Psychosocial intervention for war-affected children in Sierra Leone

Plan International Consultant, West Africa Regional Bureau, Freetown, Sierra Leone.
The British Journal of Psychiatry (Impact Factor: 7.99). 03/2008; 192(3):212-6. DOI: 10.1192/bjp.bp.107.038182
Source: PubMed


There are no psychosocial interventions to address both educational needs and psychological distress among displaced children in post-conflict settings.
To assess the psychosocial status of displaced children enrolled in the Rapid-Ed intervention; and to determine whether the Rapid-Ed intervention alleviated traumatic stress symptoms that interfere with learning among war-affected children in Sierra Leone.
A randomly selected sample of 315 children aged 8-18 years who were displaced by war were interviewed about their war experiences and reactions to the violence before and after participating in the 4-week Rapid-Ed intervention combining basic education with trauma healing activities.
High levels of intrusion, arousal and avoidance symptoms were reported at the pre-test interviews conducted 9-12 months after the war. Post-test findings showed statistically significant decreases in intrusion and arousal symptoms (P<0.0001), a slight increase in avoidance reactions (P<0.0001) and greater optimism about the future.
The findings suggest potential for combining basic education with trauma healing activities for children in post-conflict settings, but confirmatory studies using a control group are needed. Conducting research in post-conflict settings presents unique challenges.

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    • "Likewise, schools also seem to be an accommodating location for receiving mental health support in ongoing-war countries. This is shown by a programme for waraffected children in Sierra Leone which combined basic education with activities targeted at healing trauma to decrease intrusion and arousal symptoms (Gupta & Zimmer, 2008). Providing mental health interventions in school settings might be a sustainable alternative during crises and this has also been proven to work in non-crisis situations (Essau, Conradt, Sasagawa, & Ollendick, 2012). "
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    • "While the prominent trauma literature and practice tend to focus on long-term mental health interventions (Foa et al., 2005; Shin et al., 2004), there are indications that a window of opportunity for relief lies in interventions that target clients' acute stress reactions. Examples of such work (which enlists first responders) are evident in a number of traumarelated fields today, such as work with refugees (Gupta & Zimmer, 2008; Weine, 2011); communities stricken by disaster (Prasetiyawan, Maramis, & Keliat, 2006); schools affected by violent behavior (Newman, 2000; Randell, Eggert, & Pike, 2001); civilian victims of terrorist attacks (Somer et al., 2004), and survivors of sexual and physical abuse (Rogowski, 2011). "
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    • "In another study of the after effects of the Sierra Leone war de Jong et al. (2000) found that the conflict had affected almost all members of the population and that a very high proportion of those surveyed had scores indicating acute disturbance and severe post-traumatic stress disorder. Furthermore, a study conducted in Sierra Leone on children survivors showed that they experienced intrusive images, bad dreams, nightmares, and intense arousal symptoms (Gupta and Zimmer, 2008). "
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    ABSTRACT: Studies of children with atypical emotional experience demonstrate that childhood exposure to high levels of hostility and threat biases emotion perception. This study investigates emotion processing, in former child soldiers and non-combatant civilians. All participants have experienced prolonged violence exposure during childhood. The study, carried out in Sierra Leone, aimed to examine the effects of exposure to and forced participation in acts of extreme violence on the emotion processing of young adults war survivors. A total of 76 young, male adults (38 former child soldier survivors and 38 civilian survivors) were tested in order to assess participants' ability to identify four different facial emotion expressions from photographs and movies. Both groups were able to recognize facial expressions of emotion. However, despite their general ability to correctly identify facial emotions, participants showed a significant response bias in their recognition of sadness. Both former soldiers and civilians made more errors in identifying expressions of sadness than in the other three emotions and when mislabeling sadness participants most often described it as anger. Conversely, when making erroneous identifications of other emotions, participants were most likely to label the expressed emotion as sadness. In addition, while for three of the four emotions participants were better able to make a correct identification the greater the intensity of the expression, this pattern was not observed for sadness. During movies presentation the recognition of sadness was significantly worse for soldiers. While both former child soldiers and civilians were found to be able to identify facial emotions, a significant response bias in their attribution of negative emotions was observed. Such bias was particularly pronounced in former child soldiers. These findings point to a pervasive long-lasting effect of childhood exposure to violence on emotion processing in later life.
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