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1.
BMC Psychiatry ; 20(1): 17, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924182

RESUMO

BACKGROUND: The wars in the Democratic Republic of Congo have left indelible marks on the mental health and functioning of the Congolese civilians that sought refuge in Uganda. Even though it is clear that civilians who are exposed to potentially traumatizing events in war and conflict areas develop trauma-related mental health problems, scholarly information on gender differences on exposure to different war-related traumatic events, their conditional risks to developing PTSD and whether the cumulative exposure to traumatic events affects men and women differently is still scanty. METHODS: In total, 325 (n = 143 males, n = 182 females) Congolese refugees who lived in Nakivale, a refugee settlement in the Southwestern part of Uganda were interviewed within a year after their arrival. Assessment included exposure to war-related traumatic events, and DSM-IV PTSD symptom severity. RESULTS: Our main findings were that refugees were highly exposed to war-related traumatic events with experiencing dangerous flight as the most common event for both men (97%) and women (97%). The overall high prevalence of PTSD differed among women (94%) and men (84%). The highest conditional prevalence of PTSD in women was associated with experiencing rape. The dose-response effect differed significantly between men and women with women showing higher PTSD symptom severity when experiencing low and moderate levels of potentially traumatizing event types. CONCLUSION: In conflict areas, civilians are highly exposed to different types of war-related traumatic events that expose them to high levels of PTSD symptoms, particularly women. Interventions focused at reducing mental health problems resulting from war should take the context of gender into consideration.

2.
Trials ; 21(1): 4, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31898516

RESUMO

BACKGROUND: Despite the existing national and international plans of action to end violent discipline strategies used by teachers in schools, they still prevail in Tanzanian schools. This underlines the need to implement school-based interventions that aim at reducing violent discipline by teachers. In this study, we will evaluate the feasibility and effectiveness of the preventative intervention Interaction Competencies with Children - for Teachers (ICC-T) in Tanzanian primary schools. Following its success in secondary schools, we hypothesize that the intervention will reduce teachers' positive attitudes towards and their use of violent discipline at school. METHODS/DESIGN: The study will be conducted in six randomly selected regions in Tanzania. We have already randomly selected two schools in each region (12 in total) that fulfill our inclusion criteria. From each region, one school will be randomly assigned to the intervention and the other to the monitoring group (no intervention). Eighty students between the ages of 9 to 12 years (N = 960) and 20 teachers from each school (N = 240) will be included in the trial. We will collect data directly before the intervention (t1) and 6 months after the intervention (t2) both at intervention and monitoring schools. Using guided questionnaire assessments, we will measure violence by teachers using students' reports on their exposure to and teachers' reports on their use of violence using the Conflict Tactics Scale. Furthermore, we will assess teachers' positive attitudes towards violent discipline using a modified version of the Conflict Tactic Scale. The feasibility of the intervention will be evaluated using purpose-built measures assessing the demand, applicability, acceptability, and integration of core elements into daily work in the participating schools. DISCUSSION: The proposed study will allow us to test the feasibility and effectiveness of an intervention aiming to reduce positive attitudes towards and the use of violent discipline by teachers in school settings. With the reduction of violent discipline by teachers, this study contributes to national and international efforts towards ending violence against children as well as the attainment of the United Nations' Sustainable Development Goals that also aim to prevent all types of maltreatment of children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03893851. Registered on 28 March 2019.

3.
Eur J Psychotraumatol ; 10(1): 1676005, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31681466

RESUMO

Background: Although the family constitutes the prime source of risk and resilience for the well-being of children growing up in adverse conditions, the mental health of children living in refugee camps has rarely been investigated in conjunction with their parents' mental health. Objectives: To examine the prevalence of posttraumatic stress disorder (PTSD) and other mental health problems among Burundian refugee children and their parents living in Tanzanian refugee camps and to identify patterns of comorbidity among children and their parents based on PTSD symptom levels and functional impairment. Methods: We recruited a representative sample of 230 children aged 7-15 years and both of their parents (n = 690) and conducted separate structured clinical interviews. Latent Class Analysis was applied to identify patterns of comorbidity. Results: Children and parents were exposed to multiple traumatic event types. In total, 5.7% of children fulfilled DSM-5 criteria for PTSD in the past month and 10.9% reported enhanced levels of other mental health problems. 42.6% indicated clinically significant functional impairment due to PTSD symptoms. PTSD prevalence was higher among mothers (32.6%) and fathers (29.1%). Latent Class Analysis (LCA) revealed a familial accumulation of PTSD symptoms as children with high symptom levels and impairment were likely to live in families with two traumatized parents. Conclusions: Although the number of children who need support for trauma-related mental health problems was relatively low, taking into account parental trauma could aid to identify at-risk children with elevated PTSD symptom levels and impairment even in the face of existing barriers to mental health care access for children in refugee camp settings (e.g. lack of targeted services, prioritization of managing daily stressors).

