Mobile applications in adolescent psychotherapy during the COVID-19 pandemic: a systematic review.

Background: To bridge the gap in adolescent psychotherapy created by the increasing need for mental health interventions and the limited possibilities of in-person treatment during the pandemic, many health care providers opted to offer online mental health care programs. As a result, the number of mental health apps available in app stores experienced a sharp increase during the COVID-19 pandemic. Objective: The aim of the current review is to provide an overview of feasibility and effectiveness studies testing mobile applications in adolescent psychotherapy during the peak phase of the COVID-19 pandemic. Methods: We conducted a literature search in Pubmed, PsychInfo, Google Scholar, OpenSIGLE and OpenGREY for papers published from June 2020 to June 2023. Studies were included if they evaluated app-based interventions intended for psychotherapeutic treatment and targeted adolescents between 12 and 27 years of age with symptoms of psychological disorders. The quality of each study was assessed using the Systematic Assessment of Quality in Observational Research (SAQOR). Effectiveness outcomes were analyzed by vote counting and calculating a binomial probability test. Results: The search yielded 31 relevant studies that examined 27 different apps with a total of 1,578 adolescent participants. Nine articles were primary effectiveness studies and 22 focused on feasibility measures as primary outcome. There was evidence that mental health apps influenced adolescents' psychotherapy, with 83% of the studies with effectiveness outcomes favoring the intervention (p = 0.002). Sixty-one percent of the included studies were rated at low or very low quality. Conclusions: The pandemic has given apps a firm and important role in healthcare that will probably continue to expand in the future. To ensure that mental health apps are truly effective and beneficial for adolescents' psychotherapy, we need a standardized measurement of quality features of mental health apps and higher quality app evaluation studies. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=406455, PROSPERO International Prospective Register of Systematic Reviews [CRD42023406455].

Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials.

BACKGROUND: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. METHODS: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. FINDINGS: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. INTERPRETATION: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. FUNDING: Swiss National Science Foundation.

Reducing Violent Discipline by Teachers: a Matched Cluster-Randomized Controlled Trial in Tanzanian Public Primary Schools.

Violent discipline in schools infringes on children's rights and is associated with harmful developmental consequences for students. This calls for effective intervention programs, particularly in countries with high prevalence of violent discipline in schools. This study tested the effectiveness of the preventative intervention Interaction Competencies with Children-for Teachers (ICC-T) in reducing violent discipline by teachers in a two-arm matched cluster-randomized controlled trial. The sample comprised teachers (n = 173, 53.7% female) and students (n = 914, 50.5% girls) from 12 public primary schools from six regions in Tanzania. Teacher physical and emotional violent discipline reported by teachers and students was assessed before and six to eight and a half months after the intervention. The schools were randomly allocated to either intervention (6; ICC-T) or control condition (6; no intervention). Teachers were not blinded. Students and research assistants conducting the follow-up assessment were blinded. A series of multivariate multilevel models revealed significant time*intervention effects on physical violent discipline reported by teachers and students and teachers' favorable attitudes towards physical violent discipline, FDRs < .05. In addition, we found a spill-over effect on peer-to-peer violence and students' externalizing, ps < .05. There were no significant time*intervention effects either on emotional violent discipline, FDRs > .05, teachers' favorable attitudes towards emotional violent discipline or on student's internalizing problems and academic performance, ps > .05. Our results provide further evidence that ICC-T may positively change teachers' violent disciplining behavior and their attitudes towards violent discipline. ClinicalTrials.gov, NCT03893851.

Heart Rate Variability's Association with Positive and Negative Affect in Daily Life: An Experience Sampling Study with Continuous Daytime Electrocardiography over Seven Days.

Heart rate variability has been found to be related to emotional processing and emotional responses. Studies that investigated these relationships were mostly lab-based or cross-sectional. Only limited research used intensive longitudinal data, in particular investigating within-individual processes in real-life settings. This study addresses the applicability of ambulatory-assessed electrocardiograms in combination with the experience sampling methodology by investigating the associations of various HRV measures with affective states on within- and between-individual levels. A total of 26 participants aged 18-29 years (23 females) wore electrocardiograms continuously for seven days. The participants received seven prompts per day and answered questions about their affective wellbeing. The heart rate and heart rate variability measures differed between body positions and activity classes. The heart rate and ratio of low-to-high-frequency heart rate variability were consistently associated with positive affect on a within-individual (state-like) level. These associations were mainly driven by the items of feeling "enthusiastic" and "happy". No associations were found with negative affect. Overall, we found evidence that the dominance of the sympathetic nervous system over the parasympathetic nervous system was associated with higher levels of positive affect on a within-individual (state-like) level. Suggestions for the application of ambulatory electrocardiogram assessment in the study of the association between autonomous nervous system activity and ecological momentary assessment-based variables are discussed.

