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  • 1.
    Armelius, Bengt-Åke
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Personality organization defined by DMT and the structural interview1990In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 31, no 2, p. 81-8Article in journal (Refereed)
    Abstract [en]

    The psychoanalytic concept of Personality Organization (PO) may be operationalized by means of a Structural Interview as well as by means of psychological tests. The present study utilized the Structural Interview and a projective test called the Defence Mechanism Test (DMT) to operationalize the PO concept on a sample of 50 psychiatric inpatients. The reliability of the PO judgements were found to be acceptable for both the Structural Interview and the DMT. The validity, which was estimated as the correlation between the two methods, was also found to be substantial. The conclusion is that the concept of PO may be reliably operationalized for psychiatric patients and seems to have concurrent validity. Both the DMT and the Structural Interview may be used for differential diagnosis of PO.

  • 2.
    Bodlund, Owe
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundbom, Elisabet
    Höjerback, T
    Personality traits and disorders among transsexuals.1993In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 88, no 5, p. 322-7Article in journal (Refereed)
    Abstract [en]

    A group of transsexuals, 9 biological men and 10 women, was assessed according to clinical DSM-III-R diagnosis and a self-report instrument for Axis II diagnoses based on the Structured Clinical Interview for DSM-III-R (SCID screen). A control group of 133 individuals was assessed by the same instrument. Combined with a functional criterion according to the Global Assessment of Functioning, the SCID screen showed good agreement with clinical Axis II diagnoses. The overall proportion of Axis II criteria fulfilled, proportion of criteria fulfilled for every single personality disorder and number of personality disorders were calculated from the modified version of the SCID screen. Personality disorders, mainly within cluster B, were identified among 5 of 19 transsexuals, and a majority had multiple personality disorders. Among controls, no personality disorder was identified. Personality traits as measured by the SCID screen revealed significantly more subthreshold pathology among transsexuals than controls in 8 of 12 personality categories. The proportion of overall Axis II criteria fulfilled was 29% among transsexuals versus 17% among controls. Sex differences among transsexuals, the usefulness of the SCID screen and diagnostic problems in DSM-III-R with respect to gender identity disorders are discussed.

  • 3.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Defense Mechanism Test (DMT) and Kernberg’s theory of personality organization related to adolescents in psychiatric care1997In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 38, no 2, p. 95-102Article in journal (Refereed)
    Abstract [en]

    75 adolescent psychiatric patients were diagnosed with the perceptual projective test the Defense Mechanism Test (DMT) and also according to Kernberg’s theory of personality organization (PO). The test protocols were scored in respect of 130DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis. The objective was to try to separate the three types of PO, psychotic (PPO), borderline (BPO) and neurotic (NPO) by means of the DMT and also to compare the results with a similar study on adult psychiatric patients. The results showed that it is possible to separate significantly the three groups of PO. The BPO group seemed to be heterogeneous. The results were fairly similar to those obtained with adult psychiatric patients. The overall results supported the concurrent validity of Kernberg’s theory of PO and for the DMT as well. The DMT seems to be a useful diagnostic method in respect of adolescent psychiatric patients.

  • 4.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Defense Mechanism Test (DMT) and Kernberg's theory of personality organization related to adolescents in psychiatric care1994Report (Other academic)
  • 5.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Gender differences and the Defense Mechanism Test: A comparative study of adolescents in psychiatric care and healthy controls1998In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 39, no 2, p. 93-99Article in journal (Refereed)
    Abstract [en]

    The aim of this paper was to study gender differences in the percept-genetic method Defense Mechanism Test (DMT) among a group of 60 adolescent subjects. Three subgroups were used: patients with psychotic disorders (Axis 1); borderline personality disorder (Axis 2) according to the DSM-IV classification system, and a non-patient group. The test protocols were scored with respect to 124 DMT variables and analyzed by means of the multivariate projection method Partial Least Squares (PLS) in latent structures. The overall results showed considerable gender differences in the whole group as well as in the subgroups. The most striking finding was that girls compared to boys were characterized by the perceptual defense identification with the opposite sex, which means that they perceived male gestalts instead of females in the stimulus picture. When both gender and diagnostic group membership were considered simultaneously, the influence of diagnostic group membership seemed to be stronger than gender even if there was an interaction between diagnoses and gender. It was concluded that gender must be considered when the DMT is used on adolescent populations.

