Article

Trauma Exposure and Psychological Reactions to Genocide Among Rwandan Children

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Abstract

A total of 3030 children age 8–19 years from Rwanda was interviewed about their war experiences and reactions approximately 13 months after the genocide that started in April 1994. Rwandan children had been exposed to extreme levels of violence in the form of witnessing the death of close family members and others in massacres, as well as other violent acts. A majority of these children (90%) believed that they would die; most had to hide to survive, and 15% had to hide under dead bodies to survive. A shortened form of the Impact of Event Scale used in a group of 1830 of these children documented high levels of intrusion and avoidance. While children living in shelters were exposed to more trauma, they evidenced less posttraumatic reactions. Analyses showed that reactions were associated with loss, violence exposure, and, most importantly, feeling their life was in danger.

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... Intervention, 17(1), 23-30. Mukanoheli, 2000;Punamäki, Palosaari, Diab, Peltonen, & Qouta, 2015;Thabet & Vostanis, 2000;Vervliet, Lammer- tyn, Broekaert, & Derluyn, 2014). In fact, several studies suggest that for some age groups symptomology may increase over time (Bonanno & Mancini, 2008;Fan, Long, Zhou, Zheng, & Liu, 2015;Neugebauer et al., 2014;Osofsky, Osofsky, Weems, King, & Hansel, 2015;Punamäki et al., 2015;Tam, Houlihan, & Melendez-Torres, 2015). ...
... In 1994-95, UNICEF Rwanda and the new Rwandan government implemented the Trauma Recovery Programme (TRP), a nationwide effort aimed at helping children and caregivers cope with the psychological harm associated with the 1994 Genocide ( Dyregrov et al., 2000;Gupta, 1996Gupta, , 1999Neugebauer et al., 2009) through the use of trauma counsellors trained in elementary psychosocial methods of trauma alleviation. At that time, a large number of unaccompanied children's centres (UCCs) were actively trying to provide residential care for orphans and other dispossessed children in the country. ...
... UNICEF and the Rwandan Ministry of Rehabilitation and Social Integration established the TRP nationwide ( Dyregrov et al., 2000;Gupta, 1996Gupta, , 1999UNICEF, 1995). As noted, TRP's primary objective was to promote recovery for traumatised children and families by training individuals and agencies in simple trauma alleviation methods using a decentralised, community-based approach referred to as the 'training of trainers' (TOT) (Gupta, 1994(Gupta, , 1999). ...
Article
Tens of thousands of children were orphaned or separated from their parents by the 1994 Rwandan Genocide. Following an all too familiar practice in post-conflict societies, these children were placed in unaccompanied children’s centres (UCCs) referred to as orphanages. Staff in a proportion of these centres received training in simple trauma alleviation methods as part of a program instituted by United Nations Children’s Fund (UNICEF) with Rwandan governmental ministries. This study examines whether children in UCCs with staff trained in these methods had lower levels of post-traumatic stress symptoms (PTSS) than children in UCCs staffed by individuals without training. Data for these analyses derived from a National Trauma Survey conducted by UNICEF (1995) that included sampling of children from UCCs. Ordinary least squares multiple regression analysis was used to evaluate the effect of staff training on levels of PTSS among children, controlling for relevant covariates. Overall PTSS scores did not differ between children in UCCs with and without staff training. However, avoidance/numbing and hypervigilance symptoms were significantly elevated among females in UCCs with trained staff as compared with UCCs with untrained staff. Whereas these findings might result from unmeasured confounding variables, they nonetheless underscore the importance of formal assessment of treatment safety and effectiveness before implementing interventions. Key implications for practice Community-based approaches using a training of trainers approach may not always be effective when treating severe psychopathology after large scale violence Humanitarian agencies must include rigorous monitoring and evaluation protocols as part of their intervention efforts Mental health interventions should be adapted to address gender differences in child responses to interventions.
... To measure mothers' trauma through survey questions, we partially use the simplified Kessler Psychological Distress Scale (Andrews & Slade, 2001) and combine it with other survey questions that were developed following the diagnostic criteria for PTSD and ASD as laid out in American Psychiatric Association (2013). We measure children's psychological trauma through an adverse life experience survey by Dyregrov et al. (2000); Neugebauer et al. (2009). ...
... To measure depression, we use the Center for Epidemiologic Studies Depression Scale-20 that consists of self-reported measures of depressive symptoms (Radloff, 1977). We measure children's depressive symptoms using an adverse life experience survey by Dyregrov et al. (2000); Neugebauer et al. (2009). ...
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Forced displacement is a major driver of mental disorders among refugees worldwide. Poor mental health of adult refugees, particularly mothers, is also considered a risk factor for the psychological well-being and development of their children. In this study, we experimentally examine the extent to which a multifaceted psychosocial program improves the mental well-being of refugee mothers, and facilitates growth and development among children under the age of two. In partnership with BRAC, we ran a cluster randomized controlled trial on 3,500 Rohingya mother-child dyads in refugee camps in Bangladesh. Participants were given weekly psychosocial support for a year that includes psychoeducation and parenting support for mothers and play activities for both mothers and children. The intervention was largely successful and led to: (i) reductions in the psychological trauma and depression severity of mothers and children, (ii) improvements in communication, gross-motor, problem-solving, and social skills of children, and (iii) reductions in stunting, underweight, and wasting among children in the treatment group. The intervention also caused the mental health of children to be more aligned with the mental health of their mothers, implying policies targeting the mental well-being of displaced mothers can be an important stepping stone to developing psychological resilience among their children, which can help them grow into well-rounded, healthy adults.
... It appeared that scientific reports about the psychological effects of war among civilian populations and the provision of mental health services have increased in recent years since the Gulf War and the conflict in former Yugoslavia [16¸17, 18,19,20,21,22,23,24,25,26,27] . More recent reports have examined the impact of armed conflict, insurgency and war on children from many regions including: Africa [3,28,29], South Africa [30,31,32,32], the Balkans [34], the Middle East [18,26,35,36], and Southeast Asia [37,38,39,40] Afghanistan [41], Palestine [42,43], Lebanon [44], and Iraq [45]. Further analysis have highlighted that among the 95 articles reviewed, 36 articles as serially arrange examine and discuss critically the impact of Boko Haram on the entire educational activities of Borno state and some part of neighbouring states especially Yobe and Adamawa that were seriously affected by the Boko Haram insurgency. ...
... It appeared that scientific reports about the psychological effects of war among civilian populations and the provision of mental health services have increased in recent years since the Gulf War and the conflict in former Yugoslavia [16¸17, 18,19,20,21,22,23,24,25,26,27] . More recent reports have examined the impact of armed conflict, insurgency and war on children from many regions including: Africa [3,28,29], South Africa [30,31,32,32], the Balkans [34], the Middle East [18,26,35,36], and Southeast Asia [37,38,39,40] Afghanistan [41], Palestine [42,43], Lebanon [44], and Iraq [45]. Further analysis have highlighted that among the 95 articles reviewed, 36 articles as serially arrange examine and discuss critically the impact of Boko Haram on the entire educational activities of Borno state and some part of neighbouring states especially Yobe and Adamawa that were seriously affected by the Boko Haram insurgency. ...
Article
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Insurgency has long been rooted in the Nigerian society. It affected deeply in the daily activities of the country. Thousands of people including school children have been maimed, displaced, orphaned and killed in Borno and entire North Eastern Nigeria and some other part of North Western Nigeria especially in the state of Kano because of the insurgency. The Boko Haram movement for example have caused enormous chaos within the society especially the school children. The movement have targeted civilian populations irrespective of gender, tribal and religious inclination among people and, the merciless attack and bombings carried out by them including abduction and kidnapping of female students have caused destruction of the school facilities and the well-being of the society. A continuous exposure to such stress created by war resulted the development various difficulties such as Post-Traumatic Stress Disorder among school children. A systematic review was used to critically analyzed the impact of the insurgency in the society based on several related studies. The effect of the insurgency on the society was then highlighted which tells the story of the educational difficulties.
... Based on the pilot, we estimate 50 items in total for the final PRISM to be optimal in ensuring the feasibility of administration in the field (DeVellis, 2017;Nunnally & Bernstein, 1994) and having desirable psychometric properties (Furr & Bacharach, 2014). The initial pool of 150 items (three times the number of items to be included in the final product) will be developed based on the HPA, and tested for this step (Pett et al., 2003). ...
... A confirmatory factor analysis (Gorsuch, 1983; (Maximum Likelihood Model;Joreskog, 1967Joreskog, , 1969Long, 1983) with minimum n=300 will test the presence of 5 scales: (a) healing, (b) attitude change, (c) reconciliation, (d) relationship building, and (e) psychosocial development. A posthoc exploratory factor analysis with principal component analysis (Gorsuch, 1983; will be performed to 'reduce' items in each sub-scale, and only items with higher factor loading will be selected (DeVellis, 2017;Pett et al., 2003;Floyd & Widaman, 1995). We estimate the final number of items per subscale as 10 for (a) healing, 20 for (b) attitude change, 11 for (c) reconciliation, 6 for (d) relationship building, and 3 for (e) psychosocial development, reflecting the differential proportion of meaning units emerged for each theme. ...
Article
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Background: Interpersonal/psychosocial reconciliation is highly prioritized in post-Genocide Rwanda. Despite the need, empirically sound strategies have been extremely scarce. The proposed study is a segment of a broader services-research effort to develop, evaluate, and implement a novel and empirically supported interpersonal/psychosocial reconciliation approach termed Action-Based Psychosocial Reconciliation Approach (ABPRA), that is authentically founded on Rwandan people’s lived experiences of reconciliation. Methods/Design: The proposed study consists of two major steps. The purpose of step 1 is to develop and empirically validate a set of outcome measures, termed the psychosocial reconciliation impact scales module (PRISM) to assess beneficial impacts native to ABPRA. We will employ hermeneutic phenomenological analysis (van Manen, 2016) of pilot interview data to generate item pool. The purpose of step 2 is to field-test the delivery of ABPRA in Rwanda to evaluate the feasibility and acceptability of the intervention, exploring and illuminating potential procedural uncertainties in conducting a larger-scale evaluation of ABPRA. We will follow the guidance on pilot study by Thabane et al. (2010). Discussion: The study is an essential step to advance the project to a full-scale experimental evaluation of ABPRA. The project holds the possibility of making available and accessible, an empirically supported and meaningful approach to conflict resolution, genocide/war prevention and peacebuilding in Rwanda and other war/conflict-affected regions around the globe.