Sustainability of effects and secondary long-term outcomes: One-year follow-up of a cluster-randomized controlled trial to prevent maltreatment in institutional care.

BACKGROUND: Many orphans in East Africa are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. We report on the extension of a cluster-randomized controlled trial aiming to replicate and show sustainability of previous found effects and to discover long-term effects of the intervention Interaction Competencies with Children-for Caregivers (ICC-C) 12-months after the intervention's conclusion. METHODS: Conducting a robust 2x3 analysis of variance, we investigated the changes over time in the waitlist orphanages (n = 75, 62.7% female, Mage = 37.63 years, SDage = 11.81), which participated in the intervention after first follow-up and in the initial intervention orphanages (n = 81, 61.7% female, Mage = 38.73 years, SDage = 11.94). RESULTS: The caregivers in the waitlist orphanages reported less reported levels of maltreatment (d = -0.09), fewer positive attitudes towards violent discipline (d = -0.44) and increased childcare knowledge (d = 1.26) three months after intervention, replicating our findings of the initial intervention condition. In addition, these effects were maintained in the intervention orphanages 12 months post intervention. Furthermore, we found long-term improvements in negative caregiver-child relationship (d = -0.83), caregivers' stress level (d = -0.98) and their mental health problems (d = -0.61). CONCLUSIONS: The replication and maintenance of the intervention effects and first hints to additional long-term effects substantiates the effectiveness of ICC-C. As long as alternative care cannot be provided for all children in need, brief caregiver trainings can make an important contribution to enlarge the opportunities for many children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03594617. Registered on 20 July 2018.

Preventing maltreatment in institutional care: A cluster-randomized controlled trial in East Africa.

An increasing number of orphans in low- and middle-income countries are living in institutional care facilities where they experience poor quality of care and ongoing maltreatment. To prevent maltreatment, we tested the effectiveness and feasibility of the intervention Interaction Competencies with Children - for Caregivers (ICC-C). In a two-arm cluster-randomized controlled trial, 203 caregivers (65.5% female, Mage  = 36.63 years, SDage  = 12.26) and 356 children (46.1% female, Mage  = 9.43 years, SDage  = 1.93) from 24 orphanages in Dar es salaam (Tanzania) participated from August to October 2018 (Baseline) and March to April 2019 (Follow-Up). Orphanages were assigned to the intervention or waitlist-group. Caregivers in the intervention group received the ICC-C intervention to prevent maltreatment through focusing on non-violent caregiving strategies. The primary outcome was the change in self-reported maltreatment by caregivers (Conflict Tactics Scale). Trial registration: ClinicalTrials.gov, NCT03594617, 20 July 2018. Participation in the intervention resulted in a significant reduction in reported maltreatment (f2  = 0.153), a decrease of positive attitudes toward violent discipline (f2  = 0.248), and an increased level of childcare knowledge (f2  = 0.220) in the caregiver sample, each indicating a moderate effect. Caregivers' training participation did not predict reduced maltreatment reported by children. Aspects of feasibility, including motivation to participate, acceptability, and integration of the new strategies were evaluated positively. The study promises initial effectiveness and feasibility of efforts to improve the situation of children in institutional care settings in resource-poor countries by offering training to care providers.

Characterizing the prevalence and contributing factors of sexual violence: A representative cross-sectional study among school-going adolescents in two East African countries.

