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BACKGROUND: Evidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by 'coping motives': maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts. OBJECTIVE: The present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents. PARTICIPANTS AND SETTING: A sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey. METHODS: Participants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems. RESULTS: CM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives. CONCLUSIONS: The findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.
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Adaptación Psicológica , Maltrato a los Niños , Motivación , Trastornos Relacionados con Sustancias , Humanos , Adolescente , Femenino , Masculino , Sudáfrica , Maltrato a los Niños/psicología , Estudios Transversales , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , NiñoRESUMEN
In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.
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Países en Desarrollo , Accesibilidad a los Servicios de Salud , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/terapia , Servicios de Salud Mental/organización & administración , Adulto , Práctica Clínica Basada en la Evidencia , Sobrevivientes/psicologíaRESUMEN
Existing research suggests a robust association between childhood bullying victimization and depressive symptoms in adulthood, but less is known about potential mediators of this link. Furthermore, there is limited cross-national research evaluating similarities and differences in bullying victimization and its associations with mental health. The current study addressed gaps in the literature by evaluating cognitive and affective responses to stress (i.e., emotion regulation, rumination, and distress tolerance) as potential mediators of the link between recalled bullying victimization and current depressive symptoms among 5909 (70.6% female) college students from seven countries. Results revealed specific indirect associations of bullying victimization through distress tolerance and three out of four facets of rumination, as well as a persistent direct association of childhood bullying on adulthood depression. Emotion regulation strategies were not significantly associated with bullying victimization and did not mediate its association with depressive symptoms. Constrained multigroup models indicated that results were invariant across country and gender. Findings provide evidence of statistical mediation in a cross-sectional sample and await replication in prospective studies. Rumination and distress tolerance may be promising targets for resilience-promoting interventions among children experiencing peer victimization. Ongoing research is needed to clarify cross-national patterns in childhood bullying, identify additional mediators accounting for the remaining direct association, and evaluate emotion regulation as a potential moderator of associations between bullying victimization and adult mental health.
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Acoso Escolar , Víctimas de Crimen , Regulación Emocional , Niño , Humanos , Femenino , Adulto Joven , Masculino , Depresión/epidemiología , Depresión/psicología , Estudios Prospectivos , Estudios Transversales , Acoso Escolar/psicología , Víctimas de Crimen/psicologíaRESUMEN
Background: It is important to identify students who would benefit from early interventions to reduce harmful drinking patterns and associated consequences. the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) could be particularly useful as a screening tool in university settings. Objectives. The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Objectives: The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Methods: A sample of 6382 students (mean age=20.28, SD=3.75, 72.2% females) from seven countries (i.e., U.S., Canada, South-Africa, Spain, Argentina, Uruguay, England) completed the B-YAACQ, the AUDIT and different measures of alcohol use. Results: ROC analyses suggested that a cutoff score of 5 maximized the YAACQ's discrimination utility to differentiate between students at low versus moderate/high risk in the total sample and across countries (except in Canada, where the cutoff was 4). In addition, a cutoff of 7 differentiated between students at low/moderate versus high risk in the total sample, while cutoffs of 10, 9, 8 and 7 differentiate between students at low/moderate versus high risk in Uruguay, U.S and Spain (10), Argentina (9), England (8), and Canada and South-Africa (7), respectively. Students classified at the three risk levels (i.e., low, moderate and high) differed in age (i.e., a younger age was associated with higher risk) and drinking patters (i.e., higher drinking frequency, quantity, binge drinking and AUDIT and B-YAACQ scores in the higher risk groups). Conclusions: This study suggest that the B-YAACQ is a useful tool to identify college students at-risk for experiencing problematic patterns of alcohol use.
