Anna-Karin Ivert

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

BackgroundIn 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.MethodsThe 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.ResultsResults 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.ConclusionsThis 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.

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.

“It Happens All the Time” : Women’s Experiences and Normalization of Sexual Harassment in Public Space

This study explored the prevalence of sexual harassment, consequences of harassment, and reasons for not reporting these experiences through a survey among Swedish female university students (N = 1941). One fourth reported one or more incidents of sexual harassment during the 12 months period prior to the survey. Victims were more often younger and with Swedish-born parents compared with nonvictims. Victimization most frequently occurred at clubs or restaurants and the most frequently reported consequences were anger and worry about being victimized again. Few reported the incidents to the police making this, in part, an invisible problem.

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

ABSTRACT 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.

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.

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: Gender differences in morality and self-control

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 Grasmicks 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.

Criminal policy debate as an active learning strategy

Abstract One of the biggest challenges for criminal justice educators is to deal with the strongly held opinions and preconceived notions about criminal justice issues among students. It often takes the form of students being reluctant to accept certain premises that does not comply with their own experience of the issue. The general tendency to reject information that does not confirm your own view of the world and to accept information that does confirm what you believe to be true is called confirmation bias. This paper proposes the criminal policy debate format as an active learning strategy. Based on the application in an introductory course that is part of a three-year bachelor program in criminology, findings show that the debate format facilitates learning by encouraging students to formulate arguments for and against criminal policy questions.