  • 6.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Influence of gender and age in the defense mechanism test among adolescents and adults2008In: Process and personality: actualization of the personal world with process-oriented methods / [ed] Gudmund J. W. Smith and Ingegerd M. Carlsson, Heusenstamm: Ontos , 2008, p. 114-125Chapter in book (Other academic)
  • 7.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    A comparative study of adolescents in psychiatric care assessed by means of the Defense Mechanism Test and the DSM-IV classification system1998In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 52, no 6, p. 527-536Article in journal (Refereed)
    Abstract [en]

    Twenty-seven adolescents in psychiatric care, assessed by means of DSM-IV, and 33 healthy controls were tested using the projective percept-genetic Defense Mechanism Test (DMT). Three diagnostic subgroups were created: psychotic (Axis 1), borderline personality disorder (Axis 2), and a non-patient group. The test protocols were scored with regard to 130 DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis and by means of a pattern analysis of the DMT variables. The results showed that it was possible to distinguish significantly among the three groups. Specific perceptual distortions were identified among the three groups. It was concluded that DMT is a promising instrument in the assessment of adolescents in psychiatric care.

  • 8.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Patients' decision making in seeking care for suspected malignant melanoma2010In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 2, no 2, p. 164-173Article in journal (Refereed)
    Abstract [en]

    Aim. To explore patients' decision making about seeking care for malignant melanoma (MM).

    Background. Unlike other cancers, MM is generally visible and can be easily and cheaply cured if treated in time. It is the delay in diagnosis, most often attributable to the patient rather than to care providers, that results in mortality. Self-examination of suspicious lesions is important, but it is not a guarantee of immediate care-seeking, nor is early detection and increased melanoma awareness associated with early care-seeking.

    Method. During 2009, men (n = 10) and women (n = 11) diagnosed with malignant melanoma were interviewed within two years after excision and the text was analysed according to Grounded Theory.

    Results. The perception of a critical level of severity, feelings of fear and threat were found to be a key motivator for patients to seek care for suspected melanomas; as soon as sufficient insight into the severity of the disease was achieved, the patient reached a turning point and sought care immediately.

    Conclusions. Most of the participants described the process from the discovery of the lesion to the decision to seek care as a time-consuming inner negotiation about the severity of the disease, personal and social considerations, and interactions with the healthcare system.

    Relevance to clinical practice. We analysed the complex reasoning of the patients leading up to the turning point when they sought care. This study illustrates for caregivers the importance of simplifying the pathways to care, emphasising the seriousness of MM, and taking worried patients seriously from their first contact with health care. Health professionals, through their attitudes in contact with patients, can either facilitate or obstruct the patient's decision making process.

  • 9.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Health care delay in malignant melanoma: various pathways to diagnosis and treatment2014In: Dermatology Research and Practice, ISSN 1687-6105, E-ISSN 1687-6113, p. 294287-Article in journal (Refereed)
    Abstract [en]

    We aimed to describe and compare patients diagnosed with malignant melanoma (MM), depending on their initial contact with care andwith regard to age, sex, andMMtype and thickness, and to explore pathways and time intervals (lead times) between clinics from the initial contact to diagnosis and treatment.The sample from northern Sweden was identified via the Swedish melanoma register. Data regarding pathways in health care were retrieved from patient records. In our unselected population of 71 people diagnosedwith skinmelanoma of SSMandNMtypes, 75%of patients were primarily treated by primary health-care centres (PHCs). The time interval (delay) from primary excision until registration of the histopathological assessment in the medical records was significantly longer in PHCs than in hospital-based and dermatological clinics (Derm). Thicker tumors were more common in the PHC group. Older patients waited longer times for wide excision. Most MM are excised rapidly at PHCs, but some patients may not be diagnosed and treated in time. Delay of registration of results from histopathological assessments within PHCs seems to be an important issue for future improvement. Exploring shortcomings inMMpatients’ clinical pathways is important to improve the quality of care and patient safety.

