall research design combines qualitative and quantitative methods in which questionnaires and interviews were used to explore participant experiences and symptoms linked to perceived stress before and after the intervention. Data consisted of a cumulative sample of 65 young women, 16 to 25 years of age, who attended the youth-friendly health center because of stress-related problems. In paper I, multiple symptom areas of mental health and somatic problems, self-image and aspects of body perception were measured before the course. Participants were 47 of the young women. The results were compared with published normative and clinical reference groups. In paper II, the young women’s experiences of living stressful femininity were analysed with a qualitative content analysis using gender theoretical and phenomenological perspectives as an interpretative frame. The study was based on interviews with 25 of the women. In paper III, follow-up interviews were done with 32 of the women after completion of the course. Data was using qualitative content analysis to illuminate experiences of participating in the course. In paper IV, the course was evaluated by measuring changes in multiple symptom areas using the Adult Self Report (ASR), Social Analysis of Social Behaviour (SASB), and Body Perception Questionnaire (BPQ). Participants were 54 of the women who completed measurements finishing the course.

Young women present complex symptomatology of stress-related problems. The total burden of symptoms plus the narrated experiences highlight how renegotiations of gender constructions and handling of normative and stressful femininity constrain access to bodily resources. After the stress management course, their measured and narrated experiences show positive changes and release of mental health and stress problems, including a more positive self-image and sense of enhanced confidence in their bodies. Experiences of the course as a safe and explorative space for gendered collective understanding and embodied empowerment indicate the need to develop gender-sensitive interventions. The thesis contributes to youth and gender theoretical perspectives with integration of psychosomatic and psychiatric physiotherapy. A broader awareness of how gender constructions and sociocultural aspects are significant in the understanding of psychosomatic expressions of mental ill health and young femininity is valuable in development of theory and interventions in physiotherapy, as well as into other fields. 

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2014. , 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1655
Keyword [en]
mental health, stress-related health, young women, femininity, physiotherapy, psychosomatics, psychiatry, gender theory, phenomenology, corporeality, embodiment, empowerment, intervention
National Category
Physiotherapy Psychiatry Gender Studies
Research subject
Physiotherapy; Psychiatry; genusvetenskap
Identifiers
URN: urn:nbn:se:umu:diva-88767ISBN: 978-91-7601-081-5 (print)OAI: oai:DiVA.org:umu-88767DiVA: diva2:717275
Public defence
2014-06-13, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-05-22 Created: 2014-05-14 Last updated: 2014-06-03Bibliographically approved
List of papers
1. Complex symptomatology among young women who present with stress-related problems
Open this publication in new window or tab >>Complex symptomatology among young women who present with stress-related problems
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, 234-247 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: In Scandinavia and globally, mental health and stress-related problems among adolescent girls and young women are public health concerns that need attention. The aim of this study was to investigate mental health and somatic symptoms with a special focus on internalized problems, self-image, and body-mind aspects of body perception in a group of adolescent girls and young women presenting with stress-related problems at a youth-friendly Swedish health center, and to compare them with normative and clinical reference groups.

Methods: The participants were 47 adolescent girls and young women, aged 17 to 25 years. The Adult Self Report (ASR), Social Analysis of Social Behavior (SASB) and Body Perception Questionnaire (BPQ) were used to measure multiple symptom areas.

Results: Compared to reference groups, adolescent girls and young women report complex symptomatology with high levels of internalized problems such as anxiousness, depression, and somatic complaints. This manifested in attention problems, negative self-image, and perceived bodily discomfort and distrust.

Conclusion

Adolescent girls and young women emerging into adulthood present complex symptomatology of stress-related problems. This study gathered valuable information about their symptoms when they were seeking help. These young women showed higher symptom frequency than normative groups, and similar or higher symptom frequency than other clinical groups. Our findings of internalised and cognitive problems, including impaired self-image and body perceptions, point to the need for preventive strategies and tailored multidisciplinary interventions involving body-based methods to meet this complexity. Using tenets of stress theory, the complex symptomatology may be understood as logical responses to overwhelming stimuli and demands that exceed their ability to cope and disturb their ‘equilibrium’. However, the complex gendered interplays between various external/internal stressors and a broad range of stress responses and health outcomes need further study in a long-term perspective.

Keyword
mental health, stress, anxiety, adolescents, self-image, body image, body perception, physiotherapy, stress, psykisk ohälsa, psykosomatiska symtom, ungdomar, kropp, genus
National Category
Physiotherapy Psychiatry
Research subject
genusvetenskap; Psychiatry; Physiotherapy
Identifiers
urn:nbn:se:umu:diva-88763 (URN)10.1111/scs.12154 (DOI)000354260700005 ()
Projects
Umeå SHY
Funder
Swedish Research Council, 521-2005-4848Forte, Swedish Research Council for Health, Working Life and Welfare, 2006 – 1512
Available from: 2014-05-14 Created: 2014-05-14 Last updated: 2017-12-05Bibliographically approved
2. The corporeality of living stressful femininity: a gender–theoretical analysis of young Swedish women’s stress experiences
Open this publication in new window or tab >>The corporeality of living stressful femininity: a gender–theoretical analysis of young Swedish women’s stress experiences
2014 (English)In: Young - Nordic Journal of Youth Research, ISSN 1103-3088, E-ISSN 1741-3222, Vol. 22, no 3, 271-289 p.Article in journal (Refereed) Published
Abstract [en]

This article analyzes young Swedish women’s experiences of living stressful femininity from an existentialist gender theoretical perspective. The study is based on qualitative interviews with 25 women, aged 17–25, who had registered for a stress management course at a youth health centre. Our analysis suggests that their experiences of stress can be related to the renegotiation of gender constructions that have occurred within the Swedish society. The young female subject can be viewed as living through a historic break between a historical position as a subordinated ‘Other’ while simultaneously having to navigate within contemporary discourses of successful femininity. The doing of normative femininity resulted in an exhausting and draining self-evaluating circle. The experiences of having a painful and collapsing body led to a sense of loss of access to and confidence in their bodies. This should be understood as a loss both of subjectivity and connectedness with the corporeality of existence.