BACKGROUND: Sexual violence against minors is a global phenomenon with wide-ranging negative consequences. Global reports suggest that it is a particularly serious issue in East African countries, although research on prevalence and characteristics of violence in these countries is scarce. OBJECTIVE: The aim of this study was to assess sexual violence and its circumstances among Tanzanian and Ugandan adolescents. PARTICIPANTS AND SETTING: Two representative samples of secondary school students aged 12-17 from Tanzania and Uganda (N = 1402) were included in this study. METHODS: Data assessed using standardized questionnaires were analyzed to determine prevalence, characteristics, and contributing factors of sexual violence among youth. RESULTS: We found high levels of sexual violence (27.2 %) exceeding global average estimates of under 20 %. Significantly more sexual violence experiences were reported by boys (29.9 %) than girls (24.6 %) and by older compared to younger adolescents (30.2 % vs. 19.6 %). Peers were the most frequent perpetrator group, named by 47.6 % of those reporting abuse. Several potential contributing factors for victimization were identified, such as rural living area, external financial support, and being in a romantic relationship. CONCLUSIONS: Sexual violence is a relevant issue among East African adolescents that occurs in a variety of settings but appears to be most prevalent between peers. Comprehensive sexual education approaches may help to improve the protection of adolescents and to enhance autonomous sexual development.

Trajectories of posttraumatic stress symptoms during and after Narrative Exposure Therapy (NET) in refugees.

BACKGROUND: Trauma-focused therapy approaches are recommended as treatment for posttraumatic stress disorder (PTSD). This includes the treatment of trauma-related suffering in refugee populations. However, there is a lack of knowledge about symptom trajectories in refugees living in volatile conditions. This has led to fear of "retraumatisation" and general skepticism in clinicians concerning the use of exposure therapy. METHODS: To test the relevance of this concern, we investigated PTSD symptom trajectories and potentially influencing factors during the course of Narrative Exposure Therapy (NET) in a refugee sample living in Germany. Refugees filled out the PTSD Checklist prior to each treatment session and also during follow-up interviews. Therapists continuously documented positive and negative life events as well as the content of the treatment sessions. Additionally, structured clinical interviews were conducted pre-treatment and at follow-up time points. RESULTS: On average, clients presented with substantial decreases in PTSD symptoms already during and after NET. However, symptom trajectories differed and ranged from fast responders to slow responders to no immediate response during treatment. Importantly, a persistent worsening of symptoms was not observed, also not after exposure to the most distressing events. In contrast, stressful life experiences seemed to aggravate PTSD symptoms. CONCLUSIONS: Consistent with earlier studies, NET leads to clinically and behaviorally relevant reductions in PTSD symptoms both throughout and following treatment in refugees living in volatile conditions. Concerns about imaginal exposure in refugees were not substantiated. While stressful life events contributed to transient symptom increases, they weren't found to prevent the overall effectiveness of NET. TRIAL REGISTRATION: NCT02852616.

Reducing violent discipline by teachers using Interaction Competencies with Children for Teachers (ICC-T): study protocol for a matched cluster randomized controlled trial in Tanzanian public primary schools.

BACKGROUND: Despite the existing national and international plans of action to end violent discipline strategies used by teachers in schools, they still prevail in Tanzanian schools. This underlines the need to implement school-based interventions that aim at reducing violent discipline by teachers. In this study, we will evaluate the feasibility and effectiveness of the preventative intervention Interaction Competencies with Children - for Teachers (ICC-T) in Tanzanian primary schools. Following its success in secondary schools, we hypothesize that the intervention will reduce teachers' positive attitudes towards and their use of violent discipline at school. METHODS/DESIGN: The study will be conducted in six randomly selected regions in Tanzania. We have already randomly selected two schools in each region (12 in total) that fulfill our inclusion criteria. From each region, one school will be randomly assigned to the intervention and the other to the monitoring group (no intervention). Eighty students between the ages of 9 to 12 years (N = 960) and 20 teachers from each school (N = 240) will be included in the trial. We will collect data directly before the intervention (t1) and 6 months after the intervention (t2) both at intervention and monitoring schools. Using guided questionnaire assessments, we will measure violence by teachers using students' reports on their exposure to and teachers' reports on their use of violence using the Conflict Tactics Scale. Furthermore, we will assess teachers' positive attitudes towards violent discipline using a modified version of the Conflict Tactic Scale. The feasibility of the intervention will be evaluated using purpose-built measures assessing the demand, applicability, acceptability, and integration of core elements into daily work in the participating schools. DISCUSSION: The proposed study will allow us to test the feasibility and effectiveness of an intervention aiming to reduce positive attitudes towards and the use of violent discipline by teachers in school settings. With the reduction of violent discipline by teachers, this study contributes to national and international efforts towards ending violence against children as well as the attainment of the United Nations' Sustainable Development Goals that also aim to prevent all types of maltreatment of children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03893851. Registered on 28 March 2019.