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Consumo de Alcohol en la Universidad , Alcoholismo , Femenino , Humanos , Adulto Joven , Adulto , Masculino , Psicometría , Alcoholismo/diagnóstico , Etanol , Consumo de Bebidas Alcohólicas , Encuestas y Cuestionarios , Estudiantes , UniversidadesRESUMEN
Background: In low- and middle- income countries (LMICs) trauma exposure among youth is high, but mental health services are critically under-resourced. In such contexts, abbreviated trauma treatments are needed.Objective: To evaluate the efficacy of an abbreviated eight-session version of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for improving posttraumatic stress disorder (PTSD) and depression symptoms in a sample of South African adolescents.Method: 75 trauma-exposed adolescents (21 males, 54 females; mean age = 14.92, range = 11-19) with posttraumatic stress disorder (PTSD) symptoms were randomly assigned to eight sessions of TF-CBT or to usual services. At baseline, post-treatment and three-month follow-up, participants completed the Child PTSD Symptom Scale for DSM 5 (CPSS-5) and the Beck Depression Inventory II (BDI-II). The trial is registered on the Pan African Trial Registry (PACTR202011506380839).6.Results: 95% of TF-CBT participants completed treatment while only 47% of TAU participants accessed treatment. Intention-to-treat analyses found that the TF-CBT group had a significantly greater reduction in CPSS-5 PTSD symptom severity at post-treatment (Cohen's d = 0. 60, p < .01) and three-month follow-up (Cohen's d = 0.62, p < . 01), and a greater reduction in the proportion of participants meeting the CPSS-5 clinical cut-off for PTSD at both time points (p = .02 and p = .03, respectively). There was also a significantly greater reduction in depression symptom severity in the TF-CBT group at post-treatment (Cohen's d = 0.51, p = .03) and three-month follow-up (Cohen's d = 0.41, p = .05), and a greater reduction in the proportion of TF-CBT participants meeting the BDI clinical cut-off for depression at both time points (p = .02 and p = .03, respectively).Conclusion: The findings provide preliminary evidence of the efficacy of an abbreviated eight-session version of TF-CBT for reducing PTSD and depression symptoms in a LMIC sample of adolescents with multiple trauma exposure.
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is one of the leading evidence-based treatments for child and adolescent posttraumatic stress, but an abbreviated version has not been evaluated in low- and middle-income countries (LMICs).At post-treatment and three-month follow-up, eight sessions of TF-CBT were more effective than treatment-as-usual in reducing posttraumatic stress and depression symptoms in an LMIC sample of South African adolescents exposed to multiple traumas.Effect sizes were similar to those reported for standard length TF-CBT, indicating that abbreviated TF-CBT may be a suitable option for resource-constrained child and adolescent mental health services in LMICs.
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Terapia Cognitivo-Conductual , Servicios de Salud Mental , Trastornos por Estrés Postraumático , Niño , Masculino , Femenino , Humanos , Adolescente , Sudáfrica , Resultado del Tratamiento , Trastornos por Estrés Postraumático/psicologíaRESUMEN
BACKGROUND: Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study. METHODS: We conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on delivery format and common counselling components used across task-sharing interventions. Semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention design and appropriate service provider. A four-day pilot training with community-based health workers refined the counselling content and training material. RESULTS: The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions using a variety of delivery formats. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three-session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method. CONCLUSION: Input from health workers and pregnant women is a critical component of adapting existing maternal mental health protocols to the context of routine care in South Africa, providing valuable data to align therapeutic content with contextual needs. Multisector stakeholder engagements is vital to align the intervention design to health system requirements and guidelines.
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Both specific forms of violence and polyvictimization have been associated with an increased risk for negative mental health outcomes in youth. Despite evidence of gender differences in trauma experience and impact, gender patterns in the comparative contribution of specific violence exposures versus polyvictimization to mental health outcomes have seldom been explored. The few existing studies have all been conducted in high-income countries, while there is a dearth of research from lower and middle-income countries. This study examined the contribution of witnessed and direct community violence, domestic violence, sexual abuse, and different levels of polyvictimization to the severity of posttraumatic stress disorder (PTSD) and depression in a clinic sample of children and adolescents (n = 310) in South Africa. Although polyvictimization rates were high across both genders, polyvictimization posed differential risks for boys and girls. For girls, higher levels of polyvictimization, but not individual violence types, predicted both PTSD and depression severity. For boys, polyvictimization did not predict PTSD or depression severity. Higher levels of victimization in the community predicted PTSD severity among boys, while no forms of violence predicted depression. The findings confirm the value of examining gender patterns in the risk for posttraumatic sequelae posed by exposure to specific and cumulative forms of violence. Implications for interventions with youth in high-violence contexts such as South Africa are considered.