4.
Child Abuse Negl ; 98: 104194, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31629222

RESUMO

BACKGROUND: Despite global efforts to end violence against children in all settings, reports reveal that violence against children is still highly prevalent, especially in low-and middle- income countries. Violence in childhood is associated with a host of negative outcomes, and exposure in one setting can easily spill over to other contexts. For instance, exposure to family violence was not only related to mental health problems but also seems to be a risk factor for peer victimization. OBJECTIVES: The present study aimed to examine the prevalence of maltreatment within the family and adolescents' mental health problems and their relation to peer victimization. We also aimed to gain new insights into the perceptions of adolescents concerning maltreatment within their families. METHODS: Data were collected from April to November 2017 in a representative sample of 702 students from 12 public secondary schools in Southwestern Uganda who responded to self-administered questionnaires. RESULTS: Overall, 95% of the students experienced at least one type of family violence in the past month. Students (81.3%) had endorsed some level of acceptance of violent discipline as a valid strategy in response to any misbehavior. Maltreatment within the family was related to peer victimization (ß = .47) and this relation was mediated by mental health problems (0.002, 95%-CI: 0.001-0.004). CONCLUSIONS: The results indicated a high prevalence of maltreatment within Ugandan families that was associated with peer victimization. This underscores the need to implement interventions aiming to reduce maltreatment and violence in order to protect children from potentially negative consequences.

5.
Front Genet ; 10: 269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040859

RESUMO

Stress during pregnancy widely associates with epigenetic changes and psychiatric problems during childhood. Animal studies, however, show that under specific postnatal conditions prenatal stress may have other, less detrimental consequences for the offspring. Here, we studied mental health and epigenome-wide DNA methylation in saliva following intimate partner violence (IPV) during pregnancy in São Gonçalo, a Brazilian city with high levels of violence. Not surprisingly, mothers exposed to pregnancy IPV expressed elevated depression, PTSD and anxiety symptoms. Children had similar psychiatric problems when they experienced maternal IPV after being born. More surprisingly, when maternal IPV occurred both during (prenatal) and after pregnancy these problems were absent. Following prenatal IPV, genomic sites in genes encoding the glucocorticoid receptor (NR3C1) and its repressor FKBP51 (FKBP5) were among the most differentially methylated and indicated an enhanced ability to terminate hormonal stress responses in prenatally stressed children. These children also showed more DNA methylation in heterochromatin-like regions, which previously has been associated with stress/disease resilience. A similar relationship was seen in prenatally stressed middle-eastern refugees of the same age as the São Gonçalo children but exposed to postnatal war-related violence. While our study is limited in location and sample size, it provides novel insights on how prenatal stress may epigenetically shape resilience in humans, possibly through interactions with the postnatal environment. This translates animal findings and emphasizes the importance to account for population differences when studying how early life gene-environment interactions affects mental health.

6.
Child Abuse Negl ; 93: 15-26, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31039543

RESUMO

BACKGROUND: Globally, the use of violent discipline methods by teachers to manage child behavior is still highly prevalent despite enactment of laws that prohibit school violence. In the case of Uganda there is a dearth of accurate prevalence statistics on school violence and factors associated with the use of violence by teachers. OBJECTIVES: Therefore, the current study examined the prevalence of and attitudes towards violence. The study also explored the association between teachers' stress, positive attitudes towards violence and the use of violent discipline management methods. METHODS: A representative sample of 291 teachers and 702 students from 12 public secondary schools in southwestern Uganda responded to anonymous self-administered questionnaires. Data were collected from April to November 2017. RESULTS: Findings indicated that 86.5% of the teachers reported having used violent disciplinary methods on students in the past month while 91.5% of the students reported experiencing violence by teachers. Teachers (88.3%, n = 256) endorsed positive attitudes towards violent discipline. Teachers' stress was related to higher levels of violent discipline (ß = 0.20). This relation was mediated by positive attitudes towards violence (0.06, SE: 0.01, 95%-CI: 0.035-0.092). CONCLUSIONS: Our findings indicate that teacher reported stress was associated with their use of violent behavior and positive attitudes and that positive attitudes reduced the association between teachers' stress and violent behavior. Therefore, interventions aiming to reduce violence by teachers may need to integrate effective stress management skills, in addition to nonviolent discipline strategies, and fostering attitudinal change towards the use of violent methods.