... 1,2 The effects of genocide are broad and in addition to those who were killed, continue to effect the wellbeing of individuals, families and communities maimed in the 1994 Tutsi genocide in Rwanda (Tutsi genocide). 3,4 Tutsi genocide survivors continue to re-experience these traumatic events as they occurred in their communities and the traumatic reminders of the horrors they experienced are ever present and as a result significantly impact their psychosocial wellbeing. Often neighbors, former associates, and friends were the perpetrators, and seeing them on a regular basis leads to re-experiencing the events, resulting in flashbacks, phobias, substance use and chronic headaches. ...
... These results are corroborated by previous studies that also found that despite the fact that the genocide occurred more than 20 years ago, Rwandese genocide survivors still present with high rates of PTSD and other related psychological symptoms. 2,4,36 This may in part be explained by the severe trauma survivors experienced and the relative lack of professional or even community program resources in Rwanda to address this need for post-Tutsi genocide mental health care. Clearly, interventions are needed to address these stubbornly persistent trauma experiences in the Tutsi genocide survivors. ...
Article
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Background: Mental health among survivors of the 1994 Tutsi genocide in Rwanda remains poor, even after multiple efforts to assist those recovering from this trauma. The Community Resilience Model (CRM) is a biologically based set of skills that can be delivered in community settings by trained lay persons and has shown to significantly improve mental health in a number of settings and populations, though it has not been used with genocide survivors in Rwanda. This study assessed if the CRM training was able to improve mental health among genocide survivors. Methods: A quasi-experimental design was used to evaluate the CRM intervention among Tutsi genocide survivors from the Huye, Nyamagabe and Nyaruguru districts in Southern Rwanda. Consenting participants completed a questionnaire before and six months after the training to assess their level of trauma, secondary traumatic stress, depression and skills to teach CRM skills to others. Results: The findings revealed significant improvements across all trauma symptoms between the intervention and control group (t = 37, p<0.001). The CRM trainings also resulted in significant within-person declines of depressive symptoms (p < 0.001), perceived secondary traumatic stress (p = 0.003) and trauma-related symptoms (p = 0.002). Training participants also reported significant increases in perceived CRM benefits and satisfaction (p < 0.001). Conclusion: The CRM intervention was found to be effective for improving mental health in 1994 Tutsi genocide survivors. Since CRM can be delivered by trained persons to groups of persons in community settings, it has a high potential for successful broader implementation and sustainability, which is critically important in an environment with few mental health resources.
... 1,2 The effects of genocide are broad and in addition to those who were killed, continue to effect the wellbeing of individuals, families and communities maimed in the 1994 Tutsi genocide in Rwanda (Tutsi genocide). 3,4 Tutsi genocide survivors continue to re-experience these traumatic events as they occurred in their communities and the traumatic reminders of the horrors they experienced are ever present and as a result significantly impact their psychosocial wellbeing. Often neighbors, former associates, and friends were the perpetrators, and seeing them on a regular basis leads to re-experiencing the events, resulting in flashbacks, phobias, substance use and chronic headaches. ...
... These results are corroborated by previous studies that also found that despite the fact that the genocide occurred more than 20 years ago, Rwandese genocide survivors still present with high rates of PTSD and other related psychological symptoms. 2,4,36 This may in part be explained by the severe trauma survivors experienced and the relative lack of professional or even community program resources in Rwanda to address this need for post-Tutsi genocide mental health care. Clearly, interventions are needed to address these stubbornly persistent trauma experiences in the Tutsi genocide survivors. ...
Chapter
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The presence and intensity of trauma symptoms before and after Community Resiliency Model interventions werestudied in Huye, Nyamagabe and Nyaruguru districts within Southern Province of Rwanda.The quasi-experimental design was used with an experimental group and control group during six months. The intensity of trauma symptoms among participants before CRM skills training was higher in the two groups. After CRM skills trainings, a significant difference of trauma symptoms among these two groups was observed and within experimental group, the trauma symptoms were significantly decreased (t=37, p=.000). This explains the CRM skills contribution in trauma healing and improving mental health.Keywords : CRM; resilience; survivors; trauma healing
... One significant component of the TRP was to estimate the prevalence of post-traumatic stress reactions among Rwandans based on the Western psychiatric diagnosis of post-traumatic stress disorder (PTSD); this part of the programme was called the National Trauma Survey. It was a nationwide epidemiological survey involving 3030 children aged 8-19 years and estimated their experience of traumatic events and post-traumatic stress reactions ( Dyregrov et al., 2000, Neugebauer et al., 2009. The survey applied the Wartime Violence Checklist to identify experience of traumatic events and the Impact of Events Scales ( Horowitz et al., 1979), which was revised for use in Rwandan children by Dyregrov et al. (2000) to identify post-traumatic stress reactions. ...
... It was a nationwide epidemiological survey involving 3030 children aged 8-19 years and estimated their experience of traumatic events and post-traumatic stress reactions ( Dyregrov et al., 2000, Neugebauer et al., 2009. The survey applied the Wartime Violence Checklist to identify experience of traumatic events and the Impact of Events Scales ( Horowitz et al., 1979), which was revised for use in Rwandan children by Dyregrov et al. (2000) to identify post-traumatic stress reactions. Neugebauer et al. (2009), who were involved in the National Trauma Survey project, argued that those measurements correspond to the PTSD diagnostic criteria, including re- experiencing, avoidance/numbing, and arousal, according to the Diagnosis and Statistic Manual version IV by the American Psychiatric Association (APA, 1980). ...
Thesis
This thesis explores the ways in which local communities in Musanze, northern Rwanda, heal psychosocial suffering from the war period between 1990 and 2000 in the context of limited humanitarian aid. Employing a narrative approach, it unpacks experience of psychosocial suffering, elaborates the ways in which communities heal themselves, and describes the meaning of ‘healing’ in the light of local views of morality, life and death. Qualitative analysis drew on participant observation, in-depth interviews, and focus-group discussions based on ten months of ethnographic fieldwork, which built on prior life and work experience in the field over two years. Findings first describe local conceptualizations of psychosocial sufferings. These fell on a spectrum constructed by the degree of social disconnection reported by participants and how far their thoughts and memories were oriented towards a wounded past. A key element of suffering was the literal ‘unspeakability’ of many wounds due to politically-sensitive circumstances. This related to difficulties in making sense of what they have experienced. Narratives of healing pathways described a common theme of leaving the past behind and going forward to the future through participation in different communities, including church-based groups, traditional mutual-saving groups, and neighbourhood relationships. In the context of the unspeakability of many wounds, communities provided alternative ways of healing from ‘speaking’ of wounds directly. These include: allowing members to make sense of their sufferings through religious and traditional activities, everyday-life practices, and life-event ceremonies. The thesis highlights that, in this setting, healing is not conceptualized as ‘recovery’ as assumed by Western theories, but rather, as a trajectory of ‘life goes on’: that is, that time continues into the future. In this emic experience of healing, the focus is not on traumatic time but on time ‘being lived’ as part of life, and a series of lives handed over from generation to generation, through sharing everyday life and significant life events. In other words, healing can take place through social connection in a wider time-scale than trauma.
... Lenore Terr, who showed that traumatic events adversely affect the mental well-being of children for the first time 38 , pointed out everlasting effects of childhood traumatic events on mental health 39 . Other studies which investigated effects of traumatic events on psychosocial wellbeing of children also have shown the adverse results of such experiences on mental health 1,2,40,41 . Beyond the traumatic events to which refugee children had been exposed before the flight, they commonly face various stressors in the resettlement 5,42 . ...
Article
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Background: Turkey is the leading refugee-hosting country in the world. However, there are few studies which investigate mental wellbeing of refugee children in Turkey. Objective: The paper aims to examine the prevalence of emotional and behavioural problems and associated risk factors among Syrian refugee minors in Turkey. Methods: The research involved 85 students from 2 th to 8 th grades. We investigated emotional and behavioural problems with parent-reported Arabic form of Strength and Difficulties Questionnaire (SDQ). Socio-demographical findings and children's war-related experiences were also examined. Results: The study sample consisted of 49 (63.6%) girls, and 28 (36.4%) boys (total 77) from age 7 to 17. Average time after resettlement was 29.8 ± 11.2 (5 to 50 months) months. 66 (85.7%) children reported to had lost at least one familiar person due to the war. The mean experienced war-related traumatic events were calculated as 2.92 ± 1.86. Total difficulty scores of 30 (39.0%) children were above the cut off values. The rates of children whose SDQ problem scores exceeded the cut-off values were as high as 45.5% (35) for Emotional problems, 64.9% (50) for Peer, 27.3% (21) for conduct and 19.5% (15) for Hyperactivity problems. Discussion: Results indicate high prevalence rates of severe traumatic experiences and possible psychiatric disorders among child survivors of Syrian war which in its seventh year now.
... There is an active debate in the literature regarding whether to conceptualize experiences of adversity and trauma, such as maltreatment, as "formative" or "reflective" indicators (Dovran et al., 2013;Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000;Netland, 2001). Measurement models that treat items as formative indicators, such as in principal components analysis (PCA), group items into composite variables, whereas reflective models such as factor analysis assume that scores on observed indicators reflect an underlying latent construct (Widaman, 2007). ...
Article
Child maltreatment is a complex and multifaceted construct in need of advanced statistical techniques to improve its measurement. The current study compared the predictive utility of a cumulative index to a factor analytic approach for constructing a measure of maltreatment. Data were from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (Wave III: n = 14,800; Wave IV: n = 12,288). As adults, participants retrospectively reported on their childhood experiences of physical abuse, sexual abuse, emotional abuse, physical neglect, supervisory neglect, and social services investigations. Both the cumulative index and a two-factor solution showed evidence of convergent validity, predicting lifetime incidence of homelessness, being paid for sex, and various measures of running away or living apart from biological parents, and prospectively predicting depression, substance use, and criminal behavior. The latent variables, derived from a factor analytic approach, had greater explanatory power for many outcomes compared to the cumulative index, even when controlling for sociodemographic variables. Results suggest that factor analysis is a better methodology than a cumulative index for measuring maltreatment in large datasets when explanatory power for external outcomes is of greatest concern.
