Presença de risco de transtorno do estresse pós-traumático em policiais militares feridos por arma de fogo / Presence of risk of posttraumatic stress disorder in military police officers wounded by firearms / Presencia de riesgo de trastorno de estrés postraumático en policías militares heridos por armamiento de fuego

Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)

This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)

Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)

Runaway youths and correlating factors, study in Thailand.

OBJECTIVE: To study differences between runaways and non-runaways in a mental health clinic and to study differences between runaways in a mental health clinic and legal / shelter system. MATERIAL AND METHOD: Psychiatric records of runaways and non-runaways from Vajira Hospital were collected from June 1994 to October 2003. 21 cases in each group were studied in various factors. 21 runaway cases who were in child and adolescent shelters were interviewed by the researchers. RESULTS: Neglect, sexual abuse, rejection, poverty and truancy were more common in the runaway group. The runaway group had more conduct disorder and substance abuse. Physical abuse, authoritarian and being in custody were more common in runaways in shelters. CONCLUSION: Various factors correlate with running away. These factors lie beneath long before runaway has taken place and understanding and managing them help in preventing and prompt treatment.

Risk/protective factors associated with substance use among runaway/homeless youth utilizing emergency shelter services nationwide.

Rates of alcohol, tobacco, and marijuana use among runaway/homeless youth are substantially higher than found among American high school students. To understand the risk and protective factors associated with substance use, this study (1) assessed cigarette, alcohol, and marijuana use among a national sample of runaway/homeless youth, (2) identified risk/protective factors associated with lifetime substance use, and (3) examined risk/protective factors associated with six month frequency of substance use. Unduplicated cases (n = 11,841) from the 1997 Runaway/ Homeless Youth Management Information System (RHY MIS) were analyzed. Results showed that substance use levels are greater than previously reported for this population. Predictors of cigarette, alcohol, and marijuana use and frequency were predominately individual youth risk factors and demographics rather than family risk factors. Providers in emergency youth shelters are in a prime position to assess substance use behaviors, as well as the associated risk factors. Provision of appropriate screening and referral to other services is essential to meet the needs of these youth.

Assessment and treatment of elopement: a replication and extension.

The current investigation replicated and extended the assessment and treatment methodology of elopement. The environmental variables that maintained elopement were identified in each case, and successful treatments were implemented for the 3 participants in settings that were similar to those in which elopement occurred.

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons.

PURPOSE: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area of Los Angeles, California; identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. METHOD: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. RESULTS: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%), substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles versus all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including rules perceived to be restrictive, and concerns youth had about confidentiality and mandated reporting. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets. CONCLUSIONS: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that we understand the perceived barriers to service utilization.

The impact of home background on the decision of children to run away: the case of Yaounde City street children in Cameroon.

OBJECTIVE: This study sets out to investigate the phenomenon of street children and its relationship to their home background. The project stemmed from the fact that there is an enormous increase of children nowadays roaming the streets. Our premordial aim here is to investigate whether misunderstanding between parents and their children resulting from home-rearing patterns can influence children to run away from home. METHOD: The research was carried out in specific areas of the Yaounde urban center where most of these delinquent children have their meeting points. Out of about 900 street children, 21 of them were sampled for this exercise. The nonprobability or purposive sampling technique was used. The main tool for data collection was the questionnaire. Two hypotheses were formulated and tested with the chi-square test of independence. RESULTS: From the data analysis, there is a highly positive relationship (chi2 = 68.0, P = .001 ) existing between home-rearing patterns and the children found in the street. The analysis also stipulates that there is an equally positive but low relationship (chi2 = 10.5, P = .05 existing between the level of family income and children running away from home. CONCLUSIONS: From the analysis of fundings, it can be concluded that the economic crisis which many Cameroonian families are facing cannot be considered as a major factor responsible for children abandoning the home for the street as family income has been shown to have only a weak connection with the street children phenomenon. On the contrary, authoritarian parenting which characterizes 62.86% of parents is revealed as the major factor responsible for children running away from home. The researcher recommends that interventions should focus on how parents treat their children without neglecting to deal with the means required to meet family needs.

Homeless youth in London: I. Childhood antecedents and psychiatric disorder.

BACKGROUND: There has been an increase in the numbers of homeless young people in Britain. Little is known of the health and social welfare needs of this population. METHOD: This case-control study compares a random sample of homeless people aged under 22 years recruited from consecutive attenders at two of London's largest facilities for homeless young people with a contemporaneous sample of domiciled young people recruited through general practice registration lists. The homeless and domiciled groups were compared on measures of childhood care, education and psychiatric disorder. RESULTS: One hundred and sixty-one homeless people (88% of those approached) and 107 domiciled subjects (60% of those approached) were interviewed. Sixty-nine per cent of homeless and a third of the domiciled subjects reported a childhood lacking in affection, with indifferent and often violent carers. Psychiatric disorder was identified in 62% of homeless respondents and a quarter of the domiciled population. A fifth of homeless and 5 domiciled respondents had attempted suicide in the previous year. Multivariate analysis suggest that childhood adversity, low educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population. CONCLUSIONS: The evidence presented in this paper supports the hypotheses that characterize the young homeless population as experiencing higher rates of childhood adversity and psychiatric disorder than their domiciled contemporaries. A tentative model is suggested whereby childhood experiences, educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population.

