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Publications (10 of 25) Show all publications
Wikman, A., Axfors, C., Iliadis, S. I., Cox, J., Fransson, E. & Skalkidou, A. (2019). Characteristics of women with different perinatal depression trajectories. Journal of Neuroscience Research
Open this publication in new window or tab >>Characteristics of women with different perinatal depression trajectories
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2019 (English)In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547Article in journal (Refereed) Epub ahead of print
Abstract [en]

Maternal perinatal depression (PND), a common mental disorder with a prevalence of over 10%, is associated with long-term health risks for both mothers and offspring. This study aimed at describing characteristics related to background and lifestyle, pregnancy, delivery, and postpartum of different PND trajectories defined according to the onset of depressive symptoms. Participants were drawn from a large population-based cohort study in Uppsala, Sweden (n = 2,466). Five trajectory groups of depressive symptom onset were created using the Edinburgh Postnatal Depression Scale ≥13 (pregnancy) or ≥12 points (postpartum): (a) healthy (60.6%), (b) pregnancy depression (8.5%), (c) early postpartum onset (10.9%), (d) late postpartum onset (5.4%), and (e) chronic depression (14.6%). In multinomial logistic regressions, the associations between trajectories and the included characteristics were tested using the healthy trajectory as reference. Background characteristics (younger age, lower education, unemployment) were primarily associated with pregnancy depression and chronic depression. Characteristics associated with all PND trajectories were smoking prior to pregnancy, migraine, premenstrual mood symptoms, intimate partner violence, interpersonal trauma, negative delivery expectations, pregnancy nausea, and symphysiolysis. Nulliparity, instrumental delivery, or a negative delivery experience was associated with early postpartum onset. Postpartum factors (e.g., infantile colic, lack of sleep, low partner support, and bonding difficulties) were associated with early and late postpartum onset together with chronic depression. The findings suggest that different PND trajectories have divergent characteristics, which could be used to create individualized treatment options. To find the most predictive characteristics for different PND trajectories, studies with even larger and more diverse samples are warranted.

Keywords
depression, depressive disorder, mental disorders, mothers, postpartum, pregnancy, self-reports
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Identifiers
urn:nbn:se:uu:diva-378699 (URN)10.1002/jnr.24390 (DOI)30723972 (PubMedID)
Available from: 2019-03-08 Created: 2019-03-08 Last updated: 2019-04-11Bibliographically approved
Henriksson, H. E., White, R. A., Iliadis, S. I., Fransson, E., Papadopoulos, F., Sundström Poromaa, I. & Skalkidou, A. (2019). Spring peaks and autumn troughs identified in peripheral inflammatory markers during the peripartum period. Scientific Reports, 9, Article ID 15328.
Open this publication in new window or tab >>Spring peaks and autumn troughs identified in peripheral inflammatory markers during the peripartum period
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 15328Article in journal (Refereed) Published
Abstract [en]

Seasonal variations have recently been described in biomarkers, cell types, and gene expression associated with the immune system, but so far no studies have been conducted among women in the peripartum period. It is of note that pregnancy complications and outcomes, as well as autoimmune diseases, have also been reported to exhibit seasonal fluctuations. We report here a clear-cut seasonal pattern of 23 inflammatory markers, analysed using proximity-extension assay technology, in pregnant women. The inflammatory markers generally peaked in the spring and had a trough in the autumn. During the postpartum period we found seasonality in one inflammatory marker, namely monocyte chemotactic protein 4 (MCP-4). Our findings suggest that seasonal variations in peripheral inflammatory markers are only observed during pregnancy. The results of this study could be valuable to professionals working within the field of immunology-related areas, and provide insight for the understanding of obstetric complications.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-381420 (URN)10.1038/s41598-019-51527-9 (DOI)000492825800038 ()31653981 (PubMedID)
Funder
Swedish Society of Medicine, 523-2014-2342 521-2013-2339Marianne and Marcus Wallenberg Foundation, MMW2011.0115Swedish Research Council, 523-2014-2342Swedish Research Council, 521-2013-2339
Available from: 2019-04-09 Created: 2019-04-09 Last updated: 2019-11-29Bibliographically approved
Bergström, M., Fransson, E., Wells, M. B., Köhler, L. & Hjern, A. (2018). Children with two homes: Psychological problems in relation to living arrangements in Nordic 2-9 year olds. Scandinavian Journal of Public Health
Open this publication in new window or tab >>Children with two homes: Psychological problems in relation to living arrangements in Nordic 2-9 year olds
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2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: Joint physical custody, children spending equal time in each parents’ respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. Methods: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. Results: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = −0.53; 95% CI −0.89 to −0.17). Externalizing problems were also lower in nuclear families (B = −0.28, 95% CI −0.52 to −0.04) compared with joint physical custody after adjusting for covariates. Conclusions: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children’s post-separation living arrangements.