Exposure to family and organized violence and associated mental health in north Korean refugee youth compared to south Korean youth.

BACKGROUND: Studies on populations affected by organized violence have shown elevated levels of family violence against children. This form of violence has been found to contribute to children's psychopathology independently of traumatic experiences related to war, persecution or flight. Little is known, so far, about the exposure to family violence and its relation to mental health in North Korean refugee youth affected by political violence. The aim of this study was to examine the amount of organized and family violence and associated psychopathology in a sample of North Korean refugee youth living in South Korea compared to their South Korean peers. METHODS: Sixty-five North Korean refugee youth and 65 South Korean youth were recruited. Trained researchers conducted the survey in group meetings of five to ten participants. Using questionnaires researchers assessed traumatic experiences, family and organized violence, PTSD symptoms, depressive symptoms and other mental health problems. RESULTS: Higher rates of violence and trauma, and higher levels of mental health problems were found in the North Korean sample compared to the South Korean sample. Linear regression analyses including the various types of trauma as potential predictors showed that the severity of PTSD and depressive symptoms in the North Korean sample were associated with the amount of traumatic events and family violence but not with higher levels of organized violence. CONCLUSIONS: The findings suggest that in a context of organized violence, abusive experiences by family members constitute an important problem that is strongly linked to the psychopathology of adolescents. Our data suggest that psychological treatment and prevention approaches for North Korean refugees should be carefully tailored to fit the specific requirements of this population and address the mental health of the individual as well as potential problems at the family level.

Stress and positive attitudes towards violent discipline are associated with school violence by Ugandan teachers.

BACKGROUND: Globally, the use of violent discipline methods by teachers to manage child behavior is still highly prevalent despite enactment of laws that prohibit school violence. In the case of Uganda there is a dearth of accurate prevalence statistics on school violence and factors associated with the use of violence by teachers. OBJECTIVES: Therefore, the current study examined the prevalence of and attitudes towards violence. The study also explored the association between teachers' stress, positive attitudes towards violence and the use of violent discipline management methods. METHODS: A representative sample of 291 teachers and 702 students from 12 public secondary schools in southwestern Uganda responded to anonymous self-administered questionnaires. Data were collected from April to November 2017. RESULTS: Findings indicated that 86.5% of the teachers reported having used violent disciplinary methods on students in the past month while 91.5% of the students reported experiencing violence by teachers. Teachers (88.3%, n = 256) endorsed positive attitudes towards violent discipline. Teachers' stress was related to higher levels of violent discipline (ß = 0.20). This relation was mediated by positive attitudes towards violence (0.06, SE: 0.01, 95%-CI: 0.035-0.092). CONCLUSIONS: Our findings indicate that teacher reported stress was associated with their use of violent behavior and positive attitudes and that positive attitudes reduced the association between teachers' stress and violent behavior. Therefore, interventions aiming to reduce violence by teachers may need to integrate effective stress management skills, in addition to nonviolent discipline strategies, and fostering attitudinal change towards the use of violent methods.

Child neglect and its relation to emotional and behavioral problems: A cross-sectional study of primary school-aged children in Tanzania.

Child maltreatment is known to engender negative emotional and behavioral consequences. Although neglect is the most frequent form of maltreatment, it has thus far only received little attention, especially when looking at low-resource countries. The current study investigated possible associations between neglect and internalizing and externalizing problems. As neglect and abuse often co-occur, the latter was controlled for. In total, 409 Tanzanian primary school students (52% boys, M = 10.5 years, range = 6-15) participated in the cross-sectional study. Structured clinical interviews were conducted assessing maltreatment, internalizing problems, and externalizing problems. Overall, 31% (n = 128) of the children reported at least one type of physical neglect and 31% (n = 127) of emotional neglect. Using structural equation modeling, we found a significant association between neglect and internalizing (ß = 0.59, p < .01) and externalizing problems (ß = 0.35, p < .05). However, these associations could only be detected in younger children (ages 6-9), whereas in older children (ages 10-15), mental health problems were significantly related to violence and abuse. Our findings suggest that the current age may influence the association between maltreatment type and the development of internalizing and/or externalizing problems.

Course of Mental Health in Refugees-A One Year Panel Survey.

