Explaining the accumulation of victimization in vulnerable children: Interpersonal violence among children traumatized by war and disaster in a children's home in Sri Lanka.

Research in postconflict settings indicated that children's exposure to war and natural disaster is a significant predictor of experiencing violence within their families. However, it is unclear if this effect is driven by characteristics of traumatized children or their parents. To disentangle these different factors we conducted a survey in a children's home in Sri Lanka. A total of 146 institutionalized children (aged 8 to 17) were interviewed using standardized questionnaires administered by local senior counselors in order to assess children's exposure to mass trauma, family violence, and violence in the institution as well as their mental health. Linear regression analyses revealed that, controlling for potential confounds, previous exposure to civil war was a significant predictor of violence by guardians in the children's home. In addition, previous exposure to family violence was a significant predictor of violence by peers in the institutions. A mediation analysis showed that children's internalizing and externalizing behavior problems partly mediated the relationship between violence prior to the admission to the children's home and violence in the children's home. The findings of our study provide evidence for the assumption that the transmission of mass trauma into interpersonal violence can occur independently from parents through children's psychopathology.

Sex differences in PTSD risk: evidence from post-conflict populations challenges the general assumption of increased vulnerability in females.

Background: Next to the dose-dependent effect of trauma load, female sex represents a well-established risk factor for PTSD. Exposure to particularly toxic traumatic event types, different coping styles, and biological risk factors are frequently listed as potential causes for the increased PTSD vulnerability in females. Nevertheless, sex differences have not been consistently observed in all study populations. Objective: To investigate sex differences in PTSD risk in post-conflict populations from different countries while considering trauma load. Method: In civilian post-conflict samples from Northern Uganda (N = 1665), Rwanda (N = 433), Syria (N = 974) and Sri Lanka (N = 165), we investigated sex differences in PTSD risk while taking trauma load into account. PTSD and trauma load were assessed using standardized diagnostic interviews. Potential sex differences in PTSD risk were analysed by logistic regression analyses considering trauma load. Results: Across all samples, males reported more traumatic events than females. Both sexes predominantly reported war-related traumatic events. Without considering trauma load, sex effects in PTSD risk were only detected in the Syrian sample. When taking trauma load into account, evidence for an increased PTSD vulnerability in females was found in the Syrian sample, and, to a much lesser extent, in the Northern Ugandan sample. Conclusion: In contrast to the literature, we did not find evidence for a general increased PTSD vulnerability in females. The dose-response effect of trauma load was a much stronger predictor of PTSD risk than sex across all samples.

Antecedentes: Junto al efecto dosis-dependiente de la carga traumática, el sexo femenino representa un factor de riesgo bien establecido para el desarrollo del trastorno de estrés postraumático (TEPT). La exposición a tipos de eventos particularmente tóxicos, diferentes estilos de afrontamiento y factores de riesgo biológicos se enumeran con frecuencia como causas potenciales del aumento de la vulnerabilidad al TEPT en las mujeres. Sin embargo, no se ha observado de manera consistente la diferencia según sexo en todas las poblaciones estudiadas.Objetivo: Investigar las diferencias según sexo para el desarrollo del TEPT en poblaciones post-conflicto de diferentes países teniendo en consideración la carga traumática.Métodos: Se investigaron diferencias en el TEPT según sexo tomando en consideración la carga traumática a partir de muestras post-conflicto de población civil en el norte de Uganda (N = 1665), Ruanda (N = 433), Siria (N = 947) y Sri Lanka (N = 165). El TEPT y la carga traumática se evaluaron empleando entrevistas diagnósticas. Se analizaron las potenciales diferencias según sexo para el riesgo de desarrollar el TEPT empleando un análisis de regresión logística y considerando la carga traumática.Resultados: En todas las muestras, los varones reportaron mayor número de eventos traumáticos que las mujeres. Ambos sexos reportaron predominantemente eventos traumáticos relacionados a la guerra. Dejando de lado la carga traumática, los efectos del sexo para el riesgo de desarrollar el TEPT solo se encontraron en la muestra siria. Cuando se toma en consideración la carga traumática, se encontró un incremento en la vulnerabilidad para el desarrollo del TEPT en mujeres dentro de la muestra siria y, en menor medida, en la del norte de Uganda.Conclusión: En contraste con la literatura, no se encontró evidencia de un incremento generalizado de la vulnerabilidad para el desarrollo del TEPT en mujeres. El efecto dosis-respuesta de la carga traumática fue un predictor mucho más fuerte para el riesgo del desarrollo del TEPT que el sexo en todas las muestras.