Publications by authors named "Helene Flood Aakvaag"

11 Publications

  • Page 1 of 1

Characteristics of Different Types of Childhood Violence and the Risk of Revictimization.

Violence Against Women 2019 11 20;25(14):1696-1716. Epub 2019 Jan 20.

Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.

This study investigates the relationship between the characteristics of different types of childhood violence and adult victimization using two waves of data from a community telephone survey (T1) and a follow-up survey, including 505 cases and 506 controls, aged 17-35 years (T2). The logistic regression analyses showed that exposure to childhood abuse, regardless of type, was associated with adult victimization. Exposure to multiple types of abuse, victimization both in childhood and in young adulthood, and recency of abuse increased these odds. Our findings emphasize the importance of assessing multiple forms of violence when studying revictimization. Practitioners working with children and young adults should be attentive to the number of victimization types experienced and recent victimization to prevent further abuse.
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http://dx.doi.org/10.1177/1077801218818381DOI Listing
November 2019

But were you drunk? Intoxication during sexual assault in Norway.

Eur J Psychotraumatol 2018 5;9(1):1539059. Epub 2018 Nov 5.

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

: Sexual assault often occurs when victims are intoxicated. Rape myth research indicates that intoxicated assaults are sometimes seen as less severe or not as 'real' assaults; however, it is unclear if victims of intoxicated sexual assaults differ from victims of non-intoxicated assaults in terms of health and functioning. : We investigated possible differences in mental health, social support and loneliness between intoxicated and non-intoxicated sexual assault victims. : Participants were 1011 young adults (505 exposed to childhood violence and 506 non-exposed) selected from a community telephone survey (T1), and a follow-up survey 12-18 months later (T2). Analyses include one-way ANOVA with Tamhane post hoc tests. : There were no significant differences in mental health, social support and loneliness between victims of intoxicated and non-intoxicated sexual assault, although both groups differed significantly from those who did not report sexual assault. : These results indicate that intoxicated sexual assaults are no less clinically important than non-intoxicated assaults.
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http://dx.doi.org/10.1080/20008198.2018.1539059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225442PMC
November 2018

Loneliness as a mediator of the relationship between shame and health problems in young people exposed to childhood violence.

Soc Sci Med 2018 08 18;211:183-189. Epub 2018 Jun 18.

Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1-3, 0484 Oslo, Norway. Electronic address:

Rationale: Shame related to childhood violence can be detrimental to mental and physical health. Shame may erode social bonds.

Objective: In this study we tested whether loneliness is an important pathway between violence-related shame and health problems.

Method: Individuals who reported exposure to childhood violence in a telephone interview survey in 2013 (wave one) were re-contacted 12-18 months later (wave two), as part of a more general survey of the Norwegian adult population. In total, 505 adolescent and young adult participants (mean age = 21 years) responded to questions about violence exposure, violence-related shame, loneliness, anxiety/depression symptoms, and somatic health complaints. We used counterfactually based causal mediation analysis within the structural equation modelling framework to test whether loneliness mediated a potential association between shame and health.

Results: Shame had a profound effect on anxiety/depression symptoms and we identified both direct and indirect effects. Loneliness mediated about one third of the relationship between shame and anxiety/depression symptoms. The relationship between shame and somatic health complaints was weaker in total, but this more modest effect largely occurred indirectly through loneliness.

Conclusions: Our results add to the literature by highlighting the role of loneliness in the relationship between shame and health. Shame may have the potential to break down social connectedness, with a detrimental effect on health. Clinicians may find it helpful to pay close attention to the way shame regulates social interaction. Preventing social isolation and loneliness may promote good health in violence victims.
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http://dx.doi.org/10.1016/j.socscimed.2018.06.002DOI Listing
August 2018

Shame predicts revictimization in victims of childhood violence: A prospective study of a general Norwegian population sample.

Psychol Trauma 2019 Jan 10;11(1):43-50. Epub 2018 May 10.

Norwegian Centre for Violence and Traumatic Stress Studies.

Objective: Victims of childhood violence often experience new victimization in adult life. However, risk factors for such revictimization are poorly understood. In this longitudinal study, we investigated whether violence-related shame and guilt were associated with revictimization.