Keywords
Children, preschoolers, psychological problems, divorce, joint physical custody, parental separation, custody, Strengths and Difficulties Questionnaire, Nordic countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:uu:diva-357819 (URN)10.1177/1403494818769173 (DOI)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-08-21
Bränn, E., Fransson, E., White, R. A., Papadopoulos, F. C., Edvinsson, Å., Kamali-Moghaddam, M., . . . Skalkidou, A. (2018). Inflammatory markers in women with postpartum depressive symptoms. Journal of Neuroscience Research
Open this publication in new window or tab >>Inflammatory markers in women with postpartum depressive symptoms
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2018 (English)In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547Article in journal (Refereed) Epub ahead of print
Abstract [en]

Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.

Keywords
cytokines, immune system, inflammation, maternal depression, pregnancy, protein markers
National Category
Psychiatry Immunology in the medical area Psychology
Identifiers
urn:nbn:se:uu:diva-362471 (URN)10.1002/jnr.24312 (DOI)30252150 (PubMedID)
Funder
Swedish Research Council, 521-2013-2339Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg Foundation, 2011-Skalkidou
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-12-10Bibliographically approved
Gustafsson, A. M., Fransson, E., Dubicke, A., Hjelmstedt, A. K., Ekman-Ordeberg, G., Silfverdal, S.-A., . . . Bohlin, K. (2018). Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation.. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 349-356
Open this publication in new window or tab >>Low levels of anti-secretory factor in placenta are associated with preterm birth and inflammation.
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 349-356Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Anti-secretory factor is a protein that regulates secretory and inflammatory processes and preterm birth is associated with inflammation. Therefore, our hypothesis was that anti-secretory factor might play a role in immune reactivity and homeostasis during pregnancy.

MATERIAL AND METHODS: Following spontaneous onset of labor and preterm or term delivery, placenta biopsies were collected. The levels of anti-secretory factor and markers of inflammation (CD68, CD163) and vascularization (CD34, smooth muscle actin) were analyzed by immunohistochemistry.

RESULTS: The 61 placental biopsies included 31 preterm (<37 weeks of gestation) and 30 term (37-41 weeks) samples. The preterm placentas exhibited lower levels of anti-secretory factor (p = 0.008) and larger numbers of CD68-positive cells (p < 0.001) compared to term. Preterm placentas had blood vessel of smaller diameter (p = 0.036) indicative of immaturity. The level of interleukin-6 in cord blood was higher after very preterm than term birth, suggesting a fetal inflammatory response. The placenta level of anti-secretory factor was positively correlated to the length of gestation (p = 0.025) and negatively correlated to the levels of the inflammatory markers CD68 (p = 0.015) and CD163 (p = 0.028).

CONCLUSIONS: Preterm delivery is associated with low levels of anti-secretory factor in placenta. Inflammation, a potential trigger of preterm birth, is more pronounced in the preterm placenta and inversely related to the placental level of anti-secretory factor, suggesting both a link and a potential target for intervention.

Keywords
Anti-secretory factor, inflammation, placenta, preterm birth, vascularization
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-357814 (URN)10.1111/aogs.13282 (DOI)29265188 (PubMedID)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-11-28Bibliographically approved
Bergström, M., Fransson, E., Fabian, H., Hjern, A., Sarkadi, A. & Salari, R. (2018). Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent. Acta Paediatrica, 107(2), 294-300
Open this publication in new window or tab >>Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed) Published
Abstract [en]

AIM: Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

METHODS: In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

RESULTS: Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

CONCLUSION: Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3-5, but longitudinal studies are needed to account for potential preseparation differences.

