The network structure of posttraumatic stress symptoms in war-affected children and adolescents.

Background: It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods: The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results: In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion: The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.

Online training for evidence-based child trauma treatment: evaluation of the German language TF-CBT-Web.

Background: Evidence-based trauma-focused interventions for treating PTSD in children and youth are barely used in practice. Web-based training has proven to be an effective way of transferring knowledge to healthcare professionals. Objective: TF-CBT Web is a web-based training programme designed to foster the dissemination of Trauma Focused Cognitive Behavioural Therapy (TF-CBT) for children and youth, and is run by the Medical University of South Carolina. This paper describes the characteristics of healthcare professionals who registered for the adapted German language version of TF-CBT Web. It evaluates the effectiveness and user friendliness of the programme. Method: : Similar to the TF-CBT treatment manual, the German language TF-CBT Web contains 12 modules. Between 2018 and 2020, 4,020 users registered for the programme. During the registration process users provided demographic information. The knowledge of users regarding the TF-CBT components was assessed via pre-tests and post-tests in each module. Results: The programme was accessed by a sample of mostly German users with varying professional health care backgrounds and a wide-ranging spread of work experience. The results indicated a significant knowledge gain and high rates of user satisfaction with the programme. Conclusions: In summary, the results of this study suggested that web-based training is an effective and well-accepted method for knowledge gain in trauma-focused interventions. Future research should evaluate the actual application of the taught methods in clinical practice. HIGHLIGHTS: Children and adolescents with PTSD require trauma-focused treatment. However, evidence-based interventions for this patient population are barely used. Therefore, it is necessary to expand professional training for the treatment of traumatised children and adolescents.Our evaluation showed the effectiveness and feasibility of a web-based training programme for mental health practitioners in an evidence-based treatment for children and youth with PTSD (TF-CBT). Results show a significant knowledge gain of users who participate in the web-based training programme.The user satisfaction survey also revealed that users found the modus and content of the web-based training applicable and relevant for their clinical practice.

Antecedentes: Las intervenciones centradas en el trauma basadas en la evidencia para tratar el TEPT en niños y jóvenes apenas se utilizan en la práctica. La capacitación basada en la web ha demostrado ser una forma efectiva de transferir conocimientos a los profesionales de la salud.Objetivo: TF-CBT Web es un programa de capacitación basado en la web, diseñado para fomentar la difusión de la Terapia cognitiva conductual centrada en el trauma (TF-CBT por sus siglas en ingles) para niños y jóvenes, y está a cargo de la Universidad Médica de Carolina del Sur. Este artículo describe las características de los profesionales de la salud que se registraron en la versión alemana adaptada del TF-CBT Web. Evalúa la eficacia y la facilidad de uso del programa.Método: Similar al manual de tratamiento de TF-CBT, el sitio web de TF-CBT en alemán contiene 12 módulos. Entre 2018 y 2020 se registraron 4.020 usuarios en el programa. Durante el proceso de registro, los usuarios proporcionaron información demográfica. El conocimiento de los usuarios sobre los componentes de la TF-CBT se evaluó mediante pruebas previas y posteriores en cada módulo.Resultados: El programa fue completado por una muestra de usuarios en su mayoría alemanes con diferentes antecedentes profesionales en el cuidado de la salud, y una amplia variedad de experiencia laboral. Los resultados indicaron una ganancia de conocimiento significativa y altos índices de satisfacción de los usuarios con el programa.Conclusiones: En resumen, los resultados de este estudio sugirieron que la capacitación basada en la web es un método efectivo y bien aceptado para adquirir conocimientos en intervenciones centradas en el trauma. La investigación futura debe evaluar la aplicación real de los métodos enseñados en la práctica clínica.

Toward a Contextually Valid Assessment of Partner Violence: Development and Psycho-Sociometric Evaluation of the Gendered Violence in Partnerships Scale (GVPS).