Method: Young adults (age = 17-35) exposed to childhood violence (n = 505) were selected from a (Country) population study of 6,589 persons (Wave 1), and reinterviewed by telephone 12-18 months later (Wave 2). Wave 1 measures included shame, guilt, social support, posttraumatic stress, and binge drinking frequency, as well as childhood violence. Logistic regression was used to estimate associations between Wave 1 risk factors and Wave 2 revictimization (physical or sexual violence, or controlling partner behavior).

Results: In total, 31.5% (n = 159) had been revictimized during the period between Wave 1 and 2. Of these, 12.9% (n = 65) had experienced sexual assault, 22% (n = 111) had experienced physical assault and 7.1% (n = 36) had experienced controlling behavior from partner. Both shame and guilt were associated with revictimization, and withstood adjustment for other potentially important risk factors. In mutually adjusted models, guilt was no longer significant, leaving shame and binge drinking frequency as the only factors uniquely associated with revictimization.

Conclusions: Violence-prevention aimed at victims of childhood violence should be a goal for practitioners and policymakers. This could be achieved by targeting shame, both on both on the individual level (clinical settings) and the societal level (changing the stigma of violence). (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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http://dx.doi.org/10.1037/tra0000373DOI Listing
January 2019

The mediating role of shame in the relationship between childhood bullying victimization and adult psychosocial adjustment.

Eur J Psychotraumatol 2018 16;9(1):1418570. Epub 2018 Jan 16.

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

: Psychological distress following experiencing bullying victimization in childhood has been well documented. Less is known about the impact of bullying victimization on psychosocial adjustment problems in young adulthood and about potential pathways, such as shame. Moreover, bullying victimization is often studied in isolation from other forms of victimization. : This study investigated (1) whether childhood experiences of bullying victimization and violence were associated with psychosocial adjustment (distress, impaired functioning, social support barriers) in young adulthood; (2) the unique effect of bullying victimization on psychosocial adjustment; and (3) whether shame mediated the relationship between bullying victimization and these outcomes in young adulthood. : The sample included 681 respondents (aged 19-37 years) from a follow-up study (2017) conducted via phone interviews derived from a community telephone survey collected in 2013. : The regression analyses showed that both bullying victimization and severe violence were significantly and independently associated with psychological distress, impaired functioning, and increased barriers to social support in young adulthood. Moreover, causal mediation analyses indicated that when childhood physical violence, sexual abuse, and sociodemographic factors were controlled, shame mediated 70% of the association between bullying victimization and psychological distress, 55% of the association between bullying victimization and impaired functioning, and 40% of the association between bullying victimization and social support barriers. : Our findings support the growing literature acknowledging bullying victimization as a trauma with severe and long-lasting consequences and indicate that shame may be an important pathway to continue to explore. The unique effect of bullying victimization, over and above the effect of violence, supports the call to integrate the two research fields.
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http://dx.doi.org/10.1080/20008198.2017.1418570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769808PMC
January 2018

Adult Victimization in Female Survivors of Childhood Violence and Abuse: The Contribution of Multiple Types of Violence.

Violence Against Women 2017 11 30;23(13):1601-1619. Epub 2016 Aug 30.

1 Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

Child sexual abuse (CSA) is a well-established risk factor for adult victimization in women, but little is known about the importance of relationship to perpetrator and exposure to other violence types. This study interviewed 2,437 Norwegian women (response rate = 45.0%) about their experiences with violence. Logistic regression analyses were employed to estimate associations of multiple categories of childhood violence with adult victimization. Women exposed to CSA often experienced other childhood violence, and the total burden of violence was associated with adult rape and intimate partner violence (IPV). Researchers and clinicians need to take into account the full spectrum of violence exposure.
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http://dx.doi.org/10.1177/1077801216664427DOI Listing
November 2017

Broken and guilty since it happened: A population study of trauma-related shame and guilt after violence and sexual abuse.

J Affect Disord 2016 Nov 11;204:16-23. Epub 2016 Jun 11.

Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.