Keywords
Children, Divorce, Joint physical custody, Parental separation, Psychological problems
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology) Public Health, Global Health, Social Medicine and Epidemiology Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-332706 (URN)10.1111/apa.14004 (DOI)000419768200023 ()28880411 (PubMedID)
Funder
Swedish Research Council FormasForte, Swedish Research Council for Health, Working Life and WelfareVINNOVA, 259-2012-68Swedish Research Council
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-08-21Bibliographically approved
Ramberg, J., Brolin Låftman, S., Fransson, E. & Modin, B. (2018). School effectiveness and truancy: a multilevel study of upper secondary schools in Stockholm. International Journal of Adolescence and Youth
Open this publication in new window or tab >>School effectiveness and truancy: a multilevel study of upper secondary schools in Stockholm
2018 (English)In: International Journal of Adolescence and Youth, ISSN 0267-3843, E-ISSN 2164-4527Article in journal (Refereed) Published
Abstract [en]

Truancy is a problem associated with a range of negative consequences at the individual and societal level, both in the short and the long term. Few earlier studies have investigated the association between school effectiveness and truancy. The aim of this study is to examine the links between three teacher-rated features of school effectiveness – school leadership, teacher cooperation and consensus, and school ethos – and student-reported truancy. Data were collected in 2016 among 4,956 students and 1,045 teachers in 46 upper secondary schools in Stockholm. Results from two-level binary logistic regression analyses show that higher teacher ratings of the school leadership and of the school ethos (but not of teacher cooperation and consensus) are associated with a lower likelihood of truancy at the student-level, even when adjusting for student- and school-level sociodemographic characteristics. The findings indicate that effective school characteristics may contribute to reducing students’ inclination to play truant.

Keywords
truancy, absenteeism, school effectiveness, upper secondary school, contextual, multilevel, skolk, skolfrånvaro, framgångsrika skolor, gymnasiet, gymnasium, kontextuell, multilevel
National Category
Social Sciences
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:uu:diva-357831 (URN)10.1080/02673843.2018.1503085 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-10107
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-08-21
Fransson, E., Brolin Låftman, S., Östberg, V., Hjern, A. & Bergström, M. (2018). The Living Conditions of Children with Shared Residence – the Swedish Example. Child Indicators Research, 11(3), 861-883
Open this publication in new window or tab >>The Living Conditions of Children with Shared Residence – the Swedish Example
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2018 (English)In: Child Indicators Research, ISSN 1874-897X, E-ISSN 1874-8988, Vol. 11, no 3, p. 861-883Article in journal (Refereed) Published
Abstract [en]

Among children with separated parents, shared residence–i.e., joint phys-ical custody where the child is sharing his or her time equally between two custodialparents’homes–is increasing in many Western countries and is particularly commonin Sweden. The overall level of living among children in Sweden is high; however, thepotential structural differences between children in various post-separation familyarrangements have not been sufficiently studied. Potential risks for children with sharedresidence relate to the daily hassles and stress when having two homes. This study aimsat investigating the living conditions of children with shared residence compared withchildren living with two custodial parents in the same household and those living withone custodial parent, respectively. Swedish national survey data collected from childrenaged 10–18 years (n≈5000) and their parents were used. The outcomes were groupedinto: Economic and material conditions, Social relations with parents and peers, Healthand health behaviors, Working conditions and safety in school and in the neighbor-hood, and Culture and leisure time activities. Results from a series of linear probabilitymodels showed that most outcomes were similar for children with shared residence andthose living with two custodial parents in the same household, while several outcomeswere worse for children living with one parent. However, few differences due to livingarrangements were found regarding school conditions. This study highlights the in-equalities in the living conditions of Swedish children, with those living with oneparent having fewer resources compared with other children.