  • 10.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hörnsten, Asa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Malignant melanoma: gender patterns in care seeking for suspect marks2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2676-2684Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. Gender patterns in self-detection of melanoma are not sufficiently highlighted in the literature. The aim of the study was to identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men.

    Background. Females have a more favourable prognosis than males and also a higher level of perceived susceptibility and a higher level of knowledge about melanoma. Women are, furthermore, more prone to participate in screening.

    Method. Thirty patients (15 women and 15 men) with a mean age of 55.5 years and diagnosed with malignant melanoma were interviewed about their decisions to seek care for suspect skin marks. The interviews were transcribed and analysed with qualitative content analysis.

    Results. Care-seeking behaviour for suspect melanoma was influenced by gender constructions. Men seldom or never acknowledged interest in attention to bodily changes, but when they became aware of changes, they often took a quick decision and sought an expert's assessment. Men were compliant with wives' and relatives' advice about seeking care. All women reported that they paid attention to bodily changes, but they often delayed care seeking, due to family responsibilities and emotional struggles. The women also attempted self-care remedies, such as applying ointment, before seeking professional care.

    Conclusions. There are gender-specific patterns that may influence decision making in the care-seeking process. Such patterns are important to identify, since health care professionals must take these factors into account in communicating with men and women.

    Relevance to clinical practice. Nurses and in particular those working in telephone counselling, are often at the frontlines, deciding who can have access to health services. They are ideally placed to tackle the issue of gender constructions in the development of effective health care services.

  • 11.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Nursing.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Coping styles in decision making among men and women diagnosed with malignant melanoma2013In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 18, no 11, p. 1445-1455Article in journal (Refereed)
    Abstract [en]

    Early care seeking is important for prognosis of malignant melanoma. Coping styles in decision-making to seek care can relate to prognosis since avoidant strategies could delay care seeking. The aim of this study was to compare self-reported coping styles in decision-making between men and women diagnosed with malignant melanoma. We used the Swedish version of the Melbourne Decision-Making Questionnaire to assess coping styles. Men generally scored higher in buck-passing while women and those living without a partner scored higher in hypervigilance. This knowledge could be used in the development of preventive programmes with intention to reach those who delay care seeking.

  • 12.
    Johansson, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Höjerback, Torvald
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    A five-year follow-up study of Swedish adults with gender identity disorder2010In: Archives of Sexual Behavior, ISSN 0004-0002, E-ISSN 1573-2800, Vol. 39, no 6, p. 1429-1437Article in journal (Refereed)
    Abstract [en]

    This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At follow-up, 32 patients had completed sex reassignment surgery, five were still in process, and five-following their own decision-had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5-15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years), and non-homosexually oriented (56 vs. 15%). In conclusion, almost all patients were satisfied with the sex reassignment; 86% were assessed by clinicians at follow-up as stable or improved in global functioning.

  • 13. Kivling Bodén, G
    et al.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Defense mechanisms and posttraumatic symptoms among male Bosnian and Croatian refugees in psychiatric treatment2008In: Process and Personality: Actualization of the Personal World With Process-oriented methods / [ed] Carlsson, Ingegerd M, Heusenstamm: Ontos Verlag , 2008, p. 91-112Chapter in book (Refereed)
  • 14.
    Nilsson, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    A longitudinal study of perfectionism in adolescent onset anorexia nervosa-restricting type2008In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 16, no 5, p. 386-394Article in journal (Refereed)
    Abstract [en]

    This longitudinal study analyses self-reported perfectionism, eating disorders and psychiatric symptoms during recovery from anorexia nervosa (AN). With a recovered design, a group of 68 previous patients with AN was studied in two follow-up studies, 8 and 16 years after 1st admission to Child and Adolescent Psychiatry (CAP). Levels of perfectionism stayed the same while eating disorder symptoms and psychiatric symptoms decreased during recovery. Levels of perfectionism were inversely related to duration of remission so that individuals that had short illness duration had lower levels of perfectionism at both follow-ups. Patients with initial high levels of perfectionism may be at risk for a long illness duration which we recommend clinicians to acknowledge.

