Introduction: The desire to have children and form a family is for many people central for life fulfilment and the desire does not differ by sexual orientation. Due a series of societal changes during the last decade, today we see a lesbian baby boom. Planned lesbian families are a relatively new group of patients and parents in reproductive health care, yet little is known about psychological wellbeing during the transition to parenthood in these families. Aim: The overall aim of this thesis was to fill a gap of knowledge about the psychological aspects of undergoing treatment with donated sperm, at the time of pregnancy and during early parenthood that affect lesbian couples forming a family. Method: This is a multicentre study comprising all 7 university clinics that perform gamete donation. The study includes lesbian couples undergoing treatment with donated sperm and heterosexual couples undergoing IVF treatment with their own gametes. Participants were recruited consecutively during 2005 and 2008. 165 lesbian couples and 151 heterosexual couples participated in the study. Participants responded questionnaires at three time points (T); time point 1 (T1) at the commencement of treatment, (T2) after the first round of treatment, around 2 month after T1 and (T3) 12-18 months after first treatment when a presumptive child had reached 1 year. Data was analysed with statistical methodology. Results: Lesbian couples reported an all over high satisfaction with relationship quality, good psychological wellbeing and low parenting stress. Heterosexual couples also reported good satisfaction with relationship quality, however somewhat lower than the lesbian couples. Parenting stress in the heterosexual couples was similar to the lesbian couples. A strong association was found between high relationship satisfaction and low parenting stress. Conclusions: Lesbian couples forming a family through sperm donation treatment are satisfied with their relationships, they report a good psychological health and experiences of low parenting stress.

Introduction: The desire to have children and form a family is for many people central for life fulfilment and the desire does not differ by sexual orientation. Due a series of societal changes during the last decade, today we see a lesbian baby boom. Planned lesbian families are a relatively new group of patients and parents in reproductive health care, yet little is known about psychological wellbeing during the transition to parenthood in these families. Aim: The overall aim of this thesis was to fill a gap of knowledge about the psychological aspects of undergoing treatment with donated sperm, at the time of pregnancy and during early parenthood that affect lesbian couples forming a family. Method: This is a multicentre study comprising all 7 university clinics that perform gamete donation. The study includes lesbian couples undergoing treatment with donated sperm and heterosexual couples undergoing IVF treatment with their own gametes. Participants were recruited consecutively during 2005 and 2008. 165 lesbian couples and 151 heterosexual couples participated in the study. Participants responded questionnaires at three time points (T); time point 1 (T1) at the commencement of treatment, (T2) after the first round of treatment, around 2 month after T1 and (T3) 12-18 months after first treatment when a presumptive child had reached 1 year. Data was analysed with statistical methodology. Results: Lesbian couples reported an all over high satisfaction with relationship quality, good psychological wellbeing and low parenting stress. Heterosexual couples also reported good satisfaction with relationship quality, however somewhat lower than the lesbian couples. Parenting stress in the heterosexual couples was similar to the lesbian couples. A strong association was found between high relationship satisfaction and low parenting stress. Conclusions: Lesbian couples forming a family through sperm donation treatment are satisfied with their relationships, they report a good psychological health and experiences of low parenting stress. / <p>Name change: Paper 2, "Psychological health in lesbian and heterosexual couples undergoing assisted reproduction" in the list of papers has been changed to "Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study"</p>

Background: Alongside experiencing physical symptoms with no identifiable organic cause, patients with MUS commonly experience comorbid anxiety and depression. They also have high health utilisation costs, which has implications for the health service. Interventions which target these symptoms in a cost effective way need to be developed and evaluated. Objective: To develop and evaluate a self-help mindfulness-based stress reduction (MBSR) intervention for patients with medically unexplained symptoms (MUS). Methods: A systematic review of the literature was carried out to evaluate the effectiveness of MBSR for reducing psychological distress in people with MUS. Study 1 developed and evaluated a self-help MBSR intervention in a clinical setting. Fifteen participants were recruited from eight practice, however only five completed post-intervention measures. A combination of t-tests and descriptive statistics were used to compare changes in levels of psychological distress, quality of life, symptoms and mindfulness at post-intervention. Pearson‘s correlations were used to identify relationships between improvements in mindfulness and improvements in outcomes. Study 2, exploring the reasons for the difficulties recruiting participants to Study 1, was then carried out through questionnaires to GPs. Results: Though more evidence is needed, the systematic review found MBSR to have moderate effects on psychological distress, which are largely maintained or improved at follow-up. Study 1 found symptom frequency and levels of acceptance to have improved at post-intervention. Study 2 found that the main reasons for GPs not recruiting participants was that they were busy and found it difficult to prioritise given other demands. Conclusions: Evidence to date suggests that MBSR is an effective intervention for patients with MUS. Future studies may benefit from recruiting participants from relevant organisations or using alternative methods such as database searches. No firm conclusions can be made about the self-help MBSR intervention‘s efficacy due to the study‘s limitations, however changes seen in the completer group suggest that further research would be warranted.