... The diverse approaches that services offer have largely arisen from within the professional knowledge base of the founding practitioner(s) and are, thus, influenced by their professional 'philosophical' orientation towards children. Coupled with practitioners' broadening understanding derived from their work with families where a child had been bereaved, approaches and strategies were also influenced by an increase, during the 1980s and 1990s, in research on childhood bereavement (Black, 1983(Black, , 1991(Black, , 1996Black & Urbanowicz, 1987;Pennells & Smith, 1995;and Worden (1996) followed by -among others -Christ, 2000;Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000). As a result of the synergy of practice, experience, and research, practitioners were 'beginning to get the texture of evidence as well as practice' (Monroe, 2013). ...
Article
Childhood bereavement services are a relatively recent form of child welfare provision in the UK. They are predicated on assumptions about the development of children and on an increasing research base that describes the potential impact of childhood bereavement and that support following bereavement is beneficial. UK services largely began as a result of practitioners responding to the needs of bereaved children. Over time, services have become more formalised into an organisational framework, contributing to and influenced by practice based experience, research and training. They have become more sophisticated and wide-ranging in their response to the needs of bereaved children for which there is evidence of a favourable impact on their wellbeing. More importantly, as a structural form of provision now embedded within the UK’s health and social landscape, childhood bereavement services have had a significant impact on social policy and the wider cultural discourse concerning bereaved children.
... In April of 1994, the genocide against the Tutsis occurred in Rwanda. UNICEF (Chauvin, Mugaji, & Comlavi, 1998;Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000) reported that between April and July, approximately 800,000 to 1 million people of Tutsi ethnic background were systematically murdered by Hutu extremists, the Interahamwe. Subsequently, in 2003 a presidential decree was released to pardon and reintegrate genocide perpetrators/prisoners back into their community. ...
Conference Paper
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The author introduces rural communities in post-Genocide Rwanda, where needs for interpersonal and psychosocial reconciliation between survivors and perpetrators of the 1994 Genocide against the Tutsis are grave. The author illuminates unintended yet common side effects of forgiveness-seeking as a method of interpersonal reconciliation, including the dignity injuries this approach has brought to survivors. An overview of an alternative approach to interpersonal reconciliation, termed Action-Based Psychosocial Reconciliation Approach, will be introduced along with its conceptual-empirical foundations and beneficial effects. The second half of the paper discusses the author’s personal reflections on how his training in the context of Canadian counselling psychology has shaped and continues to guide his ongoing work supporting community psychosocial reconciliation in Rwanda. The author shares his views on the relational signature of the counselling psychological approach, its applied nature, a directionality of scholarship, its harmonious fit with the field of mental health services research and praxiological epistemology, and ethicality of engagements. The author concludes with a call to fellow Canadian counselling psychologists for their active participation in international/global endeavours.
... The IES-R is a frequently used scale with robust evidence supporting its reliability and validity (Weiss, 2007;Feuerherd, Knuth, Muehlan, & Schmidt, 2014). It has been used in several developing countries, including Rwanda (Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000) and South Africa (Kagee, 2005). In the current study, alpha for the IES-R was .89. ...
Article
This cross-sectional study examined religious coping, dispositional forgiveness, and posttraumatic outcomes (posttraumatic stress and growth) among adult survivors of the Liberian Civil War (1989-2003). This study contributes to the literature on religion/spirituality, forgiveness, and trauma in post-conflict African contexts. Participants were 407 adult survivors recruited in 2011 from a faith community in Liberia and a Liberian refugee camp in Ghana. Participants completed the Brief RCOPE, Heartland Forgiveness Scale, Impact of Event Scale–Revised, and Posttraumatic Growth Inventory. Relative to men, women reported lower levels of positive religious coping, dispositional forgiveness, and perceived posttraumatic growth; however, there were no sex differences in negative religious coping or posttraumatic stress. Directly exposed survivors (who experienced or witnessed the war as a combatant or noncombatant) reported higher levels of posttraumatic stress and lower levels of dispositional forgiveness and perceived posttraumatic growth, relative to indirectly exposed survivors (whose family members or close associates experienced or witnessed the war). Regression-based analyses indicated that dispositional forgiveness partially mediated (explained) the relationship between positive religious coping and perceived posttraumatic growth. These findings suggest that, in post-conflict African contexts, there may be differences in religious and posttraumatic outcomes based on sex and on war exposure. Moreover, survivors may engage in positive religious coping because it can help promote forgiveness toward others (and possibly themselves) and may help to restore a personal (and possibly communal) sense of meaning and purpose, enabling them to experience perceived posttraumatic growth.
... indicators (Dovran et al., 2013;Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000;Netland, 2001). Measurement models that treat items as formative indicators, such as in principal components analysis (PCA), group items into composite variables, whereas reflective models such as factor analysis assume that scores on observed indicators reflect an underlying latent construct (Widaman, 2012). ...
Article
Exposure to childhood adversity – such as maltreatment, violence, and living in poverty – is related to problems with health and wellbeing across the lifespan. The present research aimed to improve measurement of one form of childhood adversity (maltreatment) and explore the role of adversity in one developmental process (goal setting and appraisals) through which it may impact outcomes. Chapter 1 compared two methods of measuring maltreatment using retrospective self-report items in a nationally representative dataset. Both a cumulative index and a two-factor solution showed evidence of convergent validity, but the latent factors explained more variance in many outcomes even controlling for sociodemographic variables. Chapters 2 and 3 explored the role of adversity in adolescents’ goals for their academic futures and its relation to their actual educational outcomes. In the study described in Chapter 2, adolescents generated personal goals and rated each goal on support for and likelihood of achieving it. Controlling for grades, adolescents with more externalizing problems set fewer academic goals, and adolescents with more adverse childhood experiences and social networks characterized by higher levels of social strain appraised their goals as less supported and less achievable. In addition, adolescents’ appraisals of their academic goals, but not how many academic goals they set, predicted their grades prospectively. Chapter 3 used a quasi-experimental sibling comparison design to test whether adolescent’s appraisals of their likelihood of going to college influence their later educational attainment. Controlling for grades and IQ, adolescents who had more optimistic college appraisals than their sibling also had higher educational attainment; this was particularly true for youth in higher socioeconomic status families. However, college appraisals were not related to educational attainment among youth living in poverty and with parents with low educational attainment. Together, results of Chapters 2 and 3 suggest that optimistic appraisals of academic goals promote better academic outcomes, but the context of adversity/low socioeconomic status, and relatedly, social strain, dampens the benefits of optimistic goal appraisals. This points to increasing supports to help adolescents exposed to adversity feel that their academic goals are more supported and achievable, and ultimately improve academic outcomes for youth.
... 28 The Event Scale by Horowitz et al 29 is a 15-item scale designed to assess the nature and extent of exposure to various war events. 30 Thus, the answers indicate whether an event occurred before, during or after captivity (multiple answers possible), and whether the respondent witnessed the event or experienced it personally. ...
Article
Background Survivors of Islamic State of Iraq and Syria (ISIS) captivity are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD). Aims This study looks at the correlation between sexual abuse, shame, somatoform or bodily distress disorders, and dissociative seizures (psychogenic non-epileptic seizures). Method The psychological effects of traumatic events and dissociative seizure were assessed in Yazidi women who were held captive by ISIS in Northern Iraq between 2014 and 2018. These effects were examined comparing 64 women who were held captive and sexually abused by ISIS with 60 women suffering from PTSD who were not held captive and sexually abused by ISIS. Structured clinical-psychological interviews and established psychometric questionnaires were used to assess mental disorders especially dissociative seizures and somatoform disorders, and shame related to trauma. Results Women who were held captive by ISIS showed a significantly higher prevalence of dissociative seizures (43.7%; P = 0.02) and somatisation disorder (38.7%; P = 0.02), as well as depressive (75.0%; P = 0.42) and anxiety disorders (62.5%; P = 0.44), than women who were not held captive and sexually abused by ISIS. Dissociative disorders were identified in 40.6% (P = 0.36) of those female Yazidi who experienced sexual violence while being held captive. Conclusions Shame in connection with sexual violence seems to play an important role in negative self-perception after rape. Dissociation not only plays an important role in unprocessed childhood trauma with feelings of shame, but also in more recent trauma experiences with shame.
... Post-traumatic stress disorder (PTSD) is commonly observed in children exposed to armed conflicts, such as in Lebanon (Saigh, 1989) (current prevalence of 32.5%), Rwanda (Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000) (79%), Kuwait (Nader, Pynoos, Fairbanks, al-Ajeel, & al-Asfour, 1993) (70%), Palestine (Thabet, Abu Tawahina, El Sarraj, & Vostanis, 2008) (41%), Afghanistan (Mghir, Freed, Raskin, & Katon, 1995) (34%), or Bosnia (Papa georgiou et al., 2000) (29%). Perkins, Ajeeb, Fadel, and Saleh (2018) found a high current prevalence of PTSD in children in Syria (35.1%), which has been affected by war for several years. ...
Article
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Background: There is a dearth of therapeutic solutions for traumatized young patients. Trauma reactivation conducted under the influence of the reconsolidation blocker propranolol (Reconsolidation Therapy) is a simple, cost-effective treatment option that has some promising initial results in adults suffering from posttraumatic stress disorder (PTSD). Objective: To explore the usefulness of this novel treatment in children. The primary outcome was the reduction of PTSD symptoms at the end of treatment, while secondary outcomes included reduction in anxiety and in depressive symptoms. Method: An open-label clinical trial was conducted in a refugee camp in Syria, investigating the safety and efficacy of this therapeutic strategy in 117 children suffering from enduring PTSD symptoms. Participants received propranolol 90 minutes before briefly recalling (i.e. reactivating) a single personal traumatic memory, for 5 consecutive days. Self-reported anxiety, depressive, and PTSD symptoms were assessed at baseline, as well as 4 and 13 weeks after treatment. Results: A significant, clinically meaningful symptom reduction was observed at all post-treatment measurement times vs. baseline. More specifically, between baseline and the 13-week follow-up we observed a 64% PTSD symptoms reduction (d = 2.71). In a similar vein, we obtained a 39% symptoms reduction for depressive symptoms (d = 1.01). The general anxiety symptoms improved, but eventually returned to prior level, probably because of the deteriorating living conditions in the camp. Conclusions: This therapy appeared as a potentially safe and useful treatment strategy for children suffering from PTSD symptoms, warranting replication studies using stronger study designs. The social acceptability and ease of implementation of the treatment should also be noted.
