Training non-specialists in teaching recovery techniques (TRT) to help traumatised children in humanitarian settings: a qualitative analysis of experiences gained from 20 years of practice.

BACKGROUND: Although several manuals and guidelines have been developed to enhance the quality of task-sharing interventions, it remains challenging to train non-professional personnel in mental health and psychosocial support. Practitioners must translate general recommendations into practical applications to make them relevant in demanding contexts. However, limited research exists on practical experiences with standardised programmes in the field. AIM: To explore how experiences gained from the training of first-line health providers in a low-threshold intervention for children with trauma symptoms may guide implementation of such interventions in local communities in low-income countries. METHOD: We summarise 20 years of experience in the training of first-line health providers, teachers, and school counsellors in providing a low-threshold intervention. The intervention is called teaching recovery techniques (TRT), developed by the Children and War Foundation (CAW). Field notes containing notes from trainings and oral, informal feedback from participants are analysed using thematic analysis, a method well-suited for identifying, analysing, and reporting patterns, or themes, within data in qualitative research. FINDINGS: The analysis showed three main themes/ challenges: (1) Who can conduct the TRT intervention? (2) What form and content should the training take? (3) How can the intervention be used in a responsible way to follow the 'do no harm' principle? We discuss the implications of the findings for trainings in scalable interventions and further research.

Mental health in refugee children.

Almost half of the world's forcibly displaced population are children, most commonly originating from Syria, Iraq, and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.

Childhood disability in rural Niger: a population-based assessment using the Key Informant Method.

BACKGROUND: Data on childhood disability is essential for planning health, education and other services. However, information is lacking in many low- and middle-income countries, including Niger. This study uses the Key Informant Method, an innovative and cost-effective strategy for generating population-based estimates of childhood disability, to estimate the prevalence and causes of moderate/severe impairments and disabling health conditions in children of school-going age (7-16 years) in the Kollo department of western Niger. METHODS: Community-based key informants were trained to identify children who were suspected of having the impairment types/health conditions included in this study. Children identified by key informants were visited by paediatricians and underwent an assessment for moderate/severe vision, hearing, physical and intellectual impairments, as well as epilepsy, albinism and emotional distress. RESULTS: Two thousand, five hundred sixty-one children were identified by key informants, of whom 2191 were visited by paediatricians (response rate = 85.6%). Overall, 597 children were determined to have an impairment/health condition, giving a prevalence of disability of 11.4 per 1000 children (10.6- 12.2). Intellectual impairment was most common (6.5 per 1000), followed by physical (4.9 per 1000) and hearing impairments (4.7 per 1000). Many children had never sought medical attention for their impairment/health condition, with health seeking ranging from 40.0% of children with visual impairment to 67.2% for children with physical impairments. CONCLUSION: The Key Informant Method enabled the identification of a large number of children with disabling impairments and health conditions in rural Niger, many of whom have unmet needs for health and other services.

Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study.

Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels.

Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquakes.

BACKGROUND: In 2015, Nepal was hit by two major earthquakes, which caused 8900 deaths and displaced more than 450,000 people. We assessed the prevalence of post-traumatic stress symptoms (PTSS) and depressive symptoms and explored potential risk factors among adolescents. METHODS: This cross-sectional study comprised 893 students aged 11-17 in school grades 7-10. They lived in two districts affected by the earthquakes: Sindhupalchok and Kathmandu. Psychiatric symptoms were assessed using Child PTSD symptom scale and Depression Self-Rating Scale. Multiple logistic regression analysis examined the associations between demographic, earthquake-related factors and psychiatric symptoms. RESULTS: The prevalence of PTSS in the Sindhupalchok and Kathmandu districts were 39.5% and 10.7%, and depression symptoms were 40.4% and 23.2% respectively. The moderating effect of gender on the relationship between age and PTSS was significant. In the multivariate logistic analyses, the factors associated with PTSS and depression were: being female, prior exposure to trauma and being directly affected by the earthquakes. LIMITATIONS: Due to the lack of pre-earthquake prevalence rates, our estimates may have been due to chronic long-lasting problems of poverty and lack of access to physical and mental health services. The use of self-reported questionnaires might have overestimated the prevalence rates compared to psychiatric interviews. CONCLUSIONS: One year after the earthquakes, adolescents living in Sindhupalchok had a higher prevalence of PTSS and depressive symptoms than those living in Kathmandu. Socio-economic and earthquake-related factors were associated with psychiatric outcomes. The findings indicate the need for early psychosocial interventions, prevention and future research after emergency relief.

Are tip-of-the-tongue states universal? Evidence from the speakers of an unwritten language.

Schwartz (1999, 2002) has claimed that tip-of-the-tongue states (TOTs) are universal. The studies reported in this paper examine this claim for illiterates, unschooled literates, and schooled readers, all speakers of an unwritten Guatemalan language. The first study showed that, although there was little evidence of a dedicated verbal expression for this state of consciousness in the Mayan language of Q'eqchi', a majority of participants in all three groups recognised a description of the phenomenology associated with tip-of-the-tongue states. In two further studies it was shown that TOTs could be induced in all groups of participants, and that they were reliably resolved by the presentation of the words' initials. Thus, even in the absence of an expression for "tip-of-the-tongue state", the basic phenomenology and cueing properties of TOTs were similar to those reported in previous studies. However, only university-level participants reported partial knowledge of word targets they had failed to recall. The results are discussed from psycholinguistic and metacognitive perspectives, drawing a possible link between TOTs and epistemic curiosity.

Trauma-related and neutral false memories in war-induced Posttraumatic Stress Disorder.

Recent models of cognition in Posttraumatic Stress Disorder (PTSD) predict that trauma-related, but not neutral, processing should be differentially affected in these patients, compared to trauma-exposed controls. This study compared a group of 50 patients with PTSD related to the war in Bosnia and a group of 50 controls without PTSD but exposed to trauma from the war, using the DRM method to induce false memories for war-related and neutral critical lures. While the groups were equally susceptible to neutral critical lures, the PTSD group mistakenly recalled more war-related lures. Both false and correct recall were related more to depression than to self-rated trauma. Implications for accounts of false memories in terms of source-monitoring are discussed.

The possible benefits of difficulty: how stress can increase and decrease subjective well-being.

This study explores the effects of stress, trauma, coping and growth orientation on subjective well-being. Based on cognitive stress theory, it was hypothesized that adversity may contribute to increased or decreased well-being, depending on the subsequent meaning these experiences are given. Survey data from Norwegian UN/NATO veterans (N= 142) showed that stress and well-being were negatively associated (r=-0.20, p < 0.05) at the level of zero-order correlations. However, a full structural equation model revealed that the effect of stress on well-being was mediated positively through a problem-focused coping process combined with a growth component. Stress was negatively mediated through an avoidant-focused coping process and a distress component. The effect from stress was fully mediated in the model. The hypothesis that stress can produce both increased and decreased subjective well-being was confirmed.