This article presents a new measure for intimate partner violence (IPV), the Gendered Violence in Partnerships Scale (GVPS). The scale was developed in the Middle East with the aim to contribute to the global perspective on IPV by providing a contextual assessment tool for partner violence against women in violent-torn settings embedded in a patriarchal social structure. In an effort to generate a scale including IPV items relevant to the women of the population, a pragmatic step-wise procedure, with focus group discussions and expert panels, was performed. The study's analyses resulted in an 18-item checklist featuring four subscales of the GVPS that are based on a new typology of male-to-female partner violence presenting an alternative to the commonly used classification by type of abuse (i.e., physical, psychological, sexual acts). Therein, dominating behaviors, existential threats, impulsive aggression, and aggravated physical assault were identified as reflective of the lived realities of women in the war-torn Middle East, which was confirmed in factor analysis. The scale's psychometric properties were assessed with data from 1,009 displaced women in Iraq, and associations with measures of psychopathology were determined. Implications for IPV assessment and prevention possibilities in humanitarian contexts and beyond are discussed.

Understanding the link between child maltreatment and adolescent future expectations in Northern Uganda: A serial mediation analysis.

BACKGROUND: Recent research has identified high levels of child maltreatment and harsh parenting in post-war societies which have had detrimental effects on children's development. Future expectations are an important aspect of adolescents' development particularly in the challenging contexts of post-war societies where social instabilities and violence are prevalent. To date, however, the link between child maltreatment and adolescent future expectations remains understudied. OBJECTIVE: By applying a socio-ecological perspective, this study aimed to investigate risk (internalizing symptoms) and protective factors (community integration) linking experiences of harsh parenting with adolescents' future expectations. PARTICIPANTS AND SETTING: Data was collected from N = 199 northern Ugandan adolescents (40.2 % females, Mage = 14.56 years) with structured interviews. METHODS: Serial mediation analyses were calculated with child maltreatment as the predictor, future expectations as the outcome, and internalizing symptoms as well as community integration as mediating variables. RESULTS: Results of the mediation model (R2 = .22, F(5193) = 10.54, p <  .001, total effect (b = -0.28, p < .005) revealed a direct effect of child maltreatment on future expectations (effect size: -.20, 95 % bootstrap CI = -0.40, -.01) as well as an indirect effect of child maltreatment via internalizing symptoms and community integration on future expectations (effect size of -.07 (95 % bootstrap CI = -0.14, -0.01). CONCLUSION: Child maltreatment was found to be linked to negative future expectations among Northern Ugandan adolescents, and both internalizing symptoms as well as community integration played mediating roles in the associations. Interventions should take psychopathology and community factors into account.

Adolescent Life Perspectives After War: Evaluation and Adaptation of the Future Expectation Scale in Uganda.

The formulation of life perspectives is one of the developmental tasks of adolescence. Expectations regarding one's own future are shaped by cultural and contextual factors. However, there is little cross-cultural research that includes countries affected by war and turmoil. A Ugandan version of the Future Expectations Scale for Adolescents (FESA) was developed and evaluated with a sample of 279 Ugandan adolescents with low socioeconomic status living in rural communities affected by the Ugandan civil war (1986-2006). The Ugandan FESA was constructed on the basis of a combined item pool of the original Chilean and an adapted Brazilian FESA. Confirmatory factor analysis revealed that the factor structure of the original FESA did not fit the Ugandan data. Principal component analysis revealed a 3-factor solution, including the domains of children and family, work and education, and general future optimism. The final version consists of 19 items, which were deemed culturally appropriate by local focus groups. Overall, the item pool of the FESA was found useful for further studies in post-conflict societies.

The contribution of mental health and gender attitudes to intimate partner violence in the context of war and displacement: Evidence from a multi-informant couple survey in Iraq.