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Violencia Doméstica , Exposición a la Violencia , Trastornos por Estrés Postraumático , Adolescente , Niño , Depresión/epidemiología , Femenino , Humanos , Masculino , Factores Sexuales , Trastornos por Estrés Postraumático/epidemiologíaRESUMEN
BACKGROUND: Post-traumatic stress but also aggressive attitudes and behaviour can be found in adolescents living in a context of ongoing community and gang violence in the low-income urban areas of Cape Town, South Africa. AIMS: We investigated the long-term effects (15-20 months after therapy) of (a) Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) and (b) the cognitive behavioural intervention 'Thinking for a Change' (CBT) on post-traumatic stress disorder (PTSD) and aggression compared with a waiting list. METHOD: Fifty-four young males participated in the treatment trial, of which 17 completed the FORNET intervention, 11 the CBT intervention, and 26 were on a waiting list. The primary outcome was the change score for the Appetitive Aggression Scale; secondary outcomes were the PTSD Symptom Scale-Interview change scores, and the number of perpetrated violent event types. RESULTS: The reduction in scores for PTSD that had been observed in FORNET completers at the first follow-up were still significant at the second long-term follow-up (Cohen's d = 0.86). In this treatment arm (FORNET), the scores for appetitive aggression were also significantly reduced (Cohen's d = 1.00). There were no significant changes observed for CBT or for the waiting list. CONCLUSIONS: The study indicates that FORNET can successfully reduce post-traumatic stress as well as the attraction to violence even for individuals living under conditions of continuous traumatic stress.
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Agresión/psicología , Grupo Paritario , Psicoterapia , Medio Social , Trastornos por Estrés Postraumático/terapia , Violencia/psicología , Adolescente , Terapia Cognitivo-Conductual , Estudios de Seguimiento , Humanos , Terapia Implosiva , Masculino , Terapia Narrativa , Prisioneros/psicología , Factores de Riesgo , Ajuste Social , Sudáfrica , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Adulto JovenRESUMEN
OBJECTIVE: Cumulative violence exposure has been associated with both internalising and externalising difficulties in youth. Therefore, it is important to identify protective factors that may ameliorate both exposure to and the impact of cumulative violence. This study aimed to identify sources of perceived social support amongst early adolescents in a low-income, high-violence community in South Africa, and to examine the association of perceived support with exposure to violence and with the severity of depression, aggression and conduct disorder symptoms. METHOD: A sample of 615 Grade 7 learners completed measures of perceived social support, different types of violence exposure and symptoms of depression, aggression and conduct disorder. RESULTS: Maternal, paternal and overall family support were weakly associated with a reduced risk of domestic violence, but not with other forms of violence exposure, and were also weakly associated with a reduced risk of mental health difficulties. Peer support was associated with higher symptomatology across all mental health outcomes while teacher support was associated with greater severity of depression. CONCLUSIONS: The stress-buffering effects of social support may not be maintained in contexts of high exposure to violence. Implications for interventions to enhance youth safety and resilience in high-violence contexts are considered.
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Conducta del Adolescente/psicología , Exposición a la Violencia/psicología , Salud Mental , Apoyo Social , Adolescente , Agresión/psicología , Trastorno de la Conducta/psicología , Estudios Transversales , Depresión/psicología , Violencia Doméstica/psicología , Relaciones Familiares , Femenino , Humanos , Masculino , Pobreza , Características de la Residencia , Factores Sexuales , Sudáfrica , Encuestas y Cuestionarios , Adulto JovenRESUMEN
This article discusses the condition of continuous traumatic stress as common on the African continent and in other international settings characterised by very high levels of ongoing violence and threat of community, political or war-related origin. Through consideration of three case studies from South Africa, contexts of continuous traumatic stress are described, and the mental health and physical health effects of living in such contexts are elaborated. Cautions are raised about attempting to transpose existing posttraumatic stress models onto individuals exposed to situations of continuous traumatic stress, and guidelines for optimal interventions with such cases are proposed.