... In this regard, children may have a sense of insecurity and altered daily functioning after they have been exposed to war-traumatic events (3). Children and adolescents growing up with political violence and terrorism are vulnerable to intense psychological effects (4)(5)(6), which lead to psychiatric symptomatology (7,8). The psychiatric symptomatology varied according to the context of war that the children live in, cultural specific psychiatric symptoms, the type of the trauma, the number of ongoing traumatic and stressful events that the child has experienced, and the impact of the traumatic event on the children's mental health (9)(10)(11)(12). ...
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Background After the war, which was conducted against Palestinian civilians in the Gaza Strip, the prevalence of posttraumatic stress disorder (PTSD) among children and adolescents has increased. The counselling department at the Ministry of Education in the Gaza Strip applied a counselling program in schools in order to alleviate the effect of exposure to war. The aim of the study is to investigate the effectiveness of the counselling program after exposure to war-traumatic events among Palestinian children and adolescents in the Gaza Strip.Methods The sample consists of 572 students aged 12–18 years old. Of them, 331 (57.9%) were female and 241 (42.1%) were male. Traumatic events were measured by War-Traumatic Events Checklist (W-TECh). PTSD was measured by the Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS). Anxiety symptoms were adapted from The Anxiety Symptoms Scale, and depression symptoms were measured by Child Depression Inventory. Repeated measures design was employed as the counselling program was applied in all the schools at the same time. Specifically, the data were collected from the participants before the application of the counselling program and 2 months later.ResultsAfter applying the school-based counselling program, the prevalence of PTSD (according to DSM-V) decreased from 57.5% to 45.6% among the children and adolescents who were exposed to war-traumatic events. In addition, PTSD symptoms, and emotional, somatic and cognitive functional impairment symptoms has decreased after the implementation of the counselling program especially amongst girls.Conclusions The school-based counselling program was effective in decreasing the PTSD symptoms among children and adolescents after the exposure to war-traumatic events.
... Both short-and long-term negative consequences of exposure to the conflict have been documented. Short-term effects included distress, shock, fear, phobic avoidance of public places, anger and emotional pain [122,123], and aggressive behavior [124], while long-term effects included PTSD [125,126], anxiety, and depression [127][128][129], and sub-clinical symptoms [130]. These findings suggest the need to apply interventions at the earliest possible time postexposure to traumatic events associated with war and its aftermath affects mental health at both the individual and community levels [54]. ...
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Conflict can be a primary driver of health inequalities, but its impact on the distribution of social determinants of health is not very well documented. Also, there is limited evidence on the most suitable approaches aiming at addressing health inequalities in post-conflict settings. Thus, we undertook a systematic review of the literature concerning the current knowledge and knowledge gaps about structural determinants of health inequalities and assessed the effects of approaches aimed at addressing health inequalities in post-conflict settings. We performed a systematic search in bibliographic databases such as Web of Science, PubMed, and PsycINFO for relevant publications, as well as institutional websites that are relevant to this topic. The search was initiated in March 2018 and ultimately updated in December 2020. No time or geographical restrictions were applied. The quality of each study included in this review was independently assessed using criteria developed by CASP to assess all study types. Sixty-two articles were deemed eligible for analysis. The key findings were captured by the most vulnerable population groups, including the civilian population, women, children, internally displaced persons (IDPs), and people with symptoms of mental illness. A considerable range of approaches has been used to address health inequalities in post-conflict settings. These approaches include those used to address structural determinants of health inequalities which are accountable for the association between poverty, education, and health inequalities, the association between human rights and health inequalities, and the association between health inequalities and healthcare utilization patterns. However, these approaches may not be the most applicable in this environment. Given the multifactorial characteristics of health inequalities, it is important to work with the beneficiaries in developing a multi-sector approach and a strategy targeting long-term impacts by decision-makers at various levels. When addressing health inequalities in post-conflict settings, it may be best to combine approaches at different stages of the recovery process.
... One study has shown a negative link between the severity of traumatic experiences related to the genocide and short-term memory capacity, more than 20 years after the genocide (Blanchette et al., 2019). Another study showed impaired memory skills in Rwandan orphans, four years after the genocide (Dyregrov et al., 2000). Further, studies have documented that music has had a positive impact in reducing stress and anxiety in exposed populations in Rwanda (Walworth, 2003;Pelletier, 2004;Panteleeva et al., 2017;de Witte et al., 2019). ...
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Previous research shows that listening to pleasant, stimulating and familiar music is likely to improve working memory performance. The benefits of music on cognition have been widely studied in Western populations, but not in other cultures. The purpose of this study was to explore the impact of music on working memory in a non-Western sociocultural context: Rwanda. One hundred and nineteen participants were randomly assigned to a control group (short story) or one of four different musical conditions varying on two dimensions: arousal (relaxing, stimulating) and cultural origin (Western, Rwandan). Working memory was measured using a behavioral task, the n-back paradigm, before and after listening to music (or the short story in the control condition). Unlike in previous studies with Western samples, our results with this Rwandan sample did not show any positive effect of familiar, pleasant and stimulating music on working memory. Performance on the n-back task generally improved from pre to post, in all conditions, but this improvement was less important in participants who listened to familiar Rwandan music compared to those who listened to unfamiliar Western music or to a short story. The study highlights the importance of considering the sociocultural context in research examining the impact of music on cognition. Although different aspects of music are considered universal, there may be cultural differences that limit the generalization of certain effects of music on cognition or that modulate the characteristics that favor its beneficial impact.
... It has been argued that "[t]he notion of resiliency in children could easily become a new form of denial of trauma among children, whereby political systems evade responsibility for helping war-traumatized children". 19 Contributions in this issue uncover the complex and ambivalent nature of children's experience that finds strength and resilience during traumatic events. ...
Article
Childhood in the crossfire: How to ensure a dignified present and future for children affected by war - Volume 101 Issue 911 - Ellen Policinski, Kvitoslava Krotiuk
... Regrettably, children bear the health implications even way beyond the conflict as a result of exposure to infectious diseases, acute malnutrition and general poor sanitation. This view was confirmed by [33] having interviewed 3030 children aged 8 -9 years from Rwanda after the genocide and found that many were still traumatized by the genocide events. The authors attributed this to witnessing the killing of their loved ones, dead bodies and destruction of their homes. ...
... As a result, children may have feelings of unsafety and altered daily functioning when they are exposed to war-traumatic events (3). Moreover, children and adolescents growing up in situations of political violence and terrorism are vulnerable to damaging developmental consequences (4) and intense psychological effects (5)(6)(7)(8); these, in turn, can lead to psychiatric symptomatology (7,(9)(10)(11). ...
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Background The situation in the Gaza Strip is uncommon in the frequency with which children are exposed to war-related traumatic events on a daily basis and because of the long-term nature of the conflict. The prevalence of posttraumatic stress disorder (PTSD) among children and adolescents in the Gaza Strip increased after the recent wars. The aims of the study are: To investigate the prevalence and nature of war traumatic events and PTSD; and to investigate how these traumatic events predict PTSD when taking into account demographic and socioeconomic status factors amongst Palestinian children and adolescents in the Gaza Strip.Methods The sample consists of 1,029 school pupils (11–17 years old): 533 (51.8%) were female and 496 (48.2%) were male. War-Traumatic Events Checklist (W-TECh) Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS) were used.ResultsThe majority of children and adolescents experienced personal trauma (N: 909; 88.4%), witnessed trauma to others (N: 861; 83.7%) and observed demolition of property (N: 908; 88.3%) during the war. Compared to girls, boys showed significantly more exposure to all three event types as well as overall traumatic events. Results also demonstrated that the prevalence of DSM-V PTSD diagnosis was 53.5% (N = 549). Further, children who had experienced personal trauma, trauma to others, and the demolition of property were significantly more likely to be diagnosed with PTSD compared to those who had not, even when adjusting for demographic and socioeconomic factors. The strongest war trauma for PTSD is personal trauma followed by witnessing trauma and then observing demolition of properties.Conclusions The study provides valuable evidence that demographic and socioeconomic factors mediate the relationship between different war traumatic events and PTSD. Interventions should take into account the children’s background including their gender, age, where they live, and their socioeconomic status (e.g., family income, parents' educational level, family size) to alleviate the psychological symptoms and to enhance their resilience.
... Posttraumatic stress symptoms, such as those evident in paediatric medical traumatic stress, have been demonstrated to exist across cultures and societies (Dyregrov, Gupta, Gjestad, & Raundalen, 2002;Ehntholt & Yule, 2006, p. 1198Foa, Keane, Friedman, & Cohen, 2008); with studies of children and adolescents from LMICs including Afghanistan (Mghir, Freed, Raskin, & Katon, 1995), Bosnia-Hercegovina (Papageorgiou et al., 2000;Smith, Perrin, Yule, Hacam, & Stuvland, 2002), Cambodia (Sack, Seeley, & Clarke, 1997), India (Kar et al., 2007), Kuwait (Nader, Pynoos, Fairbanks, Al-Ajeel, & Al-Asfour, 1993), Lebanon (Saigh, 1991), Palestine (Thabet & Vostanis, 1999) and Rwanda (Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000). Further, there is cumulating evidence demonstrating that risk factors for the development of posttraumatic stress symptoms in children, adolescents and adults are consistent across cultures (Dyregrov et al., 2002;Ehntholt & Yule, 2006;Sack et al., 1997;Schnyder et al., 2016;Smith et al., 2002). ...
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Background: Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective: To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method: Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t-tests and multiple regression. Results: Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions: There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries.
... In Africa, a study was attempted using the IES-R in Rwanda after the genocide event, and reported trauma-related reactions among the Rwandese children who survived the traumatic event (Dyregrov, Gupta, Gjestad & Mukanoheli, 2000). ...
Article
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The study sought to investigate the possibility of PTSD in a community that has been a conflict zone for many years. In particular, we wanted to investigate whether or not IES-R could be used. We wanted to determine the factor structure of the IES-R in the community and finally to investigate whether any differences existed between males and females with regard to the possibility of PTSD amongst the people in the community. Purposive sampling was used to sample opinion leaders in the community. Secondly the multi-stage sampling method was used to select people from the various factions of the community. Finally the lottery method of simple random sampling was used to get to the households. The results indicated a high level of PTSD symptoms in the community. There was no significant difference between males and females with regard to possible PTSD symptoms. The internal consistence of .95for the IES-R was found to be useful for research and clinical work. Only two factor structure was found in the sample but with moderate correlation. The hyper-arousal subscale correlated highly with the intrusion subscale. Crohnbach alpha for the subscales were also high. Limitations in respect of item translation could have accounted for the two factor structure and therefore limits its generalisability.