  • 15.
    Nishikawa, Saori
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Contributions of attachment to self-concept and internalizing and externalizing problems among Japanese adolescents2010In: Journal of Child and Family Studies, ISSN 1062-1024, E-ISSN 1573-2843, Vol. 19, no 3, p. 334-342Article in journal (Refereed)
    Abstract [en]

    We examined the associations and likely pathways underlying the relationships between peer attachment style, self-concept, and Internalizing/Externalizing Problems among high school students in Japan. A total of 228 senior high school students (186 boys and 82 girls; mean age = 16.4) completed the Attachment Questionnaire for Children, Self-Description Questionnaire II-Short, and Youth Self-Report. The main results were that securely attached adolescents reported fewer mental health problems and more positive self-concept than those who reported insecure attachment. Some patterns of associations among variables appeared to be different across gender. The Structural Equation Modeling provided a support for the mediating role of self-concept in influencing the relationships between Attachment and Internalizing Problems, but not Externalizing Problems. The paths for the model were significant across gender. The results promote understanding of psychological processes that influence the relationships between attachment and psychological well-being among high school adolescents in Japan.

  • 16.
    Nishikawa, Saori
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Norlander, Torsten
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    A cross-cultural validation of adolescent self-concept in two cultures: Japan and Sweden2007In: Social behavior and personality, ISSN 0301-2212, E-ISSN 1179-6391, Vol. 35, no 2, p. 269-286Article in journal (Refereed)
  • 17.
    Nishikawa, Saori
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Influence of parental rearing on adolescent self-concept and mental health in Japan2010In: Journal of Child and Family Studies, ISSN 1062-1024, E-ISSN 1573-2843, Vol. 19, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    We examined the associations between perceived parental rearing, attachment style, self-concept, and mental health problems among Japanese adolescents. About 193 high school students (143 boys and 50 girls, mean = 16.4) completed a set of self-report questionnaires including EMBU-C (My Memories of Child Upbringing for Children), AQC (Attachment Questionnaire for Children), SDQII-S (Self-Description Questionnaire II-Short) and YSR (Youth Self-Report). There seems to be a unique influence on mental health problems from parent–adolescent relations depending on the gender of parents and adolescents. PLS (Partial Latent Squares Regression) analysis showed that insecure attachments (Avoidant and Ambivalent) and Rejection from parents were predictors of Internalizing and Externalizing Problems among boys, while all dysfunctional parenting (Rejection, Overprotection and Anxious Rearing) were determinants of these problems among girls. Non academic self-concept (social, emotional, and physical) was a predictor of Internalizing and Externalizing Problems. Power of the prediction of these problems was greater for girls than boys.

  • 18.
    Nishikawa, Saori
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Research Center for Child Mental Development, Fukui University, Fukui, Japan.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Zashikhina, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Lekkou, Spyridoula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Differences and Similarities of Mental Health Problems Reported by Adolescents: From Greece, Japan, Russia, and Sweden2016In: Psychology, ISSN 2152-7180, E-ISSN 2152-7199, Vol. 7, no 13, p. 1658-1670Article in journal (Refereed)
    Abstract [en]

    The aims of the present study were to: 1) compare scores and scales of the Youth Self-Report (YSR) reported by healthy adolescents 15 - 17 years of age from Greece, Japan, Russia, and Sweden, 2) analyze gender and age effects of the YSR syndrome scores between and within countries, and 3) compare scores of competence scales and their associations to mental health problems. A comparison of problems (n = 812) yields a small effect size of 4.8% for cross-country in YSR total problems scores. There was a deviation above the overall mean for Greece and Russia, while Sweden and Japan had deviations below the mean. The effect sizes of country for narrowband and broadband scales were small or medium. Analysis within and between countries pointed out some problems that might be more/less common in some countries than others. In their total competence score, Greek adolescents scored higher than Swedish or Japanese. There were some negative associations between syndrome and competence scales across countries. Gender differences were shown across the countries with the exception of Japan. Age differences were less consistent due to the small range of age groups. Even though YSR is used in all four countries, translations and sampling procedure may influence (be one of) the variations.