7.
Dev Psychopathol ; 31(1): 325-339, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29576033

RESUMO

Child maltreatment is known to engender negative emotional and behavioral consequences. Although neglect is the most frequent form of maltreatment, it has thus far only received little attention, especially when looking at low-resource countries. The current study investigated possible associations between neglect and internalizing and externalizing problems. As neglect and abuse often co-occur, the latter was controlled for. In total, 409 Tanzanian primary school students (52% boys, M = 10.5 years, range = 6-15) participated in the cross-sectional study. Structured clinical interviews were conducted assessing maltreatment, internalizing problems, and externalizing problems. Overall, 31% (n = 128) of the children reported at least one type of physical neglect and 31% (n = 127) of emotional neglect. Using structural equation modeling, we found a significant association between neglect and internalizing (ß = 0.59, p < .01) and externalizing problems (ß = 0.35, p < .05). However, these associations could only be detected in younger children (ages 6-9), whereas in older children (ages 10-15), mental health problems were significantly related to violence and abuse. Our findings suggest that the current age may influence the association between maltreatment type and the development of internalizing and/or externalizing problems.


Assuntos
Sintomas Afetivos/psicologia , Maus-Tratos Infantis/psicologia , Transtornos do Comportamento Infantil/psicologia , Países em Desenvolvimento , Adolescente , Sintomas Afetivos/diagnóstico , Criança , Maus-Tratos Infantis/diagnóstico , Transtornos do Comportamento Infantil/diagnóstico , Correlação de Dados , Estudos Transversais , Mecanismos de Defesa , Violência Doméstica/psicologia , Feminino , Humanos , Controle Interno-Externo , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Tanzânia
8.
J Trauma Stress ; 31(6): 795-804, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30431683

RESUMO

Forced migration is one of the major challenges currently facing the international community. Many refugees have been affected by traumatic experiences at home and during their flight, putting them at a heightened risk of developing trauma-related disorders. The new version of the International Classification of Diseases (ICD-11) introduced two sibling disorders, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). So far, little is known about risk and protective factors in refugees that are specifically associated with the disturbances in self-organization (DSO) characteristic of CPTSD. In this study, we aimed to investigate the association between PTSD and DSO symptoms and traumatic experiences, postmigration difficulties, and social support in a culturally diverse sample of refugees who resettled in Switzerland. A total of 94 refugees (85.1% male; M age = 31.60 years, SD = 10.14, range: 18-61 years) participated in this study. Trained assessors performed either guided questionnaire assessments or structured interviews. In our advice- and help-seeking sample, 32.9% of individuals suffered from PTSD and 21.3% from CPTSD. After controlling for potential gender differences, we found positive associations between PTSD symptoms and trauma exposure, ß = .22, as well as between DSO symptoms and postmigration living difficulties, ß = .42, and lack of social support, ß = .22. Our findings support the notion that it is highly important to consider differential associations among PTSD and DSO symptoms and risk and protective factors to gain a deeper understanding of the trauma-related problems refugees face.

9.
PLoS One ; 13(8): e0201362, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30110358

RESUMO

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.


Assuntos
Emoções , Competência Mental/psicologia , Abuso Físico/prevenção & controle , Professores Escolares/psicologia , Instituições Acadêmicas , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abuso Físico/psicologia , Tanzânia
10.
Trials ; 19(1): 435, 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30103776

