Traumatic Life Events and Women’s Health

Research group

Traumatic Life Events and Women’s Health

A man beats a woman. Picture

Research activity

Reasearch Projects

Reasearch Projects

Research projects for traumatic life events and womens health

Rape and sexual assault is one of the traumatic life events associated with the highest risks for developing chronic posttraumatic stress disorder (PTSD) and other mental health and psychosomatic problems. PTSD is a mental disorder characterized by involuntary, intrusive posttraumatic memories of the event, avoidance of things that reminds the victim of the rape, negative changes in emotions and beliefs about the self and the world, and hyperarousal. For most people PTSD is associated with significant functional impairment.

Presently, we have adequate research-based knowledge that trauma-focused cognitive-behavioral treatments have reasonable effects in the treatment of chronic PTSD. However, we have limited evidence about effective interventions to prevent the development of chronic PTSD after traumatic life events. Given the fact that rape is an especially potent risk factor for the development of chronic PTSD it is important to investigate how we might prevent the onset of this debilitating disorder.

Thus, in the present project we will conduct a multicenter randomized controlled trial to examine if a brief psychological intervention in the immediate period after rape might prevent the development of PTSD and other mental health and psychosomatic disorders.

Patients who seek health care at Sexual Assault Centers immediately after rape will be eligible to participate in the trial given that they consent to participate. Patients will be randomized to either up to five sessions of prolonged exposure (PE) therapy or psychosocial follow-up services as usual.

The severity of posttraumatic symptoms and other mental health and psychosomatic symptoms will be measured before and after the intervention in order to examine whether a brief specialized intervention is more effective than treatment as usual. In addition, we will strive to identify factors that might explain why some patients respond well to treatment whereas other patients do not (i.e. so-called moderators).


The study is funded by the Norwegian research

Chronic pelvic pain (CPP) in women is an often-overlooked condition, women may be reluctant to disclose the problem, the doctor may not ask, and the causes are not well understood. It has a potentially large impact on health care utilization, sexual health, quality of life, and work ability. Sometimes, the pain is found to have a distinct somatic causation as in endometriosis. More often the objective signs cannot explain the reported complaints, and the woman is at risk of unnecessary intervention with potentially harmful impact on her reproductive health. Hence, there is an urgent need to broaden the causal model and assess contributing factors such as adverse childhood experiences and psychological distress. These factors have been shown to contribute to triggering and maintaining other pain conditions, like chronic widespread pain (CWP) but less is known of their role in CPP.

The purpose of the study is to utilize the data from the HUNT Study to prospectively study if experience of interpersonal violence in adolescence is associated with risk of CPP in adulthood, and if mental distress in young adult females give increased risk of reporting CPP 10 years later. We want to obtain updated estimates for the prevalence of CPP in the general population, and the possible dependency between CPP and CWP.

Findings from the proposed study have the potential to increase identification of CPP patients, guide diagnostic process and develop optimal prevention and treatment strategies.



The Study is funded by The Liaison Committee for education, research and innovation in Central Norway.

A research group from the Netherlands led by Ellen T.M. Laan and H.W. van Lunsen has developed a questionnaire in which patients themselves report occurrence and degree of symptoms of pelvic floor hyperactivity.

This questionnaire is called the “Amsterdam hyperactive Pelvic Floor Scale” (AHPFS) for women and includes  30 questions. Each question deals with one symptom and has a 5-point Likert scale varying from never (score 1) to very often (score 5). The score of the different symptoms give an indication of general tense in the woman´s body (such as muscular pain and stiffness in shoulders and neck) and additionally symptoms often associated with “overactivity” in the pelvic floor muscles. 

The AHPFS has been translated into English. To our knowledge, the questionnaire has never been translated into Norwegian or tested in a Norwegian setting. 
The overall aim of this study is to understand the variety of symptoms and the importance of mapping out the right clinical diagnosis among women with pelvic floor disorders. These are important aspects for understanding women’s health. 

The purpose 1) to translate this questionnaire “Amsterdam hyperactive Pelvic Floor Scale for women” into Norwegian, 2)    pretesting of equivalence by performing cognitive interview, 3) testing for reliability and validation of the Norwegian version of the questionnaire among different female participants to approach pelvic floor dysfunction in women, and 4) use the collected data to describe a Norwegian female population.

Sexual assault can affect various aspects of a person's life and may have long-lasting negative mental and physical health consequences. Annually, around 2000 patients subjected to a recent sexual assault visit the 24/7 sexual assault centers(SAC) in Norway. Patients contacting SACs need acute medical care to ensure short and long-term health consequences are reduced to a minimum. The patient is examined and cared for by trained interdisciplinary health personnel providing both emergency medical treatment and psychosocial support and care.
This project will explore patients’ experiences from encountering a SAC and how health personnel experience assisting patients throughout the examination and follow-up course in the acute phase(until 1mth after sexual assault).



The study is funded by the Norwegian University of Science and Technology. 

Chlamydia is the most common sexually transmitted infection in Norway, and the prevalence is increasing. Long-term and untreated chlamydial infection is associated with an increased risk of pelvic inflammatory disease, infertility, chronic pelvic pain, and ectopic pregnancy. Therefore, we have strong recommendations for chlamydial testing after unprotected sexual intercourse, as well as antibiotic treatment when infection is diagnosed to prevent these complications.


The association between genital chlamydial infection and ectopic pregnancy was established from studies in the 1980s. However, later research has shown conflicting evidence on how high the risk actually is. The last Norwegian study was carried out in 2007 and showed only a weak association.


To ensure up-dated scientific basis for still recommending chlamydial testing and treatment, we want to investigate future risk of ectopic pregnancy among women tested for genital chlamydia infection in (formerly) Sør-Trøndelag county in Norway.