Keywords
Divorce, Shared parenting, Child health, Family policy, Joint physical custody, Welfare
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-357834 (URN)10.1007/s12187-017-9443-1 (DOI)000431427200008 ()
Available from: 2017-01-18 Created: 2018-08-21
Fransson, E., Hjern, A. & Bergström, M. (2018). What Can We Say Regarding Shared Parenting Arrangements for Swedish Children?. Journal of Divorce and Remarriage, 59(5), 349-358
Open this publication in new window or tab >>What Can We Say Regarding Shared Parenting Arrangements for Swedish Children?
2018 (English)In: Journal of Divorce and Remarriage, ISSN 1050-2556, E-ISSN 1540-4811, Vol. 59, no 5, p. 349-358Article in journal (Refereed) Published
Abstract [en]

Joint physical custody (JPC) refers to children living alternatively and about equally with both parents after a parental separation or divorce. The practice has been debated in relation to child well-being because of the frequent moves imposed on children and the potential stress from living in 2 homes. This study describes the background to the high frequency of Swedish children in JPC and the results from research on Swedish children’s well-being in this living arrangement. Children in JPC report better well-being and mental health than children who live mostly or only with 1 parent. No Swedish studies have found children’s health to be worse in JPC than in sole parental care from child age of 3 years and beyond. The existing literature cannot, however, inform us about the mechanisms behind the findings. The risks of selection effects into living arrangements are plausible. For this purpose, longitudinal studies are warranted.

National Category
Psychology
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:uu:diva-357835 (URN)10.1080/10502556.2018.1454198 (DOI)
Projects
Elvis projektet
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-08-21
Bränn, E., Papadopoulos, F., Fransson, E., White, R., Edvinsson, Å., Hellgren, C., . . . Skalkidou, A. (2017). Inflammatory markers in late pregnancy in association with postpartum depression-A nested case-control study.. Psychoneuroendocrinology, 79, 146-159
Open this publication in new window or tab >>Inflammatory markers in late pregnancy in association with postpartum depression-A nested case-control study.
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2017 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 79, p. 146-159Article in journal (Refereed) Published
Abstract [en]

Recent studies indicate that the immune system adaptation during pregnancy could play a significant role in the pathophysiology of perinatal depression. The aim of this study was to investigate if inflammation markers in a late pregnancy plasma sample can predict the presence of depressive symptoms at eight weeks postpartum. Blood samples from 291 pregnant women (median and IQR for days to delivery, 13 and 7-23days respectively) comprising 63 individuals with postpartum depressive symptoms, as assessed by the Edinburgh postnatal depression scale (EPDS≥12) and/or the Mini International Neuropsychiatric Interview (M.I.N.I.) and 228 controls were analyzed with an inflammation protein panel using multiplex proximity extension assay technology, comprising of 92 inflammation-associated markers. A summary inflammation variable was also calculated. Logistic regression, LASSO and Elastic net analyses were implemented. Forty markers were lower in late pregnancy among women with depressive symptoms postpartum. The difference remained statistically significant for STAM-BP (or otherwise AMSH), AXIN-1, ADA, ST1A1 and IL-10, after Bonferroni correction. The summary inflammation variable was ranked as the second best variable, following personal history of depression, in predicting depressive symptoms postpartum. The protein-level findings for STAM-BP and ST1A1 were validated in relation to methylation status of loci in the respective genes in a different population, using openly available data. This explorative approach revealed differences in late pregnancy levels of inflammation markers between women presenting with depressive symptoms postpartum and controls, previously not described in the literature. Despite the fact that the results do not support the use of a single inflammation marker in late pregnancy for assessing risk of postpartum depression, the use of STAM-BP or the novel notion of a summary inflammation variable developed in this work might be used in combination with other biological markers in the future.

Keywords
Immune system, Inflammation, Perinatal depression, Postpartum depression
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-319197 (URN)10.1016/j.psyneuen.2017.02.029 (DOI)000400201700018 ()28285186 (PubMedID)
Funder
Swedish Research CouncilMarianne and Marcus Wallenberg Foundation
Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2018-08-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9010-8522

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