RESUMO

BACKGROUND: An adolescent's school is often the second most important place for his development and education after the home. However, reports highlight the recurrence of the use of violent discipline in schools. There are few school-based interventions that aim at reducing violence at school that have been implemented and evaluated in sub-Saharan Africa. To reduce violent disciplinary measures used at school, we aim to implement and evaluate the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T). METHODS/DESIGN: The study will be conducted in six randomly selected districts of the Ankole region in southwestern Uganda. We shall randomly select two mixed-day secondary schools from each district that fulfill our inclusion criteria. Schools will be randomly assigned to the intervention condition, where ICC-T will be implemented, and control schools (no intervention). Sixty students between the ages of 12 and 17 years and at least 15 teachers per school will be included in the trial. We aim to collect pre-assessment data directly before the intervention (t1) and 3 months after the intervention (t2) in both intervention and control schools. Using self-administered questionnaires, we will measure students' exposure to violence using the Conflict Tactics Scale (CTS), their psychological well-being using the Strengths and Difficulties Questionnaire (SDQ), and teachers' positive attitudes towards violent disciplining and teachers' use of violent disciplinary methods (CTS). The implementation feasibility of ICC-T in the cultural context of southwestern Uganda will be assessed with purpose-built measures that follow the guidelines for feasibility studies assessing the demand, applicability, acceptability, and integration of core elements in the daily work. DISCUSSION: The proposed study will allow us to test the feasibility and efficacy of a preventative intervention seeking to reduce violent disciplinary measures in school settings using a scientifically rigorous design. The proposed study provides the opportunity to contribute to the attainment of goal number 16.2 of the United Nations' Sustainable Development Agenda 2015-2030, which aspires to end all forms of violence against children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03051854 . Registered on 14 February 2017.


Assuntos
Maus-Tratos Infantis/prevenção & controle , Capacitação em Serviço/métodos , Abuso Físico/prevenção & controle , Serviços de Saúde Escolar , Professores Escolares/psicologia , Capacitação de Professores/métodos , Adolescente , Comportamento do Adolescente , Criança , Maus-Tratos Infantis/psicologia , Comportamento Infantil , Emoções , Estudos de Viabilidade , Feminino , Humanos , Masculino , Saúde Mental , Abuso Físico/psicologia , Projetos de Pesquisa , Uganda
11.
Soc Psychiatry Psychiatr Epidemiol ; 53(7): 699-707, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29651620

RESUMO

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.


Assuntos
Maus-Tratos Infantis/psicologia , Transtornos Mentais/psicologia , Abuso Físico/psicologia , Estudantes/psicologia , Violência/psicologia , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pais/psicologia , Prevalência , Fatores de Risco , Instituições Acadêmicas , Inquéritos e Questionários , Tanzânia/epidemiologia
12.
Child Abuse Negl ; 77: 110-120, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29324272

RESUMO

Though the Sustainable Development Goals of the United Nations aim to end all forms of violence against minors, child maltreatment remains a globally prevalent phenomenon. Despite the fact that parents in numerous countries apply violent discipline methods to control children's behavior, little is known about the prevalence of maltreatment and violent discipline in Sub-Saharan Africa. In this study, we examined the prevalence of maltreatment and violent discipline from both the adolescents' and parents' perspectives. In addition, we explored risk factors that could be associated with violent discipline by parents. We administered questionnaires to a nationally representative sample of 700 Tanzanian secondary school students (52% girls, mean age: 14.92 years, SD = 1.02, range: 12-17) and 333 parents or primary guardians (53% females; mean age: of 43.47 years, SD = 9.02, range: 19-71). More than 90% of all students reported exposure to violent discipline by a parent within the past year. Concurrently, more than 80% of parents acknowledged using violent discipline techniques. Using a path model, we found that violent discipline by parents was associated with parental stress. Other risk factors contributed to a higher stress level but were not directly linked to maltreatment. Our findings indicate high levels of violent discipline in Tanzanian families. There is a pressing need to design and implement interventions that prevent children from experiencing violence at home. Reducing parents' stress levels may be a starting point for intervention. Yet, due to the high levels of violent discipline, societal beliefs also need to be considered.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Violência Doméstica/estatística & dados numéricos , Punição/psicologia , Adolescente , Adulto , Idoso , Agressão/psicologia , Criança , Maus-Tratos Infantis/psicologia , Comportamento Infantil , Violência Doméstica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Prevalência , Fatores de Risco , Estudantes , Inquéritos e Questionários , Adulto Jovem
13.
J Nerv Ment Dis ; 206(4): 270-276, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29377849

RESUMO

Prevalence rates are still lacking for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) diagnoses based on the new ICD-11 criteria. In a nationwide representative German sample (N = 2524; 14-99 years), exposure to traumatic events and symptoms of PTSD or CPTSD were assessed with the International Trauma Questionnaire. A clinical variant of CPTSD with a lower threshold for core PTSD symptoms was also calculated, in addition to conditional prevalence rates dependent on trauma type and differential predictors. One-month prevalence rates were as follows: PTSD, 1.5%; CPTSD, 0.5%; and CPTSD variant, 0.7%. For PTSD, the highest conditional prevalence was associated with kidnapping or rape, and the highest CPTSD rates were associated with sexual childhood abuse or rape. PTSD and CPTSD were best differentiated by sexual violence. Combined PTSD and CPTSD (ICD-11) rates were in the range of previously reported prevalences for unified PTSD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; ICD-10). Evidence on differential predictors of PTSD and CPTSD is still preliminary.