Background: There is increasing interest in trauma-related shame and guilt. However, much remains unknown in terms of how these emotions relate to the type of event, gender and mental health. We investigated shame and guilt in men and women following various types of severe violence and their relation to mental health.

Methods: Telephone interviews were conducted with a Norwegian general population sample (n=4529; age=18-75; response rate=42.9%). Measures included child sexual abuse, child and adult rape, severe physical violence from/between parents, severe violence from a partner and non-partners, less severe violence and non-violent trauma, the new Shame and Guilt After Trauma Scale, and the Hopkins Symptom Checklist. Analyses included t-tests and linear regressions.

Results: All types of severe violence were significantly associated with trauma-related shame and guilt (coefficients from 0.11 to 0.38, p-values <0.001). The number of violence types showed a graded relationship with both emotions. Women had significantly more shame and guilt than men did (p-values <0.001 for both emotions), which was partially explained by violence exposure. Both emotions were independently associated with mental health problems (p-values <0.001).

Limitations: The study is cross-sectional. The shame and guilt measure requires further validation.

Conclusions: The more types of violence that were reported, the higher levels of shame and guilt were. Clinicians should be aware of shame and guilt after a variety of violent events, including non-sexual violence, in both men and women and should particularly be aware of whether individuals have multiple violent experiences.
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http://dx.doi.org/10.1016/j.jad.2016.06.004DOI Listing
November 2016

Violence against children, later victimisation, and mental health: a cross-sectional study of the general Norwegian population.

Eur J Psychotraumatol 2015 13;6:26259. Epub 2015 Jan 13.

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

Background: Violence in childhood is associated with mental health problems and risk of revictimisation. Less is known about the relative importance of the various types of childhood and adult victimisation for adult mental health.

Objective: To estimate the associations between various types of childhood and adult violence exposure, and their combined associations to adult mental health.

Method: This study was a cross-sectional telephone survey of the Norwegian adult population; 2,435 women and 2,092 men aged 18-75 participated (19.3% of those we tried to call and 42.9% of those who answered the phone). The interview comprised a broad array of violence exposure in both childhood and adulthood. Anxiety/depression was measured by the Hopkins Symptom Check List (HSCL-10).

Results: Victimisation was commonly reported, for example, child sexual abuse (women: 10.2%, men: 3.5%), childhood-parental physical violence (women: 4.9%, men: 5.1%), and lifetime forcible rape (women: 9.4%, men: 1.1%). All categories of childhood violence were significantly associated with adult victimisation, with a 2.2-5.0 times higher occurrence in exposed children (p<0.05 for all associations). Anxiety/depression (HSCL-10) associated with adult abuse increased with the number of childhood violence categories experienced (p<0.001). All combinations of childhood violence were significantly associated with anxiety/depression (p<0.001 for all associations). Individuals reporting psychological violence/neglect had the highest levels of anxiety/depression.

Conclusions: RESULTS should be interpreted in light of the low response rate. Childhood violence in all its forms was a risk factor for victimisation in adulthood. Adult anxiety/depression was associated with both the number of violence categories and the type of childhood violence experienced. A broad assessment of childhood and adult violence exposure is necessary both for research and prevention purposes. Psychological violence and neglect should receive more research attention, especially in combination with other types of violence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296052PMC
http://dx.doi.org/10.3402/ejpt.v6.26259DOI Listing
January 2015

Shame and guilt in the aftermath of terror: the Utøya Island study.

J Trauma Stress 2014 Oct 24;27(5):618-21. Epub 2014 Sep 24.

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

In recent years, there has been increased interest in trauma-related shame and guilt and their relationship to mental health. Little is known, however, about shame and guilt following mass traumas, such as terrorism. This study investigates the potential associations of trauma-related shame and guilt with posttraumatic stress (PTS) reactions after the terrorist attack of July 22, 2011 on Utøya Island in Norway. Interviews were conducted with 325 of the 490 survivors 4 to 5 months after the event. Multiple linear regression analyses were employed to investigate associations. In the month previous to the interview, 44.1% (n = 143) of participants had experienced at least some guilt for what happened during the attack, and 30.5% (n = 99) had experienced at least some shame. Shame and guilt were both uniquely associated with PTS reactions after adjusting for terror exposure, gender, and other potential confounders (frequent shame: B = 0.54, frequent guilt: B = 0.33). We concluded that trauma-related shame and guilt are related to mental health after mass trauma.
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http://dx.doi.org/10.1002/jts.21957DOI Listing
October 2014

The day Norway cried: Proximity and distress in Norwegian citizens following the 22nd July 2011 terrorist attacks in Oslo and on Utøya Island.