  • 19.
    Nishikawa, Saori
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Zashikhina, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Lekkou, Spyridoula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Mental health problems reported by adolescents from four countries: Greece, Japan, Russia, and SwedenArticle in journal (Other academic)
  • 20.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Knutsson, Anders
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Is disturbed sleep a mediator in the association between social support and myocardial infarction?2008In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 13, no 1, p. 55-64Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate a mediating relationship between social support and disturbed sleep in cases surviving myocardial infarction. The case-referent studies, Stockholm Heart Epidemiological Program (SHEEP) and Västernorrland Heart Epidemiological Program (VHEEP) were used comprising 6231 participants (2046 women). Referents were randomly selected. Disturbed sleep was operationalized by the Karolinska Sleep Questionnaire, network support by the Availability of Social Integration Index and emotional support by the Availability of Attachment Index. Mediating associations were tested with logistic regression. The results show that disturbed sleep may act as a mediator between low network support and myocardial infarction in women.

  • 21.
    Nordin, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Knutsson, Anders
    Sundbom, Elisabet
    Åkerstedt, Torbjörn
    Westerholm, Peter
    Alfredsson, Lars
    Low social support and vulnerability in the association with disturbed sleep: longitudinal results from the WOLF studyManuscript (preprint) (Other academic)
  • 22.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Experiences of victimization after severe violent crime: a qualitative approach to different trajectories of recoveryManuscript (preprint) (Other academic)
  • 23.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Treatment Acceptability among Crime Victims2011In: The Open Psychology Journal, ISSN 1874-3501, Vol. 4, p. 6-11Article in journal (Refereed)
    Abstract [en]

    Crime victims receive relevant treatment too seldom and there is uncertainty as to whether those who need the treatment the most are among those who get it. Fifty-two consecutive adult crime victims were offered 10 sessions of psychotherapy within two weeks after an experienced trauma of criminal victimization. Twenty-six accepted and 26 declined the offer. The aim of the study was to explore some of the differences between these two groups. The results show that the therapy group presented a higher incidence of acute stress disorder, more negative scorings regarding immediate reactions (to the crime), more subjective ratings of physical and psychological health (GAF, according to DSM IV), and more psychiatric and trauma-related symptoms as compared to the non-therapy group. A conclusion was that those who needed treatment the most also accepted it. Traumatized people may, due to avoidant strategies, withdraw from potential treatment. Conversely, the therapy group scored higher on the coping style escape-avoidance.

  • 24.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Trauma-related symptoms after violent crime: the role of risk factors before, during and eight months after victimization2009In: The Open Psychology Journal, ISSN 1874-3501/09, Vol. 2, p. 77-88Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the prevalence of current suffering and the role of peritraumatic emotions and other risk factors for development of post-traumatic and general symptoms eight months post crime. Questionnaires assessing trauma-specific symptoms (HTQ) and general psychiatric symptoms (SCL-90) was used along with a semistructured interview covering subjective reactions of 41 civilian victims of interpersonal crime. Victims proved to still be suffering, in varying degrees, from post-traumatic symptoms and other psychological distress. Females reported more trauma-specific symptoms and other comorbid conditions than males. Prior trauma, adverse childhood, being female, previous psychiatric history, and unemployment were all associated with more distress. Peritraumatic reactions (especially secondary emotions following cognitive appraisals after the event) predicted the three core PTSD symptoms and comorbid conditions. Apart from the PTSD symptoms, an assessment of background factors, general psychiatric symptoms, peritraumatic emotions and their cognitive associated scripts in the initial post-trauma period could be helpful in identifying victims who are at risk of developing trauma symptoms.