Pregnancy among three national samples of runaway and homeless youth.

PURPOSE: To compare estimates of the prevalence of pregnancy among runaway and homeless youth between the ages of 14 and 17 years in various settings with each other and with youth in the general population. METHODS: Comparisons used three surveys of youth: (a) the first nationally representative survey of runaway and homeless youth residing in federally and nonfederally funded shelters, (b) a multicity survey of street youth, and (c) a nationally representative household survey of youth with and without recent runaway and homeless experiences. RESULTS: Youth living on the streets had the highest lifetime rates of pregnancy (48%), followed by youth residing in shelters (33%) and household youth (<10%). CONCLUSIONS: Shelter and street youth were at much greater risk of having ever been pregnant than were youth in households, regardless of whether they had recent runaway or homeless experiences. Such youth need comprehensive services, including pregnancy prevention, family planning, and prenatal and parenting services.

PIP: This study estimated and compared adolescent pregnancy rates among runaway and homeless adolescents in several settings. Data were obtained through 3 surveys: 1) a 1992 Youth Risk Behavior Survey (YRBS) among a nationally representative sample with recent runaway and homeless youth experiences; 2) the first nationally representative survey among a multistage sample of runaway and homeless youth living in federally and nonfederally funded youth shelters; and 3) the first multi-city survey of street youth. Data were collected among youth aged 14-17 years in 1992. Findings indicate that in all surveys youth were usually pregnant only once, but many street and shelter youth had 2 or more pregnancies. About 10% of both street and shelter youth reported being pregnant at the time of the interview. Significant differences occurred by age among street youth and for length of time away among both street and shelter youth. About 50% of street youth had a pregnancy experience compared to about 33% living in shelters. Less than 10% of household runaway youth had a pregnancy experience. Differences in rates were not statistically significant. The findings are based on self-reports, a purposive street sample, and potentially duplicate reporting among street youth. The high pregnancy rates are attributed, in part, to the prevalence of sexual abuse and other related reasons. 21-60% reported sexual abuse, compared to only 3-12% among the general population. A strong need exists for preventive/prenatal services for runaway and street youth.

Shelters for runaway and homeless youths: capacity and occupancy.

Data from a nationally representative sample of shelters for runaway and homeless youths (N = 160) were analyzed to determine shelter capacity, occupancy, and occupancy ratios. Analysis focused in particular on occupancy ratios by funding status, shelter size, metropolitan statistical area (MSA), season, and day of the week.

Street children in South Africa: findings from interviews on the background of street children in Pretoria, South Africa.

In the present study findings from interviews on the background of street children in Pretoria, South Africa are presented, discussed, and compared with research done in the past on South African street children. Findings from the investigation indicate that the average age of South African street children is approximately 13 years, predominantly of male African origin. Most have been on the streets for three years or longer, and they cited family violence, parental alcoholism, abuse, and poverty as the main motivating factors for leaving home. Most of these findings are common among street children all over the world.

PIP: This article presents the findings from in-depth interviews with street children in Pretoria, South Africa, during September, 1993. The average age of children was 13-14 years. This age group was younger than that found in developed countries. All of the children in this study were Black boys. The author refers to Ross's estimates of nearly 9000 Black street children and virtually no White street children in South Africa. There are 160 state-registered, subsidized residences for 10,000 White children; urban areas have no state and only 12 private residences serving 1000 Black children. The author also refers to Gebers' (1990) estimates that 81.1% of street children were male. It is argued that there are fewer girl street children because of their usefulness in household tasks and child care. All of the street children interviewed had lived on the streets since 1991. Richter estimates that about 33% of street children return home shortly, and another 33% stay on the streets for 6-18 months. Most street children in developed countries return home within a month. Findings from this study correspond to Gebers' findings that a longer time on the streets was associated with a greater distance from health or institutional care. Children in this study reporting leaving home due to family violence, parents' alcoholism, abuse, poverty, and personal reasons. Fall indicates that the pull factors for running away from home are the attractiveness of living in cities, the hope of improving their living conditions, and independence. Push factors include population pressure, urbanization, cost of living, need for increased income, child abandonment and neglect, family size, and collapse of traditional families. Swart blames family disintegration on the current political system that relies on migrant labor, racial segregation, and racial violence in Black areas. The conditions for children living in the streets appear to be universal.

Runaway and street youth at risk for HIV infection: legal and ethical issues in access to care.