Eur J Psychotraumatol 2012 7;3. Epub 2012 Dec 7.

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.

Background: Terrorism may create fear and stress reactions not only in the direct victims, but also in the general population.

Objective: This study investigated emotional responses in the Norwegian population following the 22nd July 2011 terrorist attacks. We hypothesized that Oslo residents would report a higher level of fear responses compared with people living outside Oslo and that proximity would be associated with early distress and later post-traumatic stress reactions.

Method: Representative samples were drawn from the Norwegian Population Registry. Telephone interviews were conducted 4-5 months after the attacks. The response rate for the Oslo sample (N=465) was 24% of the total sample, and 43% of those who were actually reached by phone and asked to participate. Corresponding figures for the sample living outside Oslo (N=716) were 19% and 30%.

Results: Our results show strong immediate emotional responses, particularly sadness and a feeling of unreality, in both samples. Jumpiness and other fear responses were significantly higher among Oslo residents. Current level of risk perception was low 4-5 months after the attacks; however, a significant minority reported to feel less safe than before. Geographical and psychological proximity were associated with early emotional responses. Psychological proximity was significantly associated with post-traumatic stress reactions, while measures of geographical proximity were not. Immediate emotional responses, first-week reactions, and first-week jumpiness were uniquely and significantly associated with post-traumatic stress reactions. Post-traumatic stress reactions were elevated in ethnic minorities.

Conclusions: The terrorist attacks seem to have had a significant effect on the Norwegian population, creating sadness and insecurity, at least in the short term. Proximity to the terrorist attacks was strongly associated with distress in the population, and early distress was strongly related to later post-traumatic stress reactions. Our results indicate that psychological proximity is more strongly associated with post-traumatic stress reactions than geographical proximity, and underline the importance of differentiated measurements of various aspects of early distress.
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http://dx.doi.org/10.3402/ejpt.v3i0.19709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520479PMC
December 2012

Common mental disorders and disability pension award: seven year follow-up of the HUSK study.

J Psychosom Res 2010 Jul 4;69(1):59-67. Epub 2010 May 4.

Research Section of Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.

Objective: Rates of disability pension (DP) awards remain high in most developed countries. We aimed to estimate the impact of anxiety and depression on DPs awarded both for mental and for physical diagnoses and to estimate the relative contribution of sub case-level anxiety and depression compared with case-level symptom loads.

Methods: Information from a large cohort study on mental and physical health in individuals aged 40-46 (N=15,288) was linked to a comprehensive national database of disability benefits. Case-level and sub case-level anxiety and depression were defined as scores on the Hospital Anxiety and Depression Scale of >or=8 and 5-7, respectively. The outcome was incident award of a DP (including ICD-10 diagnosis) during 1-7-year follow-up.

Results: DP awards for all diagnoses were predicted both from case-level anxiety [HR 1.90 (95% CI 1.50-2.41)], case-level depression [HR 2.44 (95% CI 1.65-3.59] and comorbid anxiety and depression [HR 4.92 (95% CI 3.94-6.15)] at baseline. These effects were only partly accounted for by adjusting for baseline somatic symptoms and diagnoses. Anxiety and depression also predicted awards for physical diagnoses [HR 3.26 (95% CI 2.46-4.32)]. The population attributable fractions (PAF) of sub case-level anxiety and depression symptom loads were comparable to those from case-level symptom loads (PAF anxiety 0.07 versus 0.11, PAF depression 0.05 versus 0.06).

Conclusion: The long-term occupational impact of symptoms of anxiety and depression is currently being underestimated. Sub case-level symptom loads of anxiety and depression make an important and previously unmeasured contribution to DP awards.
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http://dx.doi.org/10.1016/j.jpsychores.2010.03.007DOI Listing
July 2010
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