  • 25.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Kaiser, Niclas
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Sven-Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Learning psychology as a challenging process towards development as well as "studies as usual": a thematic analysis of medical students' reflective writing2014In: Advances in Medical Education and Practice, ISSN 1179-7258, E-ISSN 1179-7258, Vol. 5, p. 491-498Article in journal (Refereed)
    Abstract [en]

    Reflective writing in medical training has been shown to be most effective when combined with some form of personal meeting or dialog. During a course in medical psychology for medical students, reflective texts were followed up by an individual personal talk with a teacher from the course. Thematic analysis of the texts revealed four separate sub-themes: 1) the course has enabled me and the class to develop, which is good albeit arduous; 2) understanding myself is a resource in understanding people as well as knowing psychology; 3) the course provided me with new, purely intellectual skills as well as eye-openers; and 4) the receiving teacher is an integral part of my reflective writing. The main theme, capturing the students' writing process, concluded that students perceive the course as "Learning psychology as a challenging process towards development" as well as "studies as usual". Ethical, psychological, and pedagogical aspects are discussed in the paper.

  • 26.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychological distress associated with interpersonal violence: a prospective two-year follow-up study of female and male crime victimsManuscript (preprint) (Other academic)
  • 27.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Distress after a single violent crime: how shame-proneness and event-related shame work together as risk factors for post-victimization symptoms2011In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 109, no 1, p. 3-23Article in journal (Refereed)
    Abstract [en]

    To increase understanding of post-victimization symptom development, the present study investigated the role of shame- and guilt-proneness and event-related shame and guilt as potential risk factors. 35 individuals (M age = 31.7 yr.; 48.5% women), recently victimized by a single event of severe violent crime, were assessed regarding shame- and guilt-proneness, event-related shame and guilt, and post-victimization symptoms. The mediating role of event-related shame was investigated with structural equation modeling (SEM), using bootstrapping. The guilt measures were unrelated to each other and to post-victimization symptoms. The shame measures were highly intercorrelated and were both positively correlated to more severe post-victimization symptom levels. Event-related shame as mediator between shame-proneness and post-victimization symptoms was demonstrated by prevalent significant indirect effects. Both shame measures are potent risk factors for distress after victimization, whereby part of the effect of shame-proneness on post-victimization symptoms is explained by event-related shame.

  • 28.
    Strömsten, Lotta MJ
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Holm, Ulla
    Department of Education, Uppsala University, Uppsala, Sweden.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Assessment of self-conscious emotions: a Swedish psychometric and structure evaluation of the test of self-conscious affect (TOSCA)2009In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 50, no 1, p. 71-77Article in journal (Refereed)
    Abstract [en]

    The Test of Self-Conscious Affect (TOSCA) is a well-established scenario-based questionnaire assessing self-conscious emotions, such as shame and guilt, which have been shown to be differentially associated with a variety of functional, motivational, behavioral and health outcomes. The aim of this study was to evaluate the psychometric properties and internal structure of a Swedish version of TOSCA in a sample of 361 healthy adults. The psychometric properties and internal consistency of the Swedish version were at level with the original US TOSCA version for shame, guilt and detachment. The internal structure of the Swedish version was acceptable for shame, guilt and detachment but contained shortcomings in assessment of externalization.

  • 29.
    Strömsten, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Forsberg, Anita
    Psykiatriska kliniken Umeå, Psychiatric clinic Umeå.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Moberg, Erik
    Endokrinkliniken Karolinska universitetssjukhuset Huddinge, Department of Endocrinology Karolinska University Hospital Huddinge.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Relationships among shame-proneness, coping, and psychological distress in chronic fatigue syndrome patientsManuscript (preprint) (Other academic)
  • 30.
    Strömsten, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nyström, Markus
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shame and psychological distress: the influence of attachment styles, shame-proneness and shame coping among women and menManuscript (preprint) (Other academic)
  • 31.
    Sundbom, Elisabet
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Borderline psychopathology and the defense mechanism test1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main purpose of the present studies has been to develop the Defense Mechanism Test (DM1) for clinical assessment of severe psychopathology with the focus on the concept of Borderline Personality Organization (BPO) according to Kemberg. By relating the DMT and the Structural Interview to each other, the concurrent validity of the concept of Personality Organization (PO) for psychiatric inpatients has been investigated. Two different assessment approaches have been used for this purpose. One has been to take a theoretical perspective as the starting-point for the classification of PO by means of the DMT. The other has been a purely empirical approach designed to discern natural and discriminating patterns of DMT distortions for different diagnostic groups. A dialogue is also in progress between DMT and current research on the Rorschach test in order to increase understanding of borderline phenomena and pathology.

