Association of War-Related and Gender-Based Violence With Mental Health States of Yazidi Women.

Importance: Yazidi women in northern Iraq have experienced severe human rights violations through attacks by the so-called Islamic State group, with severe consequences for their health. However, no studies to date have investigated how war-related and gender-based violence, including partner violence, are associated with mental health disorders in this population. Objective: To evaluate the associations between Yazidi women's experiences of violence (ie, war violence, partner violence, enslavement) and their mental health. Design, Setting, and Participants: This cross-sectional study of 326 women was conducted in camps for displaced persons in the Kurdistan region of Iraq between January and July 2017. Participants were married women from the Yazidi population in northern Iraq who were affected by Islamic State attacks. Participants were selected via household-randomized sampling. Data analysis was conducted from December 2018 to September 2019. Exposures: Experiences of enslavement, war-related events, and intimate partner violence were measured with event checklists. Main Outcomes and Measures: Posttraumatic stress disorder (PTSD) and depression levels were measured using culturally validated instruments. Results: A total of 326 women (mean [SD] age, 34.3 [12.9] years) participated in the study. Almost all participants reported the experience of at least 1 war-related violent event (325 [99.7%]), 54 (16.6%) reported a history of abduction and sexual slavery, and 215 (66.0%) reported the experience of at least 1 type of intimate partner violence in the past year. There were no significant differences between women who did and did not experience abduction regarding exposure to intimate partner violence. Rates of PTSD and depression symptoms were high among the whole sample, and women who experienced abduction reported significantly higher levels of psychopathology than those who did not (mean [SD] PTSD score: 61.48 [12.38] vs 47.61 [14.42]; t324 = -6.91; P < .001; mean [SD] depression score: 3.07 [0.68] vs 2.43 [0.68]; t324 = -6.78; P < .001). Multivariate hierarchical regressions revealed that psychopathology was associated with exposure to war-related events (PTSD: ß = 0.29; P < .001; depression: ß = 0.27; P < .001) as well as with exposure to gender-based violence in Islamic State captivity (PTSD: ß = 0.19; P = .001; depression: ß = 0.28, P < .001) and in their marriage (PTSD: ß = 0.13; P = .008; depression: ß = 0.18; P < .001). Conclusions and Relevance: In this study, interviewed Yazidi women often experienced intimate partner violence as well as war-related and gender-based violence under Islamic State attacks and enslavement, experiences that were associated with mental health impairment. The findings underline the importance of also addressing gender-based violence within health care approaches for war-affected populations.

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.

Toward a Contextually Valid Assessment of Partner Violence: Development and Psycho-Sociometric Evaluation of the Gendered Violence in Partnerships Scale (GVPS).

This article presents a new measure for intimate partner violence (IPV), the Gendered Violence in Partnerships Scale (GVPS). The scale was developed in the Middle East with the aim to contribute to the global perspective on IPV by providing a contextual assessment tool for partner violence against women in violent-torn settings embedded in a patriarchal social structure. In an effort to generate a scale including IPV items relevant to the women of the population, a pragmatic step-wise procedure, with focus group discussions and expert panels, was performed. The study's analyses resulted in an 18-item checklist featuring four subscales of the GVPS that are based on a new typology of male-to-female partner violence presenting an alternative to the commonly used classification by type of abuse (i.e., physical, psychological, sexual acts). Therein, dominating behaviors, existential threats, impulsive aggression, and aggravated physical assault were identified as reflective of the lived realities of women in the war-torn Middle East, which was confirmed in factor analysis. The scale's psychometric properties were assessed with data from 1,009 displaced women in Iraq, and associations with measures of psychopathology were determined. Implications for IPV assessment and prevention possibilities in humanitarian contexts and beyond are discussed.

Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq.