Significant numbers of runaway and street youth are at risk for human immunodeficiency virus (HIV) infection. These youth are physically, socially, and psychologically vulnerable and need access to health care and related services. Legal and ethical concerns of consent and confidentiality may limit their access, although in many states the law allows some minors to consent to HIV testing and treatment and protects confidentiality of HIV-related information. Appropriate pretest and posttest counseling and follow-up for youth at risk of infection are essential. Limited access to HIV treatment for youth testing positive raises serious ethical concerns. Access to comprehensive treatment is currently limited by lack of adequate financing, despite a patchwork of numerous public funding sources providing some coverage for treatment of HIV and acquired immunodeficiency syndrome (AIDS). Research studies and clinical trials are critical elements in the planning and delivery of HIV-related services to adolescents, but require consideration of special ethical and legal concerns.

Homeless youth in Seattle. Planning and policy-making at the local government level.

Young people leave home for many reasons--a push away from problems, a pull toward the independence and seeming excitement of the street. Once on the street they face serious risks to their health and well-being. Homelessness among youths is a concern in Seattle, with as many as 2,000 on the street in a year's time. The service system is overburdened and poorly coordinated. The City of Seattle examined the problem, inadequacies of the service system, and issues affecting its ability to address the needs of homeless youths and their families. This article presents data on the problem, policies proposed to shape the city's response, and progress made in the last 2 years.

HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth.

In this article, we present data obtained with the psychosocial interview instrument, HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) that was administered to High Risk Youth Clinic clients at their initial visits during a 1-year period. Of the 1,015 new patients, 63% were homeless/runaway youths and 37% were living with their families. Utilizing the HEADSS interview instrument, we compared homeless/runaway youths to nonhomeless youths in a number of areas, including risks for human immunodeficiency virus (HIV) infection. Our results showed that homeless teens tended to be younger, female, and white compared to their nonhomeless counterparts. They were more likely to have dropped out of school and were far more likely to be depressed and actively suicidal. They demonstrated all forms of drug abuse. They engaged in first sexual intercourse at an earlier age, and experienced a higher incidence of sexual abuse and prostitution. They were 6 times more likely to be at risk for HIV infection.

Testing the limits: special treatment procedures for child and adolescent partial hospitalization.

How does a child and/or adolescent partial hospitalization program structure care for patients who are suicidal, assaultive, or combative or using drugs? Special treatment procedures designed for use in child and adolescent partial hospitalization programs must adequately address the issue of safety and involve the family and the community, while maintaining the patient in the least-restrictive environment. This paper deals with management of child and adolescent partial hospitalization patients whose behavior and level of impulsivity have escalated to the point where they require special programs. Special treatment procedures for dealing with patients displaying aggressive, acting-out behaviors, noncompliance with program rules, suicidal or runaway ideation, and drug usage are described.

Social policy and runaways.

This paper examines the relationship between social policy and the phenomenon of runaways and their health. Through an exploration of the literature and reference to empirical studies, including the author's own work, it provides background and establishes the relationship between being in care and running. Assumptions which guide social policy as well as the service delivery itself provide an explanation for the runaway--child welfare connection. The paper concludes with discussion of the implications and recommendations for a policy shift with respect to services for adolescents.

A sample of homeless and runaway youth in New Jersey and their health status.

In this study of homeless and runaway young people served by youth shelters in New Jersey mental health problems were predominant. They include anxiety, depression, suicide attempts, drug and alcohol abuse. The sample exhibited high levels of general behavioral problems and school and/or peer problems. One quarter of the sample had had trouble with the law. About two thirds of the sample were homeless rather than runaway. For a similar proportion of the sample this was a repeat experience and/or had lasted a week or more. Only one third were able to be reunited with their families after being served. The prognosis for these youth is poor without specific programs to protect them and their physical and mental health.

Runaway and homeless youth in Los Angeles County, California.

Data collected over one year from agencies in Los Angeles County serving homeless youth suggest that shelter and outreach/drop-in agencies serve different populations. Shelters serve about equal numbers of males and females, almost half of whom are 15 years old or younger. Slightly more than half of these young people are minority youth who live in Los Angeles County. Seven of 10 go on to live in a stable environment. Outreach/drop-in agencies serve predominantly males, almost all of whom are 16 years old or older. These clients are primarily white and from outside Los Angeles. Four of 10 get off the streets. Both shelters and outreach/drop-in agencies serve primarily multiproblem chronic runaway or homeless youth who have neither families nor independent living skills and have survived as best they could. To help these young people, more emergency shelter beds and transitional living programs are needed. The geographic location and program structure of services however must be carefully considered.

Childhood experiences of homeless men.

The authors interviewed homeless men in New York City shelters about their childhood experiences. Childhood placement away from the family was frequent, especially among former psychiatric patients. Childhood problem behaviors were also frequent.