Orientador: Ana Gabriela Sálvio / Resumo: Introdução: O melanoma é um tipo de câncer de pele agressivo, gerando diferentes comportamentos ao diagnóstico, dependendo da situação emocional do indivíduo. O modo como o paciente recebe o diagnóstico pode estar associado à personalidade e sua relação com a vida. Objetivo: Identificar as características emocionais e as dimensões da personalidade do paciente com melanoma no momento diagnóstico. Métodos: Foram selecionados 30 pacientes no momento do diagnóstico de melanoma e 30 sem diagnóstico oncológico sendo, ambos os grupos submetidos à avaliação psicológica através de dois instrumentos: Escala de Ansiedade e Depressão (HADS) e Inventário Fatorial de Personalidade (IFP II). Resultados: Neste estudo os sintomas de ansiedade e depressão não tiveram significância estatística e foram sintomas predominantes no grupo controle do que no grupo melanoma. Na interpretação e análise de correspondência do IPF II deste estudo as variáveis estatisticamente significativas que caracterizam os pacientes com melanoma foram Assistência, Afago, Deferência, Afiliação, Persistência e Autonomia. A dimensão Ordem é característica no que se refere aos estádios clínicos mais avançados (III e IV). Discussão: Neste trabalho não observa uma associação direta de sintomas de ansiedade e depressão na fase diagnóstica, ponto que merece atenção na escuta clínica e evolução do tratamento. Notamos as pessoas com melanoma a tendência abandono de si e busca de reconhecimento, para manter o trabalho, boa execuç... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Melanoma is a type of aggressive skin cancer, generating different behaviors at diagnosis, depending on the individual's emotional situation. How the patient receives the diagnosis may be associated with personality and its relation to life. Objective: To identify the emotional characteristics and personality dimensions of the patient with melanoma at the moment of diagnosis. Methods: 30 patients were selected at the time of diagnosis of melanoma and 30 without oncological diagnosis. Both groups were submitted to psychological evaluation through two instruments: Anxiety and Depression Scale (HADS) and Factorial Personality Inventory (IFP II). Results: In this study the symptoms of anxiety and depression were not statistically significant and were predominant symptoms in the control group than in the melanoma group. In the interpretation and correspondence analysis of the IPF II of this study, the statistically significant variables that characterize patients with melanoma were Assistance, Cuddling, Deference, Affiliation, Persistence and Autonomy. The Order dimension is characteristic for the more advanced clinical stages (III and IV). Discussion: This study does not observe a direct association of anxiety and depression symptoms in the diagnostic phase, a point that deserves attention in clinical listening and treatment evolution. We note that people with melanoma tend to abandon themselves and seek recognition, to keep the job, good execution and admiration of... (Complete abstract click electronic access below) / Mestre

The aim of the work presented in this thesis, was to investigate two general hypotheses derived from theories of the development and maintenance of medically unexplained symptoms (MUS) and health anxiety; that individual differences in attention to the body and somatic awareness contribute to the experience of physical symptoms and health anxiety. Three studies (an analogue pilot study, a prospective cohort study with primary care patients, and an analogue study involving a negative mood induction) were conducted to investigate the relationship between attention, somatic awareness, symptom reporting and health anxiety. In the pilot study, enhanced attentional disengagement from neutral material was associated with health anxiety and delayed disengagement from neutral material was associated with symptom reporting. In the primary care study, enhanced disengagement from neutral body-irrelevant material and delayed disengagement from threatening body-relevant material were independently associated with health care utilisation, but not symptom reporting or health anxiety. However, the longitudinal analysis revealed that attentional disengagement was neither a predictor of, or predicted by, health care utilisation. The tendency to experience distortions in somatic awareness was independently associated with symptom reporting, health anxiety and health care utilisation. Longitudinal analysis revealed that symptom reporting and health anxiety were independent predictors of somatic distortion, but that somatic distortion was not a predictor of symptom reporting or health anxiety. The results of a structural equation modeling analysis suggest that a model including both attentional disengagement and the tendency to experience distortions in somatic awareness improves understanding of symptom reporting, health anxiety and health care utilisation. In the negative mood induction study, however, neither attentional disengagement nor the tendency to experience distortions in somatic awareness were significantly associated with symptom reporting or health anxiety. The evidence presented here suggests that complex attentional processes may be associated with health seeking behaviours, possibly via a third unknown variable. This evidence, however, does not support the often-hypothesised general attentional bias for the body as a causative factor in the development of health anxiety or symptom reporting. This research has provided important evidence about attentional differences and how future research might extend the findings reported here. Furthermore, the findings regarding the tendency to experience distortions in somatic awareness provides empirical support for theories that suggest MUS may be associated with a tendency to place greater weight on top-down factors in the creation of somatic awareness (Brown, 2004; Edwards et al., 2013). However, whilst alterations in somatic awareness may be a maintenance factor for symptom reporting and health anxiety, somatic distortion may not be a causative factor in their development.