    The overall results support Kemberg's idea that borderline patients are characterized by specific intrapsychic constellations different from those of both psychotic and neurotic patients. Both the DMT and the Structural Interview provide reliable and consistent judgements of PO. Patients with the syndrome diagnosis Borderline Personality Disorder exhibit different perceptual distortions from patients suffering from other personality disorders. The classic borderline theory is a one-dimensional developmental model, where BPO constitutes a stable intermediate form between neurosis and psychosis. The present results suggest that a two-dimensional model might be more powerful. Hence, the level of self- and object representations and reality orientation might be considered both from a developmental gad an affective perspective across varying forms of pathology.

    Kemberg suggests that borderline and psychotic patients share a common defensive constellation, centered around splitting, organizing self- and object representations. This view did not find support. The defensive pattem of the BPO patients is significantly different from the PPO defensive pattern. The BPO patients form their self- and object images affectively and thus the self- and object representations would seem to influence the defensive organization and not the other way around. The results have implications for the procedure and the interpretation of the DMT e.g. one and the same DMT picture can discern different kinds of personality; reactions other than the operationalized defense categories in the DMT manual can be valid predictors of PO; some of the DMT defenses described in the manual have to be reconceptualized such as isolation, repression and to some degree denial. Multivariate models are powerful tools for the integration of reactions to DMT into diagnostic patterns.

  • 32.
    Sundbom, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Andersson, Sven-Olof
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Semb, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kaiser, Niklas
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Reflekterande skrivande och personligt samtal i läkarutbildningen: Nya moment i psykologikurs bidrog till ökad självkännedom2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 110, article id CA4EArticle in journal (Refereed)
    Abstract [en]

    Reflective writing and personal talks in medical education: New segments in the Medical Psychology course helped to increase self-awareness

    There is a national goal for medical students to gain self-awareness during their training. However, teaching methods and examination procedures supporting this goal are rarely discussed. Two new course segments – weekly newsletters and personal talks – aimed at stimulating self-reflection and self-awareness during the Medical Psychology course are presented, along with a student evaluation and the teachers’ experiences of the segments. The course evaluations and teachers’ comments support the perception that the new segments help to increase self-awareness. The teachers share the experience that the motivation, trust and openness shown by most of the students in their letters and talks are an impetus and important basis for increased self-reflection and self-awareness. For many students, personal talks have been important from a psychosocial point of view. It was possible to capture those in need of support and mediate further contacts when necessary.

  • 33. Sundbom, Elisabet
    et al.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Prediction of outcome in transsexualism by means of the Defense Mechanism Test and multivariate modeling: a pilot study.1999In: Perceptual and Motor Skills, ISSN 0031-5125, E-ISSN 1558-688X, Vol. 88, no 1, p. 3-20Article in journal (Refereed)
    Abstract [en]

    To elaborate the predictive value of the projective method using the Defense Mechanism Test in a 5-yr. follow-up study of 16 transsexuals, all subjects were approved for sex reassignment surgery and had completed the baseline assessments and the 5-yr. follow-up evaluation. Furthermore, we intended to create an outcome model based on the test data for prior patients wherein new consecutive applicants for sex change could be tested to predict the outcome in individual cases. Outcomes after five years showed that 62% of the transsexuals were judged as improved in a variety of areas of psychosocial functioning, 19% were unchanged, and 19% were worsened. Firstly, the analysis of the test data confirmed differences between the improved transsexuals and those who were not. Secondly, sex differences were found, with female-to-male transsexuals having a better outcome and being more homogeneous than their male counterparts. Thirdly, there was good correspondence in prediction of outcome between the model based on the Defense Mechanism Test and a clinical judgment made by a psychiatrist for two new applicants for sex reassignment surgery. It appears the Defense Mechanism Test has a predictive ability for patients with gender-identity disorder.