... The majority of research on political violence and psychological functioning has tended to focus on the first tier, applying cross-sectional designs to document the psychological effects of exposure to political violence. The bulk of these studies look at the association between experiences of violence and post-traumatic stress disorder (PTSD) in a variety of armed conflicts around the world (e.g., Allwood, Bell-Dolan, & Husain, 2002;Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000;Lavi & Solomon, 2005;Smith, Perrin, Yule, Hacam, & Stuvland, 2002). Others have also documented rates of depression (Brajša-Žganec, 2005;Giacaman, Shannon, Saab, Arya, & Boyce, 2007;Klasen et al., 2010;Kohrt et al., 2008;Thabet et al., 2004) or a combination of internalizing, externalizing, and somatic problems (Abdeen, Qasrawi, Nabil, & Shaheen, 2008;Goldstein, Wampler, & Wise, 1997;Llabre & Hadi, 2009;McAloney, McCrystal, Percy, & McCartan, 2009;Okello, Onen, & Musisi, 2007;Paardekooper, De Jong, & Hermanns, 1999;Vizek-Vidović, Kuterovac-Jagodić, & Arambašić, 2000). ...
Article
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Growing up in the aftermath of armed conflict puts youth at a higher risk for psychopathology-particularly in societies like Northern Ireland which continue to be characterized by intergroup tension and cyclical violence. This risk may be heightened during adolescence, when youth are beginning to explore their identities and are becoming more aware of intergroup dynamics in both their immediate communities and the broader society. It is also during this stage when youth increasingly witness or engage in antisocial behavior and sectarian activities. A series of studies in Belfast conducted by Cummings et al. (2014, Child Dev Perspect, 12(1), 16-38; 2019, J Clin Child Adolesc Psychol, 48(2), 296-305) showed that adolescents' exposure to sectarian violence resulted in heightened emotional insecurity about the community and subsequent adjustment problems. Though the impact of direct exposure to violence is well documented, few studies have accounted for the influence of sectarianism that occurs outside of one's immediate environment. These influences may include the general climate surrounding events that are not experienced firsthand but are nonetheless salient, such as the overarching levels of tension between groups or societal discourse that is threatening to one's identity. These higher-level influences, often referred to collectively as the macrosystem, are a necessary component to consider for adequately assessing one's socio-developmental environment. Yet, measurement at this level of the social ecology has proven elusive in past work. The current study advances research in this area by using newspaper coding as a method of measuring the political macrosystem in Northern Ireland and assessing whether a tense or threatening climate serves as an added risk factor for youth living in Belfast. In the current study, we measured sectarian violence at the level of the macrosystem by systematically collecting and coding newspaper articles from Northern Ireland that were published between 2006 and 2011 (N = 2,797). Each article was coded according to its level of overall political tension between Catholics and Protestants, threat to Catholics, and threat to Protestants. When aggregated, these assessments reflected the overarching trends in Catholic-Protestant relations during this period. In order to assess the association between these sociopolitical trends and the direct experiences of adolescents, the newspaper coding was linked with five waves of survey data from families (N = 999) in socioeconomically disadvantaged areas of Belfast. Using a series of multilevel moderation analyses, we then tested whether intergroup tension and ingroup threat moderated the relation between adolescents' direct exposure to violence and their emotional insecurity. These analyses were followed by a thematic analysis of the coded newspaper articles in order to provide further context to the findings. The results indicated that adolescents' response to direct exposure to sectarian violence varied based on the political climate at the time of their interview. Overall, the adolescents' emotional insecurity about the community increased with exposure to sectarian violence. During periods when the sociopolitical climate was characterized by high levels of intergroup political tension, this relation was slightly weaker-regardless of the adolescents' ingroup (i.e., Protestant vs. Catholic). During periods when the sociopolitical climate was coded as threatening, this relation was weaker for Catholic adolescents. That is, high levels of macro-level threat-particularly events coded as threatening for Protestants-seemed to be a protective factor for Catholic adolescents. Group differences were also found based on the adolescents' cumulative amount of exposure to sectarian violence. As threat in the macrosystem increased, Catholic adolescents who were directly exposed to higher than average levels of sectarian violence became more emotionally secure, while Catholics with little to no exposure to violence became more insecure. Contrastingly, Protestant adolescents directly exposed to higher than average levels of sectarian violence were more insecure than Protestants with little to no violence exposure. A thematic analysis of the newspaper articles revealed the categories of events that were viewed by coders as politically tense and threatening. Five primary themes emerged: ineffective policing and justice, family and community unrest, memories of violence, destabilized leadership, and organized paramilitary activity. Many of the articles coded as most threatening reported on a spike in attacks organized by dissident republican groups-that is, members of the Catholic community with, particularly hardline views. This may be pertinent to the finding that associations between sectarian violence exposure and emotional insecurity were exacerbated during this time for Protestants but not for Catholics. Findings from the thematic analysis provide a deeper examination of the context of events taking place during the study period, as well as their potential bearing on interpretation of the macro-level effects. In conclusion, these findings illustrate how one's response to the immediate environment can vary based on shifts in the political macrosystem. The current study thus contributes conceptually, empirically, and methodologically to the understanding of process relations between multiple levels of the social ecology and adolescent functioning. These results may further inform the design of future interventions and policies meant to lessen the impact of political violence. The methods used here may also be useful for the study of other contexts in which macrosystem effects are likely to have a salient impact on individual wellbeing.
... However, the service was used by less than one percent of the target population as it was disconnected from the cultural context (Chauvin et al. 2012). Numerous surveys have estimated the prevalence of PTSD and other mental disorders, including among children, typically registering high prevalence rates (Dyregrov et al. 2000;Kayiteshonga et al. 2018;Munyandamutsa et al. 2012;Schaal and Elbert 2006). There has been increasing attention to the well-being of the 'second generation' born after 1994, amid concerns of ITT (Berckmoes et al. 2017;Rudahindwa et al. 2020). ...
Article
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The intergenerational legacies of conflict and violence for children and young people are typically approached within research and interventions through the lens of trauma. Understandings of childhood and trauma are based on bio-psychological frameworks emanating from the Global North, often at odds with the historical, political, economic, social and cultural contexts in which interventions are enacted, and neglect the diversity of knowledge, experiences and practices. Within this paper we explore these concerns in the context of Rwanda and the aftermath of the 1994 Genocide Against the Tutsi. We reflect on two qualitative case studies: Connective Memories and Mobile Arts for Peace which both used arts-based approaches drawing on the richness of Rwandan cultural forms, such as proverbs and storytelling practices, to explore knowledge and processes of meaning-making about trauma, memory, and everyday forms of conflict from the perspectives of children and young people. We draw on these findings to argue that there is a need to refine and elaborate understandings of intergenerational transmission of trauma in Rwanda informed by: the historical and cultural context; intersections of structural and ‘everyday’ forms of conflict and social trauma embedded in intergenerational relations; and a reworking of notions of trauma ‘transmission’ to encompass the multiple connectivities between generations, temporalities and expressions of trauma.
... The mental health consequences for civilians who are victims of conflict have been well studied. PTSD and MDD are prevalent among those affected (Morina et al. 2018;Thabet and Vostanis 1999), especially when conflict results in displacement (Miller and Rasmussen 2016), and the effects can last from childhood to adulthood (Dyregrov et al. 2000). ...
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The connections between climate change and mental health are well known (Berry et al., Int J Publ Health 55(2):123–132, 2010; Clayton and Manning 2018; Kim et al., J Environ Sci Health C 32(3):299–318, 2014). Research also points to the positive impacts of nature on mental health, well-being, and attention (Capaldi et al., Int J Wellbeing 5(4):1–16, 2015; Kaplan and Kaplan 1989; Tillmann et al., J Epidemiol Community Health 72(10):958–966, 2018). However, no empirical research has examined how degradation of nature as a result of climate change can impact the mental health benefits that nature provides. This paper first reviews the existing research on the negative mental health consequences of climate change and the benefits of nature exposure for stress, mental health, and well-being. The connection between these two lines of research is examined in order to fully understand the impacts of climate change on mental health. Suggestions for future research are included.
... In the case of child and adolescent refugees, many have been exposed to experiences of persecution, violence, war, killing, or torture as well as the subsequent losses, which increase the risk of psychological distress and psychiatric disorders. PTSD symptoms have been found in children exposed to persecution, war, and organized violence in many parts of the world, including Cambodia, [6] Rwanda, [7] Kuwait, [8] Palestine, [9] Afghanistan, [10] Bosnia, [11] and Cuba. [12] ...
Article
This article explores how family framings of childhood experiences of violence shape Rwandan artistic responses to the 1994 genocide against the Tutsi. It examines work by both child survivors of genocide and Rwandans who grew up in exile. This enables consideration of the longer legacies of violence that began against the Tutsi nearly 60 years ago, alongside the more recent aftermath of genocide. While child survivor narratives frame memory as fragile, an ongoing challenge negotiated alongside the demands of daily life and remaining family relationships; returnee narratives demonstrate a stronger intergenerational historical thread, which is nevertheless complicated by the overlaying of parental memories with the younger generation’s personal contact with violence. Drawing on specific examples of artistic testimony – two memoirs, a photo essay, two solo performances, a feature film and a novel – this analysis links different genres with particular framings of family memory and examines complex identities in post-genocide Rwanda.
Article
Background Former child soldiers are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD); however, their comprehensive mental health has yet to be examined. Aims This study looks at the prevalence of PTSD, depression and associated risk factors such as disturbed self-esteem among former child soldiers of the so-called ‘Islamic State’. Method The psychological effect of traumatic events was assessed in 81 Yazidi children who had been child soldiers for the Islamic State in northern Iraq between 2014 and 2017 for at least 6 months. The children were between 8 and 14 years of age. Thirty-two Yazidi boys and 31 Muslim boys who were not child soldiers in Iraq served as control groups. A structured psychological interview and established psychometric questionnaires were used to assess traumatisation and mental disorders. Results The child soldiers showed a significantly higher prevalence of PTSD (48.3%), depressive disorders (45.6%), anxiety disorders (45.8%) and somatic disturbances (50.6%) than the boys who had not been child soldiers. Developmentally crucial self-esteem was significantly reduced in former child soldiers. No significant differences between the two control groups could be found. Conclusions PTSD and other mental disorders are highly present among former child soldiers in northern Iraq. The study highlights the huge and as yet unmet need for psychological services among former child soldiers. Declaration of interest None.