Background: Cross-sectional studies indicate that a substantial proportion of refugees have psychiatric disorders. However, longitudinal studies on the course of psychiatric symptoms and on influencing factors are scarce. The current study investigates the development of symptoms in an untreated refugee sample in Germany and seeks to identify potential predictors. Methods: Over the course of 1 year, 57 refugees participated in monthly assisted self-reports on the phone assessing emotional distress. At the same time, semi-annual, semi-structured clinical interviews focusing on posttraumatic stress disorder (PTSD) and depression were conducted. The overall dropout rate for the year was 23% for the assisted self-reports and 33% for the clinical interviews. Results: Symptoms did not systematically change over the course of the year. On the individual level, a reliable change in PTSD symptoms was observed in 13% who showed improvement and 24% who showed worsening symptoms. Figures for depression symptoms were 24 and 16% respectively. A higher number of traumatic experiences was related to a greater intensity of PTSD symptoms. In addition, postmigrational stressors were associated with a worsening of PTSD symptoms over the course of the year. Emotional distress was associated with current negative life events, unemployment, and frequent visits to physicians. Conclusions: There is on average no improvement or worsening of symptoms over the period of 1 year. However, individual courses vary, and thus show the importance of risk factors. Accordingly, the identification of risk factors such as trauma load and postmigrational stressors can be useful to determine the need of further monitoring and to provide appropriate interventions when necessary.

Reducing violence by teachers using the preventative intervention Interaction Competencies with Children for Teachers (ICC-T): A cluster randomized controlled trial at public secondary schools in Tanzania.

The high global prevalence of school violence underlines the need for prevention. However, there are few scientifically evaluated intervention approaches that aim at preventing violence by teachers. We evaluated the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T). In a cluster randomized controlled trial we assessed attitudes towards and use of violence by teachers (self-reported and reported by students) at eight schools in four regions in Tanzania. Two regions were randomly assigned as intervention regions. Data were assessed in the months before and three months after intervention. In total, 158 teachers (58% females; age: 32.08 years, SD = 5.65) and 486 students (54% females; age: 15.61 years, SD = 0.89) participated in this study. The feasibility was very good: Participants' acceptance was high and they reported a good integration of the core elements in their working routine. The significantly stronger decrease in the use of emotional and physical violence reported both by teachers and students as well as the stronger decrease in positive attitudes of teachers towards physical and emotional violence in the intervention schools at follow-up provide initial evidence of the efficacy. However, further evidence for the sustainability of its effect is needed.

Reducing violence against children by implementing the preventative intervention Interaction Competencies with Children for Teachers (ICC-T): study protocol for a cluster randomized controlled trial in Southwestern Uganda.

BACKGROUND: An adolescent's school is often the second most important place for his development and education after the home. However, reports highlight the recurrence of the use of violent discipline in schools. There are few school-based interventions that aim at reducing violence at school that have been implemented and evaluated in sub-Saharan Africa. To reduce violent disciplinary measures used at school, we aim to implement and evaluate the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T). METHODS/DESIGN: The study will be conducted in six randomly selected districts of the Ankole region in southwestern Uganda. We shall randomly select two mixed-day secondary schools from each district that fulfill our inclusion criteria. Schools will be randomly assigned to the intervention condition, where ICC-T will be implemented, and control schools (no intervention). Sixty students between the ages of 12 and 17 years and at least 15 teachers per school will be included in the trial. We aim to collect pre-assessment data directly before the intervention (t1) and 3 months after the intervention (t2) in both intervention and control schools. Using self-administered questionnaires, we will measure students' exposure to violence using the Conflict Tactics Scale (CTS), their psychological well-being using the Strengths and Difficulties Questionnaire (SDQ), and teachers' positive attitudes towards violent disciplining and teachers' use of violent disciplinary methods (CTS). The implementation feasibility of ICC-T in the cultural context of southwestern Uganda will be assessed with purpose-built measures that follow the guidelines for feasibility studies assessing the demand, applicability, acceptability, and integration of core elements in the daily work. DISCUSSION: The proposed study will allow us to test the feasibility and efficacy of a preventative intervention seeking to reduce violent disciplinary measures in school settings using a scientifically rigorous design. The proposed study provides the opportunity to contribute to the attainment of goal number 16.2 of the United Nations' Sustainable Development Agenda 2015-2030, which aspires to end all forms of violence against children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03051854 . Registered on 14 February 2017.

Mental health problems and their association to violence and maltreatment in a nationally representative sample of Tanzanian secondary school students.