  • 34.
    Sundbom, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Semb, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Betydelse av tidig kontakt och behandling av våldsdrabbade brottsoffer: en prospektiv longitudinell studie2011Report (Other academic)
  • 35. Sundbom, Elisabet
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Penayo, Ulises
    Personality and defenses: a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden.1998In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 83, no 3 Pt 2, p. 1331-47Article in journal (Refereed)
    Abstract [en]

    This study examined cross-cultural variability in personality and defenses among Nicaraguan and Swedish healthy individuals, patients with borderline personality disorder and schizophrenic disorders by means of the projective perceptual Defense Mechanism Test. The over-all aim was to test the hypothesis proposed by Anthony Marsella of 'severity related cross-cultural variability' suggesting that differences in symptom profile or personality patterns between cultures are most pronounced among healthy individuals and less so among individuals with severe mental disorders as they are perceived as more universal and less culturally determined. The over-all results showed that cross-cultural differences were in accordance with the proposed hypothesis. In addition, there were significant intracultural differences between the different diagnostic groups in both countries. The conclusion is that the Defense Mechanism Test and Partial Least Squares analysis seem to be powerful methods for personality assessment and potentially for cross-cultural research, and culture-specific norms in the Defense Mechanism Test must be employed.

  • 36. Sundbom, Elisabet
    et al.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Multivariate modelling and the Defence Mechanism Test: a comparative study of defensive structures in borderline, other personality disorders and schizophrenic disorder.1992In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 86, no 5, p. 379-85Article in journal (Refereed)
    Abstract [en]

    The study aims at discerning discriminating patterns in the perceptual responses according to the projective percept-genetic method Defence Mechanism Test (DMT) among 45 subjects with the diagnoses borderline personality disorder (BPD), other personality disorders (OPD), schizophrenic disorder (SD) and a non-patient group. The overall results show that, by means of partial least squares (PLS) discriminant analysis of 130 DMT variables, it is possible to separate these groups. Patients with a BPD or a SD diagnosis and the non-patient group are clearly separated, whereas the OPD group shows a less homogeneous pattern. The findings support both the validity of the DMT as a method to measure personality features and the psychodynamic validity of BPD. The most characteristic properties of the BPD group are responses of emotional expressions, especially introaggression and frequent distortions of the stimulus picture. Regarding the SD/OPD group, a pattern of high threshold values for perception emerges as a discriminating feature as well as different variants of introjection. The non-patients are characterized by very few DMT distortions and consequently show a good reality orientation. The conclusion is that the DMT and the PLS discriminant analysis are powerful methods in the assessment of personality pathology.

  • 37. Sundbom, Elisabet
    et al.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Armelius, B A
    Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test.1989In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 80, no 1, p. 101-5Article in journal (Refereed)
    Abstract [en]

    Twenty-seven psychiatric inpatients, diagnosed according to DSM-III and the Diagnostic Interview for Borderline (DIB), and 7 healthy controls were tested with the Defense Mechanism Test (DMT), a test of subliminal perception based on psychoanalytic theory. In the test a specific stimulus is presented subliminally in a tachistoscope and the patient's perceptual distortions are registered. Patients with borderline personality disorder (BPD) were compared with patients with other personality disorders, patients with schizophrenic disorders and healthy controls. Specific perceptual distortions were identified among patients with BPD. Some individual DMT signs correlated with some deviant behaviors as identified by the DIB. The findings supported the psychodynamic validity of the concept of borderline personality disorder. It is concluded that DMT is a promising research instrument that provides an empirical approach to crucial psychodynamic phenomena.

1 - 37 of 37
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