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Estado de Salud , Trastornos Mentales/psicología , Trastornos de Estrés Traumático/psicología , Violencia/psicología , Adulto , Femenino , Humanos , Persona de Mediana Edad , SudáfricaRESUMEN
Background: In violent communities, social rejection as a person with victim-offender attributes is associated with more intense symptoms of posttraumatic stress disorder (PTSD) and a higher propensity towards violence, i.e. appetitive aggression. Successful community reintegration encompassing adequate social acknowledgment of individuals with both a history of violence exposure and perpetration may be necessary to enhance the treatment effects of interventions addressing PTSD and aggression. Objective: In this study, the effects of treatment and post-treatment traumatic events, violent offenses, and social acknowledgment (with sub-dimensions of general disapproval, family disapproval, and recognition as a person with both a history of violence exposure and commission) on changes in PTSD symptom severity and appetitive aggression from baseline to 8-month follow-up were investigated. Method: Data were collected from 54 males recruited through a Cape Town offender reintegration programme for an intervention study targeting trauma and aggression (n = 28 treatment; n = 26 wait-list). Changes in PTSD symptom severity after treatment were assessed with the PTSD Symptom Scale-Interview, changes in appetitive aggression with the Appetitive Aggression Scale (AAS), post-treatment traumatic events with an adapted version of the Child's Exposure to Violence Checklist, offenses with an adapted checklist from the AAS, and social acknowledgment with an adapted form of the Social Acknowledgment Questionnaire. Results: Path analyses revealed negative relationships between ongoing societal disapproval and changes in PTSD symptom severity and appetitive aggression at 8-months, controlling for age. All other variables were non-significant, except for treatment, which was associated with PTSD symptom reduction. Conclusions: As a complementary strategy to effective psychotherapeutic treatment, increased social acknowledgment may contribute significantly to the alleviation of PTSD symptoms and appetitive aggression. Psychological interventions should, therefore, not neglect the impact of societal factors on treatment effects.
Planteamiento: En comunidades violentas, el rechazo social como persona con atributos de víctima-agresor se asocia con síntomas más intensos del trastorno por estrés postraumático (TEPT) y una mayor propensión a la violencia, es decir, a la apetencia por la agresión. Puede que sea necesaria una reintegración con éxito en la comunidad que incluya un adecuado reconocimiento social de aquellos individuos con una historia tanto de exposición a la violencia como de agresión para mejorar los efectos del tratamiento de las intervenciones que abordan el TEPT y la agresión.Objetivo: En este estudio, se investigaron los efectos del tratamiento y los eventos traumáticos post-tratamiento, los delitos violentos y el reconocimiento social (con subdimensiones de desaprobación general, desaprobación familiar y reconocimiento como persona con antecedentes tanto de exposición a la violencia como de perpetración) sobre los cambios en la gravedad de los síntomas del TEPT y la apetencia por la agresión desde el inicio hasta el seguimiento a los 8 meses.Método: Se recogieron datos de 54 varones reclutados a través de un programa de reintegración de delincuentes de Ciudad del Cabo para un estudio de intervención dirigido a trauma y agresión (n = 28 tratamiento, n = 26 lista de espera). Se evaluaron los cambios en la gravedad de los síntomas del TEPT después del tratamiento con la Escala-Entrevista de Síntomas de TEPT (PTSD Symptom Scale-Interview), los cambios en la apetencia por la agresión con la Escala de Apetencia por la Agresión (AAS, siglas en ingles de Appetitive Aggression Scale), los eventos traumáticos posteriores al tratamiento con una versión adaptada de la Lista de verificación de exposición a la violencia para niños (Child's Exposure to Violence Checklist), las agresiones con una lista de verificación adaptada del AAS, y el reconocimiento social con una forma adaptada del Cuestionario de Reconocimiento Social (Social Acknowledgment Questionnaire).Resultados: Los análisis de ruta revelaron relaciones negativas entre la desaprobación social continuada y los cambios en la gravedad de los síntomas del TEPT y la apetencia por la agresión a los 8 meses, controlando la edad. Todas las demás variables no fueron significativas, excepto por el tratamiento, que se asoció con la reducción de los síntomas de TEPT.Conclusiones: Como estrategia complementaria a un tratamiento psicoterapéutico efectivo, el aumento del reconocimiento social puede contribuir significativamente al alivio de los síntomas del TEPT y la apetencia por la agresión. Por lo tanto, las intervenciones psicológicas no deben descuidar el impacto de los factores sociales sobre los efectos del tratamiento.