Place, publisher, year, edition, pages
Sage Publications, 2014
Keyword
stress, mental health, gender, gender theory, embodiment, corporeality, phenomenology, post-feminism, stress, psykisk ohälsa, kropp, kroppslighet, genus, genusteori, fenomenologi, postfeminism
National Category
Physiotherapy
Research subject
genusvetenskap; Psychiatry; Physiotherapy
Identifiers
urn:nbn:se:umu:diva-88758 (URN)10.1177/0973174114533464 (DOI)000342825600004 ()
Projects
Umeå SHY
Funder
Swedish Research Council, 521-2005-4848
Available from: 2014-05-14 Created: 2014-05-14 Last updated: 2017-12-05Bibliographically approved
3. 'Girls need to strengthen each other as a group': experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services: a qualitative study
Open this publication in new window or tab >>'Girls need to strengthen each other as a group': experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services: a qualitative study
2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 907, 1-17 p.Article in journal (Refereed) Published
Abstract [en]

Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women's experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden.

A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17--25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis.

The overall results of our interview analysis suggest that the stress management course we evaluated facilitated 'a space for gendered and embodied empowerment in a hectic life', implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants' narrated experiences of 'finding a social oasis to challenge gendered expectations', 'being bodily empowered', and 'altering gendered positions and stance to life' point to empowering processes of change that allowed them to cope with distress, despite sometimes continuously stressful life situations. This intervention also decreased stress-related symptoms such as anxiousness, restlessness, muscle tension, aches and pains, fatigue, and impaired sleep.

The participants' experiences of the intervention as a safe and exploratory space for gendered collective understanding and embodied empowerment further indicates the need to develop gender-sensitive interventions to reduce individualisation of health problems and instead encourage spaces for collective support, action, and change.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keyword
Stress, Mental health, Psychiatry, Physiotherapy, Gender, Gender-sensitive intervention, stress management, group intervention, young women, adolescents, girls, qualitative method, interviews, Stress, Psykisk hälsa, Genus, genusmedveten intervention, stresshantering, gruppintervention, sjukgymnastik, psykiatri, unga kvinnor tonårsflickor, kvalitativ metod, intervjuer
National Category
Physiotherapy Gender Studies Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health; Physiotherapy; Psychiatry; hälso- och sjukvårdsforskning
Identifiers
urn:nbn:se:umu:diva-81141 (URN)10.1186/1471-2458-13-907 (DOI)000325199700001 ()
Projects
Stress and Health in Youth (Umeå SHY)
Funder
Swedish Research Council, 521-2005-4848Forte, Swedish Research Council for Health, Working Life and Welfare, 2006–1512
Available from: 2013-10-02 Created: 2013-10-02 Last updated: 2017-12-06Bibliographically approved
4. Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women
Open this publication in new window or tab >>Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women
2016 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 32, no 1, 20-33 p.Article in journal (Refereed) Published
Abstract [en]

This article describes and evaluates initial steps of a gender-sensitive, youth-friendly group intervention model designed for teenage girls and young women who experience stress-related or psychosomatic problems. Fifty-four young women (16–25 years of age) participated in a gendersensitive physiotherapy stress management course at a youth health center. Inclusion criteria were self-defined stress-related problems and a wish to participate in the group intervention. Measurements of aspects of body perception, self-image, multiple somatic problems, and mental health symptom areas were assessed both before and after intervention with the Body Perception Questionnaire ad modum Schiöler, social analysis of social behavior, and Adult Self-Report scale. Significant positive changes were found in aspects of body perception, self-image, and mental health and somatic symptoms. The changes were most significant in lower internalization of anxiety and depression symptoms. Symptoms such as headaches and sleeping problems decreased. Participants were more satisfied with their bodies and more able to listen to body signals. Among cognitive issues, significant change occurred in thought problems, but not in attention problems. The intervention model needs further evaluation in controlled trials, but is promising and should be developed further in other physiotherapy settings and subgroups of young people.

Keyword
Anxiety, body awareness therapy, body image, gender, mental health, physiotherapy, psychosomatics, self-image, stress, stress management, youth, stress, genus, psykisk hälsa, kroppsbild, självbild, ångest, kroppskännedom, basal kroppskännedom, avspänning, fysioterapi, ungdomsmottagning, ungdomar, unga vuxna, unga kvinnor, flickor
National Category
Physiotherapy Psychiatry Gender Studies
Research subject
genusvetenskap; Psychiatry; Physiotherapy; Public health
Identifiers
urn:nbn:se:umu:diva-88766 (URN)10.3109/09593985.2015.1075639 (DOI)000369278600003 ()
Projects
Umeå SHY
Funder
Swedish Research Council, 344-2011-5478
Note

Originally published in manuscript form with title "Gender-sensitive and youth-friendly physiotherapy: initial steps towards a stress management intervention for girls and young women".

Available from: 2014-05-14 Created: 2014-05-14 Last updated: 2017-12-05Bibliographically approved

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