Psychopathology and Quality of Life in Traumatized or Victimized Underage Individuals as Factors for Forensic Multilevel Assessment-A Pilot Investigation.

Background: Psychological sequels to criminal violence can be long lasting and severe. They are in many countries not sufficiently considered in court cases as an important circumstance that could be used to assess the severity of the crime, also guiding redress, compensation, and rehabilitation of the victim, and-in children-child custody considerations. So far, the focus of forensic assessment has often been limited to diagnostic categories, especially "posttraumatic stress disorder" (PTSD), a diagnosis that presently is subjected to rapidly changing definitions both in and between diagnostic systems. Other indicators such as quality of life (QoL) might be of equal importance as compared to clinical or research diagnostic categories to understand and evaluate the impact of a crime and the amount of help needed and, in the legal context, redress to be asked. Symptoms might differ depending on the crime encountered. Objective and Methods: QoL and general symptom patterns including a PTSD diagnosis were assessed in a group of 10- to 17-year-old minors with (n = 33) and without (n = 49) PTSD diagnosis who all had experienced sexual abuse, physical abuse, death of a parent, or their parents' divorce, using standardized diagnostic instruments. Results: PTSD patients reported a significantly lower QoL than non-PTSD controls. Reported symptom patterns with potential impact on life, such as intrusive thoughts, differed between the victims of different crime types, with the highest rates of both intrusive symptoms and combined symptom profile in victims of sexual abuse. Data indicate that the changes between older and present criteria and between DSM and recently published ICD 11 might help identify different groups and symptom profiles. Conclusion: Specific trauma-related symptom profiles integrating the type of crime encountered and its individual impact on QoL may help improve future forensic assessment and guide compensation and rehabilitation plans. Carefully designed studies are now needed to further explore the use and forensic usability of complex indicators and the impact of violence in different forensic settings.

Psychopathology in African unaccompanied refugee minors in Austria.

We assessed the prevalence of a range of psychopathology among African unaccompanied refugee minors (URMs) in Austria. Additionally, the predictive value of war exposure on PTSD symptoms was examined. Forty-one URMs were assessed with the Mini-International Neuropsychiatric Interview for children and adolescents, the Youth Self-Report, the UCLA PTSD Reaction Index and Facts About You. As expected, 56% of youth had at least one diagnosis by structured clinical interview. The most common diagnoses were adjustment disorder, PTSD and dysthymia. War affliction marginally predicted (p = 0.065) PTSD controlling for age and gender. URMs had high levels of psychopathology compared to norms. Their PTSD rates were somewhat lower than found in previous studies. We discuss methodological and substantive reasons for this finding. Future studies need to examine URMs across the entire diagnostic spectrum and employ multi-method designs to yield valid results. The psychopathology in URMs has clinical and forensic implications.

Mental health issues in unaccompanied refugee minors.

Previous studies about unaccompanied refugee minors (URMs) showed that they are a highly vulnerable group who have greater psychiatric morbidity than the general population. This review focuses on mental health issues among URMs. Articles in databases PsycINFO, Medline and PubMed from 1998 to 2008 addressing this topic were reviewed. The literature had a considerable emphasis on the assessment of PTSD symptoms. Results revealed higher levels of PTSD symptoms in comparison to the norm populations and accompanied refugee minors. In several studies, age and female gender predicted or influenced PTSD symptoms. The existing literature only permits limited conclusions on this very hard to reach population. Future research should include the analysis of long-term outcomes, stress management and a more thorough analysis of the whole range of psychopathology. Additionally, the development of culturally sensitive norms and standardized measures for diverse ethnic groups is of great importance.

[On the work of Austrian authorised experts on procedures in custodial and visiting rights--a survey of current practice from the parents and children view]. / Die Arbeit österreichischer Sachverständiger in Obsorge- und Besuchsrechtsverfahren aus der Perspektive betroffener Eltern und Kinder.

OBJECTIVE: Children who are involved in their parents' contentious separations, and about whom custody or visiting rights have become a matter of legal dispute, often demonstrate changes in behaviour, sometimes to the extent that these changes develop into noticeable psychological problems. Where custody and visiting rights are in dispute the expert child psychological/psychiatric evaluator appraises the family and recognises the suffering of the children involved, but is unable to intervene to treat the child for they have only been authorised to provide an appraisal. The goal of this study is to determine the extent to which an expert's evaluation provides the opportunity to intervene with the child's parents, and to what extent it offers a greater insight and understanding of the child's behaviour. The study also aims to record the children's own attitude to the expert evaluation. METHODS: With the support of each Austrian district court, 1200 parents involved in custodial proceedings were contacted by post. Likewise, 27 children aged between 6 and 14 years old who were referred to a forensic psychology outpatient's clinic as a result of their parent's highly contentious separations, were recruited as test persons. Parents as well as children were asked to complete an especially designed questionnaire in order to assess the work of the expert evaluator; this took place before the study began and was conducted by an expert who didn;t work at the forensic outpatient clinic of the department of child and adolescent psychiatry. RESULTS: Overall, the parents displayed a high level of dissatisfaction with the expert evaluation procedure. More than a third of those questioned highlighted the lack of information about the psychological and educational contents of the appraisal, and about the way the child is treated in terms of the provisions for custody and visiting rights. A key point of criticism turned out to be the brevity of the discussion with the expert evaluator, whilst the opportunity to hold a sympathetic and understanding discussion with the expert evaluator was commonly regarded as desirable. The children evaluate the appraisal experience and the evaluator more positively, but they believe themselves to be responsible for the outcome of the court decision and feel insecure about the statements they make regarding their father and mother. CONCLUSIONS: In order to provide greater relief for the affected children, and because of the demonstrable and overwhelming parental dissatisfaction with the evaluation process, a modification of the current form of evaluation to create a solution-oriented process approach should be considered in Austria. The feasibility of this proposal, and its adherence to methodological-theoretical and normative framework conditions, should be discussed amongst expert evaluators. This requires relevant legal input to ensure that a modified form of the expert evaluator's work is implemented in a manner which is legally compliant.