Article
Background In August 2014, the Islamic State in Iraq and Syria (ISIS) attacked the Sinjar district and destroyed several villages and towns and killed several individuals. Aim In this study, the Yazidi young women who survived the ISIS attack were encouraged to express their lived experiences through paintings following participation in a 6-month art-based intervention program. Methods A total of 13 Yazidi Kurdish females aged 18 to 25 years (Mean: 21.7 years) were invited to participate in an art-based (drawing and painting) course for 6 months in 2018. They were invited to draw or paint images that portrayed their lived experiences of attack and capture by the ISIS. Qualitative research situated within feminist methodology was used with the young women in this study. The interviews were analyzed using the descriptive content analysis method. Results The paintings and narratives of the participants were constructed into three main themes: fear and traumatic experiences; feeling of hopelessness; and freedom and hope. During the attack and capture, due to the escape, rape, and horrific treatments by the ISIS fighters, the young women were traumatized severely. They were sold as a sex slave by the ISIS fighters. The participants still had severe anxiety and psychological challenges after being free from the capture. However, despite their traumatic experiences and feeling of hopelessness, most of them were hoping for freedom and a better future. Conclusions This study showed that the Yazidi young females still experienced psychological challenges burdens even 3 years after the traumatic day. However, the participants showed their resilience through feeling hopeful for freedom and a better future.
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The authors apply a positive youth development (PYD) approach to examine self-descriptors of Roma adolescents in domains of positive self-appraisal, self-knowledge and goals, and positive interpersonal relationships. They first quantitatively explore the relationships among self-esteem, ethnic identity, and self-description domains, then use qualitative content analysis to explore youths’ sense of self across domains including future orientations, relationships, and personal characteristics. Intragroup comparisons of self-esteem revealed more positive, less critical self-references among youth with high self-esteem. Additionally, youth with higher ethnic identity scores invoked more descriptors that involved culture or group differences. Despite experiences of isolation and negative self-evaluation, self-descriptors also depicted a deep sense of family closeness and meaningful friendships with peers. The conclusions of this study underscore the existence of positive self-systems among Roma youth despite complex life challenges.
Book
Cambridge Core - African Studies - Rwanda After Genocide - by Caroline Williamson Sinalo
Article
This article describes the migration, resettlement and integration challenges and strengths of members of the African Diaspora in Canada who identify as survivors of the 1994 genocide against the Tutsi of Rwanda. Data were generated from semi-structured interviews with 16 adult community members and a thematic analysis conducted inductively and collectively with the research team consisting of academics and representative community members. This article provides insights into the unique long-term impacts of genocide on migration, resettlement and community-level functioning for this group of African migrants living in a mid-Western city in Canada. Results highlight how Canadian immigration policies limit migration options and prevent family reunification for migrants with none or few remaining family members and the associated resettlement challenges experienced by this group. Results also show the vital role the Rwandan Diaspora community, and particularly other survivors, play in supporting resettlement, integration and overall well-being of genocide survivors.
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The literature on mental health in refugee and post-conflict populations has become quite sophisticated in modeling and measuring psychological distress. However, this has not been matched by development in approaches to measuring exposure to trauma. In this chapter we present three critiques of common practices that limit our understanding of refugee and other war-affected populations’ mental health: (1) using trauma exposure checklists that are limited to measuring trauma types and not events per se, (2) examining trauma exposure data using factor analysis (and reflective-indicator models in general), and (3) ignoring how trauma interacts with pre-conflict conditions in models of psychological distress. We argue that addressing these critiques will bring models of mental health closer to refugees’ experiences. Although not an exhaustive list, solutions should include measuring frequency and schedule of trauma exposure, conceptualizing trauma exposure as a composite variable (as opposed to a latent factor), and identifying how trauma moderates the effects of pre-existing stressors on mental health.
Article
This study examined the challenges and critical psychosocial needs of Syrian refugee families with young children in Western Canada, and the role of cultural brokering in facilitating their psychosocial adaptation. Using a community-based participatory research approach and an adapted critical incident method, the study involved nine Arabic-speaking cultural brokers who were working with Syrian refugee families using holistic supports during early resettlement. Data collected through focus groups and semi-structured interviews are presented in five illustrative case studies, and reveal that Syrian families struggled with feeling safe and secure in Canada, adjusting to the changing roles in the family, and trying to find meaning in their lives. These struggles were attributed to families’ overall challenges navigating various domains of integration (i.e., health, social services, and education), resulting in a heavy reliance on cultural brokers for social linking and bonding activities (Ager & Strang, Journal of Refugee Studies, 21, 166–191, 2008), including connecting families to needed supports and helping family members build relationships with one another. Challenges faced by families mapped onto the five psychosocial needs of Silove’s (Intervention, 11, 237–248, 2013) Adaptation after Persecution and Trauma (ADAPT) conceptual framework as well as most of the core domains of Ager and Strang’s (Journal of Refugee Studies, 21, 166–191, 2008) Social Integration framework. This study provides evidence for the use of both of these frameworks in further studies involving Syrian refugee populations; they proved useful for understanding how families, over time, can develop necessary skills to engage on their own in linking activities with various Canadian institutions and bridging activities with communities at large.
Article
Drawing on a corpus of accounts written by survivor children in 2006, this article looks at the Tutsi genocide through the eyes of children, enabling us to see the radical social and emotional transgressions of 1994 from a new angle. As members of society and prime targets of the genocide, these children tell how the world of their childhood was turned upside-down, through the unique intensity of their own words. An idealized “before”, inhabited by the beloved characters of their parents, brothers and sisters, is brutally swept away as everything they have known becomes inverted. Forced to watch killings and cruelty, they adopt survival strategies that show how thoroughly they understand the radical nature of what is unfolding. An extreme distrust of adults will forever mark these children – now orphans – who still live in “the time of the genocide”.
Article
This study examined 240 adults exposed to the 1998 Nairobi USA Embassy terrorist bombing nine months post-disaster. There were three aims: (a) assess the level of bombing exposure; (b) examine the relationship between traumatic exposure and posttraumatic stress (PTS); (c) evaluate roles of social support, and religious participation on PTS. About 86% of the subjects reported high-level of bombing exposure with 80% falling within the cut off score for high-level clinician concern for severity of PTS. Due to the homogeneous nature of the sample on severity of both bombing exposure and PTS, there were no significant relationships between exposure and PTS. However, social support was negatively related to severity of PTS. Implications of these findings are discussed.
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Background: Prior studies indicated that post-traumatic stress disorder is becoming a global health concern even though still poorly known and treated. In the aftermath of 1994 Genocide against Tutsi, studies found high rates of depressive and anxious symptoms along with PTSD among genocide survivors. Due to the highest cruelty in which the Genocide was committed, genocide survivors still need high special humanitarian services, of those including specialized health care services. The aim of this study was to assess the efficacy of psychosocial group therapies created by AVEGA Agahozo in reducing PTSD symptoms among Genocide survivors in Rwanda, 25 years after 1994 Genocide against Tutsi. Methods: We conducted a comparative cross-sectional study design with a sample of 98 genocide survivors who received group therapy by AVEGA Agahozo. We used a multi-stage random sampling method to select participants and 7 trained psychologists interviewed genocide survivors about their PTSD status before and after treatment using Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The analysis was performed using SPSS version 17.1. Results: The results showed that women were 97.96% and men presented 2.04% of all participants because AVEGA Agahozo mainly focuses on helping women survivors who lost their husbands in Genocide and previous findings also concluded that women are very prone to suffer from PTSD than men. Paired t-test results showed significant differences between symptoms, before and after treatment (P<0.001 in all pairs). Cohen's d results also showed high effect sizes (d>0.5), only in pair 8 where the difference appears to be less significant (d=0.28). The descriptive statistics showed that the severity of PTSD symptoms dramatically reduced after treatment. But this difference of severity is only statistically significant among five (5) PTSD symptoms.: (Marked physiological reactivity after exposure to trauma-related stimuli [P=0.045, x2=38.111]; inability to recall key features of the traumatic event [P<001, x2=56.309]; persistent negative trauma-related emotions [P=0.013, x2=43.184]; self-destructive or reckless behavior [P=0.041, x2=38.535]; hypervigilance [P=0.020, x2=41.596]. Conclusion: Psychosocial group therapies created by AVEGA Agahozo effectively alleviate post-traumatic stress disorder symptoms and severity among genocide survivors.
Article
Rwandan leaders in the health and educational sectors have begun to discuss the necessity for establishing culturally appropriate community-based mental health counselling services in Rwanda, especially trauma counselling. The need for a community psychology approach is anchored in the lingering effects of the genocide and the continuing post-traumatic stress symptoms suffered by many in the population. Capacity building in an effort like this would require the design of multi-level counselling curricula that are sensitive to the social structures within Rwandan culture. These curricular endeavours call for the development of a National Counselling Centre to serve as a structural mechanism for organizing community-based counselling initiatives. We consider the community health services needs in Rwanda here, along with associated challenges and strategies for effective mental health services in a country with a recent history of genocide. A community psychology approach to mental health would benefit Rwandan society by making trauma counselling and recovery services available and accessible to citizens throughout the country.
Book
Cambridge Core - Human Rights - Child Perpetrators on Trial - by Jastine C. Barrett
Article
This paper aims to unpack the empirical and theoretical complexity that surrounds ‘resilience’, with particular attention to its application to war-affected children and youth. We expand current conceptual frameworks to adopt a more inclusive and intergenerational approach that accounts for the added layers of national, global and intergenerational resilience, arguing for greater recognition of the shared or relational nature of resilience. We introduce a multidimensional model of resilience that integrates the macro- and micro-level to include resilience-enabling systems at the family, community, national, global and intergenerational levels. The purpose of this conceptual framework is to provide a more holistic and integrative model that combines both bottom-up and top-down approaches to cultivating resilience, highlighting the power of interconnections across interrelated systems and social structures. Using the case example of post-genocide Rwanda and the experiences of children born of genocidal rape, we apply our multidimensional model to illustrate concrete examples of resilience-enabling systems at the family, community, national, global and intergenerational levels. Our proposed multidimensional model as applied to youth born of genocidal rape in Rwanda reveals key gaps in their surrounding social ecological systems, highlighting the importance of coordinated and mutually-reinforcing efforts to engender resilience across all dimensions concurrently. We conclude with a set of policy and practice implications, directions for future research, and lessons-learned on how best to champion the resilience of this unique and important population of children.