Assuntos
Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Abuso Sexual na Infância/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Estupro/psicologia , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Adulto Jovem
14.
Child Abuse Negl ; 76: 173-183, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29112855

RESUMO

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.


Assuntos
Esgotamento Profissional , Estresse Ocupacional/epidemiologia , Abuso Físico/psicologia , Professores Escolares/psicologia , Adulto , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Instituições Acadêmicas , Inquéritos e Questionários , Tanzânia/epidemiologia , Adulto Jovem
15.
Eur J Psychotraumatol ; 8(1): 1283086, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28326164

RESUMO

Background: In the ongoing conflict in the Democratic Republic of the Congo (DRC), civilians have been heavily exposed to traumatic stressors. Traumatizing experiences cumulatively heighten the risk for trauma-related disorders, and with it affect cognitive and psycho-social functioning. Objectives: We aimed at investigating the association between trauma-related disorders and cognitive and psycho-social functioning and hypothesized that PTSD symptom severity would negatively correlate with executive functioning, working memory and psycho-social functioning in everyday life. Method: In total, 323 Congolese refugees (mean age: 31.3 years) who arrived in the Ugandan Nakivale refugee settlement after January 2012 were assessed regarding their exposure to traumatic events, PTSD symptom severity (posttraumatic symptom scale interview), executive functioning (Tower of London), working memory performance (Corsi block tapping task) and psycho-social dysfunctioning (Luo functioning scale). Results: Hierarchical regression analyses indicated a significant negative association between PTSD symptom severity and working memory (ß = -0.32, p < 0.001), as well as executive functions (ß = -0.19, p = 0.003). Furthermore, the impairment of psycho-social functioning in everyday life was positively related with PTSD symptom severity (ß = 0.70, p < 0.001), and negatively with executive functioning (ß = -0.15, p = 0.003). However, working memory performance was not significantly related to psycho-social dysfunctioning (ß = 0.09, p > 0.05). Conclusion: Trauma survivors not only suffer from the core PTSD symptoms but also from impaired cognitive functioning. PTSD symptom severity seems furthermore to be related to impaired psycho-social functioning. Our findings suggest that trauma-related mental health problems may heighten the risk for poverty and lack of prospect and further aggravate the consequences of war and conflict.

16.
Clin Psychol Psychother ; 24(4): 807-825, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26676201

RESUMO

BACKGROUND: Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex-combatants present with trauma-related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma-related suffering and the lowered threshold for aggressive behaviour. OBJECTIVE: Supporting the demobilization process of ex-combatants in the eastern DR-Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). METHOD: In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3-week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment-as-usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. RESULTS: Six months post-intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. CONCLUSIONS: Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. KEY PRACTITIONER MESSAGE: Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET). The intervention is effective in the context of ongoing conflict. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET. It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors. Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war-torn regions.


Assuntos
Agressão/psicologia , Transtorno Depressivo/terapia , Terapia Narrativa/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Congo , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Seguimentos , Humanos , Masculino , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
17.
Trauma Violence Abuse ; 18(5): 544-561, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-27075337

RESUMO

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.


Assuntos
Cuidadores/educação , Cuidado da Criança/normas , Desenvolvimento Infantil , Criança Institucionalizada/estatística & dados numéricos , Crianças Órfãs/estatística & dados numéricos , Adolescente , Criança , Maus-Tratos Infantis/prevenção & controle , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Orfanatos
18.
Aggress Behav ; 43(3): 241-250, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27747888

RESUMO

It has been postulated that the violent behavior that characterizes armed conflict is reinforced by the possibility of receiving rewards. The present study examined the potential influence of two types of rewards in an ongoing setting of conflict: extrinsic and intrinsic rewards. Former combatants active in the Democratic Republic of the Congo (N = 198) were interviewed and questioned about the way they were recruited, the offenses they committed during combat, their level of perceived intrinsic rewards (i.e., appetitive perception of violence), and the number of received extrinsic rewards during their time in the armed group (e.g., money, extra food, alcohol, or drugs). A moderated multiple regression analysis showed that the number of received extrinsic rewards and the level of intrinsic rewards were significantly positively related to the number of different types of offenses committed. In contrast to our expectations and previous findings, the recruitment type (forced conscription vs. voluntary enlistment) did not moderate this relation. Our findings suggest that both types of rewards play a role in committing violence during combat. We suggest, therefore, that reintegration programs should not only consider the influence of extrinsic rewards, but also need to address the influence of intrinsic rewards to counter violent behavior among former combatants. Aggr. Behav. 43:241-250, 2017. © 2016 Wiley Periodicals, Inc.