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OBJECTIVE: In an observer-blinded intervention trial, we tested the reduction of posttraumatic stress symptoms, aggressive attitude, and behavior in young males living in a context of ongoing community and gang violence by means of (a) forensic offender rehabilitation narrative exposure therapy (FORNET), and (b) the cognitive-behavioral intervention "Thinking for a Change" (TFAC). A waiting list served as the control condition. METHOD: A total of 39 young men were included in the data analysis: 15 completed FORNET, 11 underwent cognitive-behavioral therapy (CBT), and 13 were on a waiting list for later treatment. The primary efficacy endpoints were the PTSD Symptom Scale-Interview (PSS-I) severity score, the Appetitive Aggression Scale (AAS) score, and the number of perpetrated violent event types 8 months (on average) after treatment. RESULTS: Only in the sample receiving FORNET were posttraumatic stress disorder (PTSD) scores significantly reduced at the first follow-up (Cohen's d = -0.97) and significantly different from those of the control group (Cohen's d = -1.03). The changes in scores for appetitive aggression and perpetrated events were not significant for any of the treatment conditions. CONCLUSIONS: The study shows that trauma-focused treatment can reduce the psychological symptoms of posttraumatic stress even for individuals living under unsafe conditions in low-income urban communities. However, achieving changes in violent behavior within a context of ongoing violence may require more than the treatment of trauma-related suffering, confrontation with one's offenses, or cognitive-behavioral interventions. (PsycINFO Database Record
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Terapia Cognitivo-Conductual/métodos , Terapia Implosiva/métodos , Terapia Narrativa/métodos , Trastornos por Estrés Postraumático/terapia , Adolescente , Adulto , Agresión/psicología , Estudios de Factibilidad , Humanos , Masculino , Sudáfrica , Trastornos por Estrés Postraumático/psicología , Resultado del Tratamiento , Violencia/psicología , Adulto JovenRESUMEN
BACKGROUND: In persistently unsafe environments, the cumulative exposure to violence predicts not only the development of posttraumatic stress disorder (PTSD), but also of increased aggression and violent outbursts. Substance use disorders interact with these developments, as drug consumption may blunt symptoms and also reduce the threshold for violent acts. Investigating the interplay between these variables and the possible cumulative effect of drug abuse on the attraction to cruelty is a crucial step in understanding the cycle of violence and developing intervention programs that address this cycle in violence-troubled communities such as low-income urban areas in South Africa. METHODS: Young males at risk (N=290) were recruited through a reintegration center for offenders in Cape Town. We assessed types of traumatic events experienced, PTSD symptom severity, appetitive aggression, committed offenses and patterns of drug abuse prior to the perpetration of violence. RESULTS: Path-analyses confirmed a positive relationship between exposure to traumatic events and PTSD symptom severity, appetitive aggression, the number of committed offenses and drug abuse prior to violence. PTSD symptoms were positively associated with the propensity toward aggression. Furthermore, more severe drug abuse was related to higher attraction to violence and more committed offenses. CONCLUSIONS: We conclude that like exposure to violence, drug abuse may play a key role in the attraction to aggression and criminal acts. Measures of violence prevention and psychotherapeutic interventions for trauma-related suffering may not be effective without enduring drug abuse rehabilitation.
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Agresión/psicología , Crimen/psicología , Criminales/estadística & datos numéricos , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/psicología , Violencia/psicología , Adolescente , Adulto , Crimen/estadística & datos numéricos , Criminales/psicología , Humanos , Masculino , Pobreza/psicología , Pobreza/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Sudáfrica/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Población Urbana/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Life in the low-income urban communities of South Africa is imprinted by a cycle of violence in which young males predominantly are in the roles of both victim and perpetrator. There is some evidence that adolescents who show an attraction to cruelty can display high levels of psychosocial functioning despite the presence of posttraumatic stress symptoms. However, the role of appetitive aggression in the context of ongoing threats and daily hassles is not yet fully understood. OBJECTIVE: In this study, we examine the role of attraction to violence in areas of continuous traumatic stress exposure and its effect on posttraumatic stress disorder (PTSD) severity and violence perpetration. METHOD: A sample of 290 young males from two low-income Cape Town communities was surveyed. We assessed appetitive aggression with the Appetitive Aggression Scale (AAS), PTSD symptoms with the PTSD Symptom Scale-Interview, the number of witnessed and self-experienced traumatic event types with an adaptation of the Child Exposure to Community Violence questionnaire, and the number of perpetrated violence event types with an adapted offence checklist from the AAS. RESULTS: Appetitive aggression scores were predicted by witnessed as well as self-experienced traumatic events. Higher appetitive aggression scores resulted in higher levels of PTSD severity and perpetrated violence. CONCLUSIONS: Young males living in the low-income areas of South Africa may develop an attraction to cruelty in response to exposure to violence. Their willingness to fight in turn can increase the likelihood of continued violent behaviour. In contrast to previous research from postconflict areas, appetitive aggression and engagement in violence do not prevent the development of PTSD, but are instead associated with higher levels of posttraumatic stress. PTSD symptoms such as avoidance and hyperarousal, as well as an attraction to cruelty and thus the willingness to fight, might support survival in areas of ongoing conflict, but at the same time they could fuel the cycle of violence.