BACKGROUND: Since the Syrian civil war began in March 2011, more than half of the Syrian population was forced to escape from their homes, and more than 5 million of them fled their country. The aim of the present study is to estimate the psychological consequences of this conflict among the refugee population who fled to Iraq. METHOD: In 2017, a team of locally trained psychologists and social workers interviewed 494 married couples (988 individuals) who were Syrian Kurdish refugees in the Kurdistan Region of Iraq. Validated Kurdish Kurmanji and Arabic versions of post-traumatic stress disorder (PTSD) Checklist for DSM-5 and depression section of Hopkins Symptom Checklist-25 were used for assessing PTSD and depression symptoms. RESULTS: Almost all of the participants (98.5%) had experienced at least one traumatic event and 86.3% of them experienced three or more traumatic event types. The prevalence of probable PTSD was about 60%. Gender, length of time in the camp, area in which participants were grown up, and the number of traumatic event types were significant predictors for the presence of PTSD symptoms. Approximately the same rate of participants (59.4%) experienced probable depression, which was associated with gender, age, time spent in the camp, and the number of traumatic event types. CONCLUSION: PTSD and depression are prevalent among refugees exposed to traumatic events, and various variables play important roles. The pattern of risk factors in this population is consistent with findings from war-affected populations in other regions and should be considered for intervention within this population and more broadly.

The contribution of mental health and gender attitudes to intimate partner violence in the context of war and displacement: Evidence from a multi-informant couple survey in Iraq.

RATIONALE: Intimate partner violence is a prevalent issue in refugee and internally displaced populations in post-war and migration settings including camps in the Middle East. In this context, partner violence has been associated with war-related trauma, camp factors, individual characteristics, and gender attitudes. OBJECTIVE: With a dual-informant survey among a sample of Iraqi couples residing in a camp for displaced people in the Kurdistan Region of Iraq (N = 92) this study investigated the relationship between war-related psychopathology, attitudes towards women, and male-perpetrated partner violence. METHOD: Moderated regression analysis was applied using information from both partners to predict partner violence reported by wives. RESULTS: Over 58% of the women in this sample reported past-year exposure to partner violence. Further analyses revealed significant main effects of men's self-reported psychopathology (posttraumatic stress disorder and depression) and their own gender attitudes on partner violence. In a multivariate regression, moderating effects were found, as higher psychopathology levels and inequitable gender attitudes in men interacted in the prediction of male-perpetrated partner violence. CONCLUSIONS: This study highlights the high prevalence of partner violence among Iraqi displaced women. In addition, the results show an interplay of several violence-impelling factors in war-affected men. This emphasizes the importance of addressing both mental health issues and gender attitudes in the efforts to reduce or end violence against women in post-war settings.

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.

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.

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.

Fostering Child Development by Improving Care Quality: A Systematic Review of the Effectiveness of Structural Interventions and Caregiver Trainings in Institutional Care.

Quality of child care has been shown to have a crucial impact on children's development and psychological adjustment, particularly for orphans with a history of maltreatment and trauma. However, adequate care for orphans is often impacted by unfavorable caregiver-child ratios and poorly trained, overburdened personnel, especially in institutional care in countries with limited resources and large numbers of orphans. This systematic review investigated the effects of structural interventions and caregiver trainings on child development in institutional environments. The 24 intervention studies included in this systematic review reported beneficial effects on the children's emotional, social, and cognitive development. Yet, few studies focused on effects of interventions on the child-caregiver relationship or the general institutional environment. Moreover, our review revealed that interventions aimed at improving institutional care settings have largely neglected violence and abuse prevention. Unfortunately, our findings are partially limited by constraints of study design and methodology. In sum, this systematic review sheds light on obstacles and possibilities for the improvement in institutional care. There must be greater efforts at preventing violence, abuse, and neglect of children living in institutional care. Therefore, we advocate for combining attachment theory-based models with maltreatment prevention approaches and then testing them using rigorous scientific standards. By using approaches grounded in the evidence, it could be possible to enable more children to grow up in supportive and nonviolent environments.