Article
Purpose This research aimed to describe and examine the effects of war followed by forced displacement on Syrian mothers and their children in terms of Reuben Hill's Family Stress Theory and identify essential elements to consider in social work practice with this population. Design/methodology/approach Semi-structured interviews were conducted with 19 Syrian mothers living in the United Arab Emirates (UAE). A thematic analysis at both a semantic and latent level was completed. A case study – “Noor” – was developed to offer insight into one Syrian woman's experiences and response to war-related stressors and displacement. Findings The findings from the analysis of the interviews and case study indicated that for Syrian families displaced by conflict the traumas of war were compounded by ongoing and multiple emotional and practical stressors, with ongoing experiences of “loss” being the significant stressor. Giving context to these findings highlights the demand and impost on the host countries, in this study, the UAE, to continue their significant humanitarian efforts to Syrian families. Research limitations/implications These findings will assist social workers, humanitarian organisations and their staff and others working with Syrian families, to respond more effectively. Originality/value There is no research in evidence in the professional literature that addresses the effects of war on displaced Syrian families in terms of Reuben Hill's Family Stress Theory.
Article
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Background: A number of studies have investigated transgenerational effects of parental post-traumatic stress disorder (PTSD) and its repercussions for offspring. Few studies however, have looked at this issue in the African context. Methods: The present study addresses this gap by utilizing a Pearson correlation matrix to investigate symptom severity within the three Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD symptom domains in mothers exposed to the genocide against the Tutsi in Rwanda (n=25) and offspring (n=25), and an ethnically matched set of controls (n=50) who were outside of Rwanda during the 1994 genocide. All mothers were pregnant with the offspring included in the study during the time of the genocide. Results: Total PTS score was significantly (p<0.01) correlated with each of the three symptom domains at various strengths in both cases and controls. No significant differences in association of total PTS score and PTSD symptom domains were observed between exposed mothers and offspring, suggesting that each symptom domain contributed equivalently to both exposed mothers and offspring distress. In contrast, the re-experiencing symptom domain showed a significant difference in correlation to overall PTS score in non-exposed mothers compared to their offspring (p<0.05), with mothers showing a significantly higher correlation. Furthermore, the correlation between avoidance/numbing symptoms to overall PTS was significantly different (p≤0.01) across exposed and non-exposed mothers. As a secondary analysis, we explored the relationship between DNA methylation in the glucocorticoid receptor ( NR3C1) locus, an important stress modulating gene, and PTSD symptom domains, finding an association between DNA methylation and re-experiencing among genocide-exposed mothers that exceeded any other observed associations by approximately two-fold. Conclusions : This is the first report, to our knowledge, of a symptom-based analysis of transgenerational transmission of PTSD in sub-Saharan Africa. These findings can be leveraged to inform further mechanistic and treatment research for PTSD.
Article
The research that is presented here explores the place of maternal memory among child survivors of the Bosnian Muslim genocide that took place in Bosnia-Herzegovina during the 1990s. Using a qualitative research approach, the study is comprised of 24 in depth interviews with child survivors whose families immigrated to the United States in the aftermath of war. Based on the importance of child memory as a source of recollection, the study explores three intersecting areas of research: (1) the role of child survivor memory in documenting histories of civilian warfare; (2) the importance of child survivor memory for the study of gender and genocide; and (3) the significance of child memory for the construction of collective memories of maternal agency. The findings of the research reveal the roles that mothers play in emotion management and in the protection of families during genocidal warfare.
Article
Full-text available
Investigated the relationship between exposure to war violence, separation from parents, posttraumatic stress disorder (PTSD) symptoms, and cognitive functioning among 63 Hispanic children (aged 7–16 yrs) living in the US, 52 of whom were born in Central America. Ss completed an interview, the Exposure to Violence Index, the PTSD Symptom Checklist, the Wechsler Intelligence Scale for Children—Revised (WISC—R), the Wide Range Achievement Test—Revised (WRAT—R), and measures of separation from mothers or father. Age of entry into the US was also examined. Exposure to war violence was a strong and consistent predictor of Ss' cognitive functioning and number of PTSD symptoms, thus suggesting that such exposure had a negative effect on cognitive and emotional development. Separation from parents consistently predicted the WRAT—R Reading Score but was only erratically associated with other outcome measures. (Spanish abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
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The concept of resilience, the ability to withstand and rebound from crisis and adversity, has valuable potential for research, intervention, and prevention approaches aiming to strengthen couples and families. Resilience has been viewed as residing within the individual, with the family often dismissed as dysfunctional. This article advances a systemic view of resilience in ecological and developmental contexts and presents the concept of family resilience, attending to interactional processes over time that strengthen both individual and family hardiness. Extending our understanding of normal family functioning, the concept of family resilience offers a useful framework to identify and fortify key processes that enable families to surmount crises and persistent stresses. There are many pathways in relational resilience, varying to fit diverse family forms, psychosocial challenges, resources, and constraints. Shared beliefs and narratives that foster a sense of coherence, collaboration, competence, and confidence are vital in coping and mastery. Interventions to strengthen family resilience have timely relevance for weathering the rapid social changes and uncertainties facing families today.
Article
Full-text available
Because of the prevalence of wars, political violence and other forms of man-made disaster in Third World countries many individuals and communities suffer prolonged and often multiple traumas. In Western psychiatry certain conceptions of the response to violence and trauma have been developed, including the widely used category of post-traumatic stress disorder (PTSD). We argue that because concepts such as PTSD implicitly endorse a Western ontology and value system, their use in non-Western groups should be, atmost, tentative.
Article
This report examines the community‐based mental health preventive measures undertaken by the school psychology services in response to the missile attacks on Israel during the Gulf war. It attempts to report and delineate the major assumptions and components of some of the key interventions.
Article
The social-emotional state and cognitive development was compared between a group of 74 4-7-year-old Eritrean orphans and refugee children living in families. Both groups had been exposed to the chronic stresses of war and drought and the orphans had, in addition, lost both parents to the violence of war, and were living in an overcrowded orphanage- Contrary to expectations, there were relatively few clinically significant differences between comparison groups. The orphans showed more behavioral symptoms of emotional distress, but performed at a more advanced level on cognitive and language performance measures. The findings suggest that when group care is child-centered, it can under some circumstances be a viable solution for unaccompanied children in countries where adoption and foster care are not realistic alternatives.
Conference Paper
This report presents an update of psychosocial research in the traumatic stress field, presenting an overview of recent studies in several areas: the epidemiology of traumatic events and of PTSD in the general adult population, other diagnoses associated with trauma exposure and PTSD, the course and longevity of PTSD symptomatology, and risk factors for the diagnosis. Other areas of increasing interest and focus are briefly noted.
Article
A large proportion of Indochinese refugees are children. This article suggests that uprooted children may experience powerful grief, not only in response to personal loss of loved ones, but also to loss of their culture. It is further postulated that personal bereavement and cultural bereavement are complementary, which can be an important factor in a refugee child's adjustment. These children are vulnerable to "disrupted development time" and so earlier losses of family and culture can seed problems which can emerge after resettlement.
Article
This report examines the community-based mental health preventive measures undertaken by the school psychology services in response to the missile attacks on Israel during the Gulf war. It attempts to report and delineate the major assumptions and components of some of the key interventions.
Article
To define resilience and its components for individuals with severe burns, the authors integrated findings of a general literature review with opinions offered by 39 burn survivors through individual interviews. Results indicate that core factors influencing resiliency include social support (cultural influences and community, school, personal, and familial support,), cognitive skills (intelligence, coping style, personal control, and assignment of meaning), and psychological resources. Counseling strategies to strengthen resilience are suggested.
Article
The Impact of Events Scale has become one of the most widely used instruments in the assessment of post-traumatic stress reactions in adults. However, its reliability and validity with adolescents remains uncertain. The aim of the present study was to investigate its psychometric properties with a sample of 334 adolescent survivors of the Jupiter cruise ship disaster. Recent research with adults has found slight differences in the factor structure of the scale and these were confirmed in this study. Moreover, the factor structure appears to be different for girls and boys. It is concluded that scores on the Impact of Events Scale might reflect sex differences in reactions to traumatic events which may have important diagnostic implications.
Article
Childhood trauma has profound impact on the emotional, behavioral, cognitive, social, and physical functioning of children. Developmental experiences determine the organizational and functional status of the mature brain. The impact of rruumufic experiences on the development and function of the brain are discussed in context of basic principles of neurodevelopment. There are various adaptive mental and physical responses to trauma, including physiological hyperarousal and dissociation. Because the developing brain organizes and internalizes new information in a use-dependent fashion, the more a child is in a state of hyperarousal or dissociation, the more likely they are to have neuropsychiatric symptoms following trauma. The acute adaptive states, when they persist, can become maladaptive traits. The clinical implications of this new neurodevelopmental conceptualization of childhood trauma are discussed. Le trauma de l'enfance a un impact profond sur le fonctionnement émotionnel, comportemental, cognitif, social et physique des enfants. Les expériences en matière de développement déterminent l'organisa-tion et le fonctionnement du cerveau arrivé à maturité. L'impact d'expériences traumatiques sur le développement et le fonctionnement du cerveau sont discutés dans le contexte de principes de bases de neurodéveloppe-ment. Il existe plusieurs résponses mentales et physiques d'adaptation au trauma, parmi lesquelles l'excitation physique intense et de la dissociation. Parce que le cerveau qui se développe organise et internalise les nouvelles “informations” d'une manière liée B l'utilisation et en dépendant, plus un enfant se trouve dans un état d'excitation ou de dissociation et plus il risque d'y avoir des symptǒmes neuropsychiatriques aprés le trauma. L'“état” adaptatif aigu peut devenir persistent et conduire à des “traits” d'inadaptation. Les implications cliniques de cette nouvelle conceptualisation de neurodéveloppement du trauma de l'enfance sont discutées.
Article
The Persian Gulf war subjected the civilian population of Israel to 18 Scud-missile attacks over a period of six weeks. The purpose of this report is to outline the principles guiding community-wide emergency intervention and to examine the preventive proactive measures for children and parents undertaken by the school psychological services. In particular, the reorganization of the services to respond to the situation-specific conditions and the implementation of the intervention principles (outreach, immediacy, proximity, community, expectancy and continuity) are presented.