PURPOSE: Little is known about the prevalence of mental health problems among adolescents in Sub-Saharan Africa. Research consistently determined violence and maltreatment to be important risk factors. In this study, we examined the prevalence of mental health problems among adolescents in Tanzania, as well as the association with exposure to violence and maltreatment. METHODS: We administered a set of questionnaires (e.g., strength and difficulties questionnaire; conflict tactic scale) to a nationally representative sample of 700 Tanzanian secondary school children (52% girls; age 14.92 years, SD = 1.02) and 333 parents or primary caregivers (53% females; age 43.47 years, SD = 9.02). RESULTS: 41% of the students reported an elevated level of mental health problems (emotional problems 40%, peer problems 63%, conduct problems 45%, hyperactivity 17%) in the past 6 months. Concordantly, 31% of parents reported observing an elevated level of mental health problems in their children (emotional problems 37%, peer problems 54%, conduct problems 35%, hyperactivity 17%). After controlling for other risk factors, we found significant associations between physical violence by parents and adolescent's mental health problems reported by students (ß = 0.15) and their parents (ß = 0.33). CONCLUSIONS: Our findings suggest a high prevalence of mental health problems using screening tools among secondary school students in Tanzania as well as an association between physical violence by parents and adolescents' mental health problems. Our findings emphasize the need to inform the population at large about the potentially adverse consequences associated with violence against children and adolescents.

Violence and maltreatment in Tanzanian families-Findings from a nationally representative sample of secondary school students and their parents.

Though the Sustainable Development Goals of the United Nations aim to end all forms of violence against minors, child maltreatment remains a globally prevalent phenomenon. Despite the fact that parents in numerous countries apply violent discipline methods to control children's behavior, little is known about the prevalence of maltreatment and violent discipline in Sub-Saharan Africa. In this study, we examined the prevalence of maltreatment and violent discipline from both the adolescents' and parents' perspectives. In addition, we explored risk factors that could be associated with violent discipline by parents. We administered questionnaires to a nationally representative sample of 700 Tanzanian secondary school students (52% girls, mean age: 14.92 years, SD = 1.02, range: 12-17) and 333 parents or primary guardians (53% females; mean age: of 43.47 years, SD = 9.02, range: 19-71). More than 90% of all students reported exposure to violent discipline by a parent within the past year. Concurrently, more than 80% of parents acknowledged using violent discipline techniques. Using a path model, we found that violent discipline by parents was associated with parental stress. Other risk factors contributed to a higher stress level but were not directly linked to maltreatment. Our findings indicate high levels of violent discipline in Tanzanian families. There is a pressing need to design and implement interventions that prevent children from experiencing violence at home. Reducing parents' stress levels may be a starting point for intervention. Yet, due to the high levels of violent discipline, societal beliefs also need to be considered.

Teachers' stress intensifies violent disciplining in Tanzanian secondary schools.

Violent forms of discipline in schools continue to be widespread across the globe despite their damaging effects. Since little is known about factors influencing the extent of violence applied by teachers, this study aimed to investigate the influence of teachers' stress, work satisfaction, and personal characteristics on their disciplining style. Using structural equation modeling, associations between violent discipline, burnout symptoms, and job perceptions (pressure and difficulties in class) reported by 222 teachers from 11 secondary schools in Tanzania in 2015 were analyzed. Results indicated a direct association between perceived stress and emotional violent discipline (ß=.18, p<.05) as well as physical violent discipline (ß=.37, p<.001). Perceived stress also mediated the association between job perceptions and both forms of violent disciplining. The model showed good model fit (χ2 [44, n=222]=67.47 (p=.013), CFI=.94, TLI=.91, IFI=.94, RMSEA=.049 [90%-CI=.02-.07, PCLOSE=.50], SRMR=.06). Our findings suggest that teachers' personal perceptions of their work as well as their stress burden play a role in their disciplining styles. Our findings underline the importance of integrating topics, such as stress and coping as well as positive, nonviolent discipline measures into the regular teacher's training and in addition to develop and evaluate school-based preventative interventions for teachers.

Efficient identification of mental health problems in refugees in Germany: the Refugee Health Screener.