The current study objective was to investigate the interrelationship between five attachment styles (need for approval, preoccupation, discomfort with closeness, relationship as secondary, and confidence), perceived social support from family and friends, and symptoms of anxiety and depression. A total of 133 university students at the Department of Psychology in Umeå University filled out a form with a perceived social support from family and friends questionnaire, a scale on symptoms of anxiety and depression, and an attachment style questionnaire. Correlational analysis revealed a significant relationship between (avoidant) attachment style, discomfort with closeness, and low perception of social support from family and friends, and a significant relationship between (secure) attachment style, confidence, and high perception of social support from family. Furthermore, all five attachment styles were significantly related to symptoms of anxiety and depression, e.g., attachment style confidence was related to low reports of symptoms of anxiety and depression, and attachment style preoccupation was related to higher reports of symptoms of anxiety and depression. Results also showed that the relationship between symptoms of anxiety and depression and perceived social support was not significant. Additionally, no mediation of perceived social support from family and friends was found between attachment styles and symptoms of anxiety and depression. It was concluded that individuals with high levels of secure attachment perceive more social support from family and friends than individuals with avoidant attachment style. Moreover, individuals with high levels of insecure and/or avoidant attachment have an increased symptoms of anxiety related to social connection than individuals with high levels of secure attachment. No conclusions could be drawn from no mediation of perceived social support from family and friends on the relationship between attachment style and symptom of anxiety from the current population. Several limitations were discussed. / Syftet med den aktuella studien var att undersöka relationen mellan fem anknytningsmönster (bifallsbehov, relationsfixering, distans, sakorientering, och tillit), uppfattat socialt stöd från familj och vänner, och symtom på ångest och depression. Totalt 133 universitetsstudenter från institutionen för psykologi på Umeå universitet fyllde i ett formulär med en enkät om uppfattat socialt stöd från familj och vänner, en enkät för symtom på ångest och depression, samt en enkät om anknytningsmönster. Korrelationsanalys visade en signifikant relation mellan (undvikande) anknytningsmönster, distans, och låg uppfattning om socialt stöd från familj och vänner, och ett signifikant samband mellan (trygg) anknytningsmönster, tillit, och hög uppfattning om socialt stöd från familj. Dessutom var alla fem anknytningsmönstren relaterade till symtom på ångest och depression, t.ex., anknytningsmönstret, tillit, relaterad   till lägre symtom på ångest och depression, och anknytningsmönstret relationsfixering var relaterade till ökade symtom på ångest och depression. Resultaten visade också att relationen mellan symtom på ångest och depression och uppfattat socialt stöd inte var signifikant. Dessutom fanns ingen mediering genom uppfattat socialt stöd från familj och vänner på relationen mellan anknytningsmönster och symtom på ångest och depression. Slutsatsen var att individer med hög grad av trygg anknytning uppfattar mer socialt stöd från familj och vänner än individer med hög grad av undvikande anknytning. Dessutom att individer med höga nivåer av otrygg och/eller undvikande anknytningsmönster har ökade symtom på ångest relaterade till social förbindelse än individer med hög nivå av trygg anknytningsmönster. Inga slutsatser kunde dras från bristen på mediering genom uppfattat socialt stöd från familj och vänner på relationen mellan anknytningsmönster och symptom på ångest från den nuvarande befolkningen. Flera begränsningar diskuterades.