The study design is a retrospective cohort study, where the study population will consist of women with at least one genital chlamydial test in the laboratory database of the Department of Medical Microbiology, St. Olavs hospital, Trondheim University Hospital in the period 1990–2020. These women will be divided into two groups (cohorts), where one group consists of women with only negative chlamydial tests (unexposed), while the other group consists of women with at least one positive test (exposed). At the same time, we will extract information from medical records of women who have been admitted for ectopic pregnancy to the same hospital in the period 2005–2021. Furthermore, we will link these data to study the incidence of ectopic pregnancy in the two groups, chlamydia-exposed and -unexposed. Hence, we will register chlamydia exposure 10–15 years before we register any ectopic pregnancies, as this complication usually happen years after the infection. As ectopic pregnancy is regarded as a sign of reduced fertility, we will also obtain data from the Medical Birth Registry of Norway to be able to study the association between women's fertility, ectopic pregnancy and any positive chlamydial test.

The incidence of ectopic pregnancy (EP) increased until the end of the 1980s in Norway, then falling until 2004. There are no studies describing updated trends for EP in Norway. EP is not included as a quality indicator for e.g. fertility. Therefore, new estimates of incidence will provide new knowledge on further development of the disease.

There has been a significant development in the possibility of ultrasound diagnostics and laboratory medicine (rapid test results on hemoglobin and the pregnancy hormone in serum (s-hCG). Has this affected how fast the EP diagnosis is set? We have little updated information on how often the expectant management is used, nor on medical treatment with methotrexate. Are there changes in the use of surgical methods, e.g., do most gynecologists now use laparoscopic surgery solely, or are laparotomy still commonly used? To what extent are national recommendations for EP treatment followed in regard to clinical presentation, s-hCG values and ultrasound findings? There is also a lack of knowledge about how type of EP treatment (surgery vs. methotrexate) will affect the women’s later fertility?

The purpose of the project is therefore to investigate trends in the incidence, diagnostics, and treatment of EP in former Sør-Trøndelag, as well as to study subsequent fertility for these patients.

The study design is a retrospective cohort study where the study population is women with at least one EP registered in the medical record system at St. Olavs hospital in the period 2005 - 2021.

The data source is the electronic medical records from St. Olavs hospital. We collect the following information: year of birth, sociodemographic data (municipality, civil status), previous gynecological history (previous treatment for tubal inflammation, contraceptive use, previous pregnancies), data on current pregnancy (spontaneously achieved pregnancy or treatment with artificial reproduction), diagnostics (clinical findings, s-hCG values, ultrasound, surgery, histology), treatment (expectant management, methotrexate, surgery), findings at surgery, data on future pregnancies (number, type, how the pregnancy has been achieved), and data on infertility investigation and treatment.

Regarding calculating the incidence: Here, the number of EPs is calculated per 1,000 women aged 15-44, and in 10-year age groups, as well as per 1,000 births.

The women eligible for the study has received information about the project in June 2022, and has had the opportunity to withdraw their medical record data

from the study. However, in the autumn of 2022 we have received approval from the Regional Committee for Medical and Health Research Ethics to carry out a so-called dropout analysis. For this, we have been permitted to collect information about the age and the number of births among the women who have withdrawn their information. The reason for the approval is that such information is very little sensitive and that the dropout analysis is important for the quality and generalizability of the EP study. However, women who have already withdrawn their medical records, can still have information on age and births removed from this analysis by contacting the project manager at

Giving birth and becoming a mother is usually associated with happiness. For some women, however, childbirth becomes a negative experience that may cause trauma symptoms, reduced quality of life and reduced level of functioning. Around 4% of women develop a post-traumatic stress disorder (PTSD) following childbirth, hence, corresponding to more than 2,000 women each year in Norway. PTSD following childbirth can have a negative effect on attachment to the newborn, breastfeeding, and relationship to her partner in the vulnerable postpartum period. Women with PTSD following childbirth have a higher risk of postpartum depression and anxiety, seem to have longer interval to next child, and have fewer children overall.

There is currently insufficient knowledge about childbirth-related trauma symptoms regarding treatment needs of the women, what treatment is effective, and at what level of the health care service the treatment should be offered. Many maternity women with traumatic birth experiences are caught between different health care units in the search for help in the vulnerable postpartum period. There is a need for the development of better treatment services of PTSD symptoms following childbirth, and the cooperation between primary and secondary health care around this group should be strengthened.

Our project aim to contribute to improving health services for such mothers.
We will develop an online treatment program through innovative and user-centered development methodology based on empiricism, theory and experiences from patients and healthcare personnel. Then, we will test the treatment effect of this online program in a randomized controlled multicenter study at four hospitals in Norway where women with birth-related trauma symptoms are invited to complete the treatment 15 to 30 days after their childbirth. We will investigate whether the program can reduce trauma symptoms, prevent the development of PTSD following childbirth, and have a positive effect on breastfeeding, attachment, postpartum depression, and relationship to her partner in the maternity period.

Early treatment of trauma symptoms that prevents PTSD following childbirth will be of great importance for women's health and quality of life, as well as for their children and partners. Online treatment can make the healthcare service cost-effective and easily accessible regardless of the woman's place of residence and access to specialized healthcare personnel. Also, online treatment can be offered to women who have difficulty attending a physical appointment and can be adapted to functional variations linked to e.g. vision and hearing, as well as being translated into several languages. Our project therefore contributes to a more patient-tailored service where equal access to effective treatment is ensured for more women.

The study is funded by the Foundation Dam, through the NGO The Norwegian Women's Public Health Association.