Background: A substantial number of refugees present with mental disorders. This appears particularly acute in the currently increasing refugee populations in Europe. Although EU guidelines demand the identification and support of vulnerable individuals such as survivors of trauma, no adequately validated and comprehensive mental health screening instruments for refugees residing in Europe currently exist. Objective: We studied the feasibility, validity, and reliability of the Refugee Health Screener-15 (RHS-15) - a time-efficient and easy-to-implement screening developed by Hollifield et al. (2013) - as a self-rating and interview instrument. Methods: A sample of refugees from different countries (N = 86), representative of those who had arrived around the turn of the year 2015/2016 in Germany, filled in the RHS-15 on their own. A semi-structured clinical interview was later conducted with a random subsample (n = 56). Results: Fifty-two percent of the refugees examined screened positive in the RHS-15, thus indicating current mental health problems. The RHS-15 showed a good feasibility, reliability, and validity in both the self-rating and the interview version. It detected clinically relevant mental health problems when PTSD, depression, anxiety, or somatization problems were present. A shorter 13-item version proved to be equally valid. Conclusions: Together with previous research on the RHS in refugees living in the US, this suggests that the RHS is a time-efficient and accurate instrument that is able to detect common mental health problems in a wide range of refugees. Prospectively, the RHS could be used as an instrument for identifying vulnerable refugees, for example, by integrating it in the initial medical examination in the host community, thereby initiating support.

Planteamiento: Un número considerable de refugiados presenta trastornos mentales. Esto parece ser particularmente grave en poblaciones de refugiados que actualmente están aumentando en Europa. Aunque las directrices de la UE exigen identificar y apoyar a individuos vulnerables, como los sobrevivientes de trauma, actualmente no existen instrumentos de detección de salud mental adecuados e integrales para los refugiados que residen en Europa. Objetivo: Se estudió la viabilidad, la validez y la fiabilidad de la Pruebas de salud para refugiados - 15 (RHS-15, siglas en inglés de Refugee Health Screener) - una evaluación eficiente y fácil de implementar, desarrollada por Hollifield et al. (2013) - como instrumento de autoevaluación y entrevista. Métodos: Una muestra de refugiados de diferentes países (N = 86) ­representativa de aquellos que habían llegado a Alemania a finales de 2015 y principios de 2016­ rellenó el RHS-15 por su cuenta. Posteriormente se realizó una entrevista clínica semiestructurada con una submuestra aleatoria (n = 56). Resultados: El 52% de los refugiados examinados obtuvieron resultados positivos en la RHS-15, lo que indicaba que tenían problemas de salud mental en la actualidad. La RHS-15 mostró una buena viabilidad, fiabilidad y validez tanto en la autoevaluación como en la versión de la entrevista. Detectaba problemas de salud mental clínicamente relevantes cuando había TEPT, depresión, ansiedad o somatización. Una versión más corta de 13 ítems resultó ser igualmente válida. Conclusiones: Junto con investigaciones previas sobre la RHS en refugiados que viven en los Estados Unidos, esto sugiere que la RHS es un instrumento eficiente y preciso, capaz de detectar problemas de salud mental comunes en una amplia gama de refugiados. Posiblemente, la RHS podría ser utilizado como instrumento para identificar a refugiados vulnerables, por ejemplo, integrándolo en el examen médico inicial en la comunidad de acogida, con lo cual ya se comenzaría a apoyarles.

The role of intrinsic and extrinsic rewards in committing violence during combat: A cross-sectional study with former combatants in the DR Congo.

It has been postulated that the violent behavior that characterizes armed conflict is reinforced by the possibility of receiving rewards. The present study examined the potential influence of two types of rewards in an ongoing setting of conflict: extrinsic and intrinsic rewards. Former combatants active in the Democratic Republic of the Congo (N = 198) were interviewed and questioned about the way they were recruited, the offenses they committed during combat, their level of perceived intrinsic rewards (i.e., appetitive perception of violence), and the number of received extrinsic rewards during their time in the armed group (e.g., money, extra food, alcohol, or drugs). A moderated multiple regression analysis showed that the number of received extrinsic rewards and the level of intrinsic rewards were significantly positively related to the number of different types of offenses committed. In contrast to our expectations and previous findings, the recruitment type (forced conscription vs. voluntary enlistment) did not moderate this relation. Our findings suggest that both types of rewards play a role in committing violence during combat. We suggest, therefore, that reintegration programs should not only consider the influence of extrinsic rewards, but also need to address the influence of intrinsic rewards to counter violent behavior among former combatants. Aggr. Behav. 43:241-250, 2017. © 2016 Wiley Periodicals, Inc.