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While many youth are exposed to multiple forms of co-occurring violence, the comparative impact of different forms of violence on the mental health of children and adolescents has not been clearly established. Studies from low and middle income countries in particular are lacking. The present study examined the contribution of different forms of violence to internalizing and externalizing symptoms among young adolescents in South Africa. A community-based sample of 616 high school learners completed self-report scales assessing exposure to six different forms of violence and the severity of depression, aggression and conduct disorder symptoms. In bivariate analyses, all six forms of violence were significantly associated with internalizing and externalizing difficulties. When the contribution of all forms of violence to mental health outcomes was examined simultaneously, domestic victimization emerged as the strongest predictor of both internalizing and externalizing difficulties. Cumulative exposure to other forms of violence contributed further to the prediction of aggression and conduct disorder, but not depression. Recommendations for future research, and the implications of the findings for prioritizing the development of violence prevention and intervention initiatives in the South African context, are considered.
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Conducta del Adolescente/psicología , Agresión/psicología , Trastorno de la Conducta/epidemiología , Trastorno de la Conducta/psicología , Control Interno-Externo , Violencia/psicología , Adolescente , Niño , Depresión/psicología , Femenino , Humanos , Masculino , Análisis de Regresión , Instituciones Académicas , Autoinforme , Distribución por Sexo , Delitos Sexuales/estadística & datos numéricos , Sudáfrica/epidemiología , EstudiantesRESUMEN
Successful memory consolidation during sleep depends on healthy slow-wave and rapid eye movement sleep, and on successful transition across sleep stages. In post-traumatic stress disorder, sleep is disrupted and memory is impaired, but relations between these two variables in the psychiatric condition remain unexplored. We examined whether disrupted sleep, and consequent disrupted memory consolidation, is a mechanism underlying declarative memory deficits in post-traumatic stress disorder. We recruited three matched groups of participants: post-traumatic stress disorder (n = 16); trauma-exposed non-post-traumatic stress disorder (n = 15); and healthy control (n = 14). They completed memory tasks before and after 8 h of sleep. We measured sleep variables using sleep-adapted electroencephalography. Post-traumatic stress disorder-diagnosed participants experienced significantly less sleep efficiency and rapid eye movement sleep percentage, and experienced more awakenings and wake percentage in the second half of the night than did participants in the other two groups. After sleep, post-traumatic stress disorder-diagnosed participants retained significantly less information on a declarative memory task than controls. Rapid eye movement percentage, wake percentage and sleep efficiency correlated with retention of information over the night. Furthermore, lower rapid eye movement percentage predicted poorer retention in post-traumatic stress disorder-diagnosed individuals. Our results suggest that declarative memory consolidation is disrupted during sleep in post-traumatic stress disorder. These data are consistent with theories suggesting that sleep benefits memory consolidation via predictable neurobiological mechanisms, and that rapid eye movement disruption is more than a symptom of post-traumatic stress disorder.