Assuntos
Recompensa , Violência/psicologia , Guerra , Adolescente , Adulto , Estudos Transversais , República Democrática do Congo , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
BMC Psychiatry ; 16: 118, 2016 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-27129400

RESUMO

BACKGROUND: Child maltreatment poses a risk to children and adolescents' mental health and may also affect cognitive functioning. Also harsh discipline has been frequently associated with mental health problems. However, within societies in which harsh disciplinary methods are culturally normed and highly prevalent less is known about the association between harsh punishment, mental health problems, and cognitive functioning. METHODS: In a cross-sectional study, we conducted structured clinical interviews with a sample of Tanzanian primary school students assessing exposure to harsh discipline (Maltreatment and Abuse Chronology of Exposure), internalizing problems (Strength and Difficulties Questionnaire, Children's Depression Inventory), and working memory (Corsi Blocktapping Task). School performance was measured by using the exam grades in 4 core subjects. The 409 children (52% boys) had a mean age of 10.5 years (range: 6 - 15). RESULTS: Using structural equation modeling, a strong relationship was found between harsh discipline and internalizing problems (ß = .47), which were related to lower working memory capacity (ß = -.17) and school performance (ß = -.17). CONCLUSIONS: The present study suggests that harsh discipline is closely linked to children's internalizing mental health problems, which are in turn associated with lower cognitive functioning and school performance. Given the high rates of harsh discipline experienced by children in East African homes and elsewhere, the findings of the present study emphasize the need to inform the population at large about the potentially adverse consequences associated with harsh discipline.


Assuntos
Maus-Tratos Infantis/psicologia , Transtornos do Comportamento Infantil/psicologia , Mecanismos de Defesa , Punição/psicologia , Adolescente , Criança , Transtornos do Comportamento Infantil/epidemiologia , Cognição , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Saúde Mental , Prevalência , Inquéritos e Questionários , Tanzânia/epidemiologia
20.
Psychol Trauma ; 8(4): 468-76, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27031081

RESUMO

OBJECTIVE: Spirit possession is a phenomenon frequently occurring in war-torn countries. It has been shown to be an idiom of distress entailing dissociative symptoms. However, its association with trauma exposure and trauma-related disorders remains unclear. This study aimed to explore subjective disease models and the relationship between pathological spirit possession and trauma-related disorders in the Eastern Democratic Republic of the Congo. METHOD: Seventy-three (formerly) possessed persons (74% female, mean age = 34 years), referred by traditional and spiritual healers, were interviewed about their experiences of pathological spirit possession, trauma exposure, posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, shame and guilt, psychotic symptoms, somatic complaints, and the impairment of psychosocial functioning. RESULTS: The most common disease model for pathological spirit possession was another person having sent the spirit, mostly a family member or a neighbor, out of jealousy or conflict over resources. Significant correlations were found between spirit possession over lifetime and PTSD symptom severity, feelings of shame and guilt, depressive symptoms, somatic complaints, and psychotic symptoms. Spirit possession during the preceding 4 weeks was associated with PTSD symptom severity, impairment of psychosocial functioning, and psychotic symptom severity. CONCLUSIONS: The results of this study indicate that pathological spirit possession is a broad explanatory framework for various subjectively unexplainable mental and physical health problems, including but not limited to trauma-related disorders. Understanding pathological spirit possession as a subjective disease model for various mental and physical health problems may help researchers and clinicians to develop culturally sensitive treatment approaches for affected individuals. (PsycINFO Database Record


Assuntos
Trauma Psicológico/etnologia , Transtornos Psicóticos/etnologia , Possessão Espiritual , Transtornos de Estresse Pós-Traumáticos/etnologia , Adulto , República Democrática do Congo/etnologia , Feminino , Humanos , Masculino
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