RATIONALE: Intimate partner violence is a prevalent issue in refugee and internally displaced populations in post-war and migration settings including camps in the Middle East. In this context, partner violence has been associated with war-related trauma, camp factors, individual characteristics, and gender attitudes. OBJECTIVE: With a dual-informant survey among a sample of Iraqi couples residing in a camp for displaced people in the Kurdistan Region of Iraq (N = 92) this study investigated the relationship between war-related psychopathology, attitudes towards women, and male-perpetrated partner violence. METHOD: Moderated regression analysis was applied using information from both partners to predict partner violence reported by wives. RESULTS: Over 58% of the women in this sample reported past-year exposure to partner violence. Further analyses revealed significant main effects of men's self-reported psychopathology (posttraumatic stress disorder and depression) and their own gender attitudes on partner violence. In a multivariate regression, moderating effects were found, as higher psychopathology levels and inequitable gender attitudes in men interacted in the prediction of male-perpetrated partner violence. CONCLUSIONS: This study highlights the high prevalence of partner violence among Iraqi displaced women. In addition, the results show an interplay of several violence-impelling factors in war-affected men. This emphasizes the importance of addressing both mental health issues and gender attitudes in the efforts to reduce or end violence against women in post-war settings.

Daring to process the trauma: using a web-based training to reduce psychotherapists' fears and reservations around implementing trauma-focused therapy.

Although trauma-focused interventions are the first-line therapies for patients with posttraumatic stress disorder (PTSD), they are not frequently used in clinical practice. Factors preventing therapists from applying trauma-focused methods include a lack of training and negative attitudes towards trauma-focused therapy. The aim of the present study was to investigate which factors predict willingness to carry out trauma-focused therapy and to examine whether a web-based training is able to reduce negative attitudes and reservations about these interventions. In a wait-list controlled evaluation study, therapists (N = 499) were randomized into an intervention or a wait-list control group. Results show that trauma-treatment specific competencies and overcoming pre-existing concerns towards trauma-focused therapy significantly predict therapists' willingness to utilize trauma-focused interventions. Thus, the content alignment of the web-based course is appropriate for improving therapists' willingness to conduct trauma-focused therapy. A retrospective examination of therapists after the training and a comparison of fears and reservations before and after the training demonstrate a significant reduction of fears and reservations. In terms of perceived contraindications, no effects of the web-based training were found. The present study provides compelling evidence that web-based training in evidence-based PTSD therapy is able to reduce reservations that may prevent therapists from applying evidence-based trauma-focused interventions.

Aunque las intervenciones centradas en el trauma son las terapias de primera linea para pacientes con TEPT, no son usadas frecuentemente en la pracitca clinica. Los factores que hacen que los terapeutas eviten la aplicacion de metodos centrados en el trauma incluyen la falta de entrenamiento y las actitudes negativas hacia la terapia centrada en el trauma. El objetivo de este estudio fue investigar que factores predicen la disposicion para llevar a cabo la terapia centrada en el trauma y examinar si el entrenamiento basado en la web es capaz de reducir las actitudes negativas y reservas acerca de estas intervenciones. En un estudio de evaluacion controlado en la lista de espera, los terapeutas (N = 499) fueron aleatorizados en una intervencion o un grupo de control de lista de espera. Los resultados muestran que las competencias especificas del tratamiento del trauma y la superacion de las preocupaciones preexistentes hacia la terapia centrada en el trauma predicen significativamente la disposicion de los terapeutas para utilizar intervenciones centradas en el trauma. Por lo tanto, la alineacion del contenido del curso basado en la web es apropiada para mejorar la disposicion de los terapeutas a realizar una terapia centrada en el trauma. Una evaluacion retrospectiva de los terapeutas despues del entrenamiento y una comparacion de los temores y reservas antes y despues del entrenamiento demuestra una reduccion importante de los temores y reservas. En terminos de contraindicaciones percibidas, no se encontraron efectos del entrenamiento basado en la web. El presente estudio provee pruebas convincentes que el entrenamiento basado en la web en la terapia del TEPT basado en la evidencia es capaz de disminuir las reservas que pueden hacer que los terapeutas eviten aplicar intervenciones centradas en el trauma basadas en la evidencia.