Asunto(s)
Trastornos de la Memoria/fisiopatología , Memoria/fisiología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Sueño REM/fisiología , Trastornos por Estrés Postraumático/fisiopatología , Adulto , Estudios de Casos y Controles , Electroencefalografía , Femenino , Voluntarios Sanos , Humanos , Trastornos de la Memoria/psicología , Polisomnografía , Violación/psicología , Retención en Psicología/fisiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos por Estrés Postraumático/psicología , Estrés Psicológico/fisiopatología , Estrés Psicológico/psicologíaRESUMEN
OBJECTIVE: Identifying the comparative contributions of different forms of violence exposure to trauma sequelae can help to prioritize interventions for polyvictimized youth living in contexts of limited mental health resources. This study aimed to establish gender patterns in the independent and comparative contributions of five types of violence exposure to the severity of posttraumatic stress symptoms among Xhosa-speaking South African adolescents. METHOD: Xhosa-speaking adolescents (n=230) attending a high school in a low-income urban community in South Africa completed measures of violence exposure and posttraumatic stress symptoms. RESULTS: While witnessing of community violence was by far the most common form of violence exposure, for the sample as a whole only sexual victimization and being a direct victim of community violence, together with gender, contributed independently to the severity of posttraumatic stress symptoms. When the contribution of different forms of violence was examined separately for each gender, only increased exposure to community and sexual victimization were associated with symptom severity among girls, while increased exposure to direct victimization in both the community and domestic settings were associated with greater symptom severity in boys. CONCLUSIONS: The findings provide some preliminary motivation for focusing trauma intervention initiatives in this community on girls who have experienced sexual abuse compounded by victimization in the community, and boys who have been direct victims of either domestic or community violence. Further research is required to establish whether the risk factors for posttraumatic stress symptoms identified among adolescents in this study are consistent across different communities in South Africa, as well as across other resource-constrained contexts.
Asunto(s)
Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Violencia/psicología , Adolescente , Abuso Sexual Infantil/psicología , Víctimas de Crimen/psicología , Femenino , Humanos , Masculino , Pobreza , Factores Sexuales , Sudáfrica , Encuestas y Cuestionarios , Población Urbana , Adulto JovenRESUMEN
OBJECTIVE: Premature termination of treatment amongst children and families attending mental health services is a significant problem for both outcomes research and clinical practice in South Africa and elsewhere. This study investigated factors that are associated with premature termination of treatment at a public service child and family clinic in Cape Town. METHOD: A retrospective archival analysis of clinic files from 2002-2009 was conducted. Administrative, child and family factors, and type of treatment were explored as risk factors for premature termination. RESULTS: A single-parent household and the presence of a child or oppositional defiant disorder were risk factors for premature termination of treatment, while the presence of a maternal psychiatric diagnosis was associated with a lower likelihood of terminating treatment prematurely. Conducting a scholastic assessment with the child was associated with a lower risk of premature termination, while there was a trend towards a higher risk of premature termination when individual child therapy was the recommended treatment. CONCLUSIONS: This study offers recommendations for how these findings could assist South African clinicians to enhance client retention in child and family mental health services, and suggestions for future research.
RESUMEN
BACKGROUND: Controversy exists about the utility of DSM-IV posttraumatic stress disorder (PTSD) criterion A2 (A2): that exposure to a potentially traumatic experience (PTE; PTSD criterion A1) is accompanied by intense fear, helplessness, or horror. METHODS: Lifetime DSM-IV PTSD was assessed with the Composite International Diagnostic Interview in community surveys of 52,826 respondents across 21 countries in the World Mental Health Surveys. RESULTS: Of 28,490 representative PTEs reported by respondents, 37.6% met criterion A2, a proportion higher than the proportions meeting other criteria (B-F; 5.4%-9.6%). Conditional prevalence of meeting all other criteria for a diagnosis of PTSD given a PTE was significantly higher in the presence (9.7%) than absence (.1%) of A2. However, as only 1.4% of respondents who met all other criteria failed A2, the estimated prevalence of PTSD increased only slightly (from 3.64% to 3.69%) when A2 was not required for diagnosis. Posttraumatic stress disorder with or without criterion A2 did not differ in persistence or predicted consequences (subsequent suicidal ideation or secondary disorders) depending on presence-absence of A2. Furthermore, as A2 was by far the most commonly reported symptom of PTSD, initial assessment of A2 would be much less efficient than screening other criteria in quickly ruling out a large proportion of noncases. CONCLUSIONS: Removal of A2 from the DSM-IV criterion set would reduce the complexity of diagnosing PTSD, while not substantially increasing the number of people who qualify for diagnosis. Criterion A2 should consequently be reconceptualized as a risk factor for PTSD rather than as a diagnostic requirement.