Article
This paper compares the effectiveness of the General Health Questionnaire (GHQ-30) and the Impact of Event Scale (IES) for assessing the impact of disasters on volunteers involved in the rescue work following the Armenian earthquake. The IES gave fewer zero scores and so was less likely to result in helpers being labelled symptom-free when they were not. It was conclude that IES was a more sensitive instrument and a more effective means of assessing the psychological consequences of disaster work.
Article
This study examined a stratified random sample of 191 Kuwaiti boys and giris between the ages of 8 and 12 years, approximately 10 to 15 months after the Gulf crisis. The purpose of the study was to determine whether their level of exposure to violence during the crisis was associated with health-related variables. Health problems after the crisis were greater than problems before the crisis, and associated with level of exposure to violence. Cardiovascular reactivity to an interview about their crisis experience exceed their reactivity to speaking about a general topic. The results underscore the importance of assessing health-related variables in studies of trauma in children and suggest the potential utility of a cardiovascular reactivity paradigm for assessing children across cultures.
Article
The present research, conducted in Israel during the recent “Desert Storm” operation in the Gulf, sets out to assess the degree of anxiety and bodily symptoms of Israeli citizens, threatened by Scud missile attacks and undergoing a period of acute stress. Data were gathered via questionnaires distributed during the crisis period to over 500 respondents, most of them residing in Haifa, one of the high-risk areas for the missile attacks at the time. State anxiety was reported to be highly elevated during the crisis period, in comparison with norm group data collected during normal times. The most frequently reported bodily symptoms were changes in eating habits (loss of appetite or overeating), fatigue, and insomnia. Women reported more anxiety and bodily symptoms, on average, than men, as well as higher tension, fear and depression. The younger adults in the sample reported more anxiety and bodily symptoms, as well as tension, fear and depression, than their older counterparts. Lower levels of fear and depression were reported at the later stages of the crisis than at the earlier ones; most stress indicators evidenced lower levels with the passage of time. Finally, a strong positive relationship between anxiety and bodily symptoms was found, over and above the contribution of background variables and response tendencies. The possible explanations for the effects of background variables, as well as the strong relationship between anxiety and symptoms reported, are discussed.
Article
The relations between the level of traumatic experiences, degree of active participation in the Intifada, and cognitive and emotional responses were studied among 108 Palestinian children of 11–12 years of age in the Gaza Strip. The results showed that the more traumatic experiences the children had and the more they participated in the Intifada, the more concentration, attention, and memory problems they had. Traumatic experiences also increased neuroticism and risk-taking, and Intifada participation decreased self-esteem. Children's active participation in the Intifada could not protect children from developing emotional problems, as was originally assumed. The highest level of neuroticism was found among active boys who were exposed to many traumatic experiences.
Article
Studied 22 children's (aged 10–12 yrs) response to an earthquake 6–8 mo after the event, particularly Ss' traumatic stress-related symptoms and factors mediating individual response. Principal variables examined were (1) experience of and proximity to loss of life and severe property damage, (2) family reactions, and (3) psychological vulnerability to having an adverse response, based on previous experience of psychological trauma. Measures administered during interview included a posttraumatic stress reaction index for children. Ss reported experiencing traumatic stress-related symptoms that appeared associated with the seismic event. Ss who lived closer to a heavily damaged area were more likely to experience a greater degree of stress than Ss who lived farther away. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A growing number of psychologists are becoming involved in research with migrants, particularly those from developing countries. This article highlights the unique methodological difficulties in research with refugees and immigrants. The main examples given are from Indochinese refugees and Pacific Island immigrants to New Zealand. Six areas of difficulty are identified: (1) contextual differences between migrants and the receiving society, (2) conceptual problems with translation of instruments, (3) sampling difficulties, (4) linguistic problems, (5) observation of etiquette, and (6) personality characteristics of researchers. Recommendations are made to resolve some of the difficulties encountered in each area. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
In the editors' opinion, this book has served three functions. First, it has brought together scholars and researchers from many different disciplines who have common interests in mental health, but who have not often interacted with one another in a true interdisciplinary manner. Second, this book has synthesized and presented most of the conceptual and empirical information currently available on ethnocultural aspects of PTSD. Third, this book has identified current controversies in the field and generated an agenda for future research, which are encapsulated by 10 questions. These questions are elaborated on in the remainder of the chapter. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
657 students (aged 14–24 yrs) from 2 areas of high risk that were bombarded by missiles were administered a self-report Stress Reactions Scale that measured adverse emotional, cognitive, and physiological disturbance symptoms at 2 points in time, the 1st and 4th wks of the Gulf War. Between these 2 points, there was a noted reduction in incidents of stress reaction. Ss from the most attacked area reported significantly greater frequency of some symptoms; female Ss reported a higher frequency of stress reactions, specifically 7th-grade girls from the most attacked area. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
the present chapter has 3 major purposes: (a) to summarize and critically review the existing cross-cultural posttraumatic stress disorder (PTSD) literature, especially as it pertains to veterans and refugees, the 2 groups most frequently studied; (b) to discuss some of the major conceptual and methodological issues involved in understanding the relationship between culture and PTSD; and (c) to recommend conceptual and research approaches for studying enthnocultural aspects of PTSD (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Discusses the concepts of construct and content validity, the requirements of convergent and discriminant evidence, norm and criterion-referenced interpretations, values in measurement and the uses of counterhypotheses, and the identification of bias. The importance of construct-referencing all measurement is noted. The need for a dialectical evaluation where a particular thesis is confronted with its antithetical elements is stressed. This approach should help uncover assumptions and ideologies implicit in many measurement and evaluation activities. (61 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Chapter
Analysis of Ordinal Categorical Data Alan Agresti Statistical Science Now has its first coordinated manual of methods for analyzing ordered categorical data. This book discusses specialized models that, unlike standard methods underlying nominal categorical data, efficiently use the information on ordering. It begins with an introduction to basic descriptive and inferential methods for categorical data, and then gives thorough coverage of the most current developments, such as loglinear and logit models for ordinal data. Special emphasis is placed on interpretation and application of methods and contains an integrated comparison of the available strategies for analyzing ordinal data. This is a case study work with illuminating examples taken from across the wide spectrum of ordinal categorical applications. 1984 (0 471-89055-3) 287 pp. Regression Diagnostics Identifying Influential Data and Sources of Collinearity David A. Belsley, Edwin Kuh and Roy E. Welsch This book provides the practicing statistician and econometrician with new tools for assessing the quality and reliability of regression estimates. Diagnostic techniques are developed that aid in the systematic location of data points that are either unusual or inordinately influential; measure the presence and intensity of collinear relations among the regression data and help to identify the variables involved in each; and pinpoint the estimated coefficients that are potentially most adversely affected. The primary emphasis of these contributions is on diagnostics, but suggestions for remedial action are given and illustrated. 1980 (0 471-05856-4) 292 pp. Applied Regression Analysis Second Edition Norman Draper and Harry Smith Featuring a significant expansion of material reflecting recent advances, here is a complete and up-to-date introduction to the fundamentals of regression analysis, focusing on understanding the latest concepts and applications of these methods. The authors thoroughly explore the fitting and checking of both linear and nonlinear regression models, using small or large data sets and pocket or high-speed computing equipment. Features added to this Second Edition include the practical implications of linear regression; the Durbin-Watson test for serial correlation; families of transformations; inverse, ridge, latent root and robust regression; and nonlinear growth models. Includes many new exercises and worked examples.
Article
Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.
Article
The diagnosis and clinical understanding of posttraumatic stress disorder (PTSD) rests upon the explicit identification of traumatic experiences that give rise to a well-defined constellation of symptoms. Most efforts to investigate the characteristics of these experiences have attempted to specify war zone stressors as objectively as possible. In this study, we add specification of the psychological meaning of war zone stressors to their objective specification. Eleven traumas are organized in terms of four roles that veterans played in the initiation of death and injury; namely, target, observer, agent, and failure. These roles can be ordered in terms of the degree of personal responsibility involved in the initiation of death and injury. The relationships of these roles to current symptomatology were examined in combination with a set of objective measures of war zone stressors. The sample consisted of the first 1709 Vietnam theater veterans who were assessed in a national evaluation of the PTSD Clinical Teams initiative of the Department of Veterans Affairs. Results show that having been a target of others' attempts to kill or injure is related more uniquely than any other role to symptoms that are diagnostic criteria for PTSD. On the other hand, having been an agent of killing and having been a failure at preventing death and injury are related more strongly than other roles to general psychiatric distress and suicide attempts.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Fourteen months after a sniper attack at an elementary school, level of exposure to that event remained the primary predictor of ongoing posttraumatic stress reactions in 100 schoolchildren who were followed up. Guilt feelings and knowing the child who was killed were associated with a greater number of symptoms. Grief reactions occurred independent of degree of exposure to the event. The authors discuss the public health implications of these longitudinal findings.
Article
Investigated the reactions of 251 elementary school children (aged 6–13 yrs) 1 yr subsequent to a sniper attack on their school playground in which a 10-yr-old was killed and 14 others were wounded. A childhood grief reaction inventory was developed to collect data. Scores increased with degree of acquaintance with the deceased schoolmate and with degree of exposure to the violence. Results show that children responded similarly to adults (as previously reported in a number of studies), both in the nature and frequency of grief reactions and in that normal grieving was still ongoing after 1 yr. There is also evidence that while at times there was an interplay between grief and posttraumatic stress reactions in children, at other times the 2 reactions occurred independently. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The social-emotional state and cognitive development was compared between a group of 74 4-7-year-old Eritrean orphans and refugee children living in families. Both groups had been exposed to the chronic stresses of war and drought, and the orphans had, in addition, lost both parents to the violence of war, and were living in an overcrowded orphanage. Contrary to expectations, there were relatively few clinically significant differences between comparison groups. The orphans showed more behavioral symptoms of emotional distress, but performed at a more advanced level on cognitive and language performance measures. The findings suggest that when group care is child-centered, it can under some circumstances be a viable solution for unaccompanied children in countries where adoption and foster care are not realistic alternatives.
Article
To assess the amount of stress exposure and reactions among children following a war situation, two comparative groups of non-displaced (N = 64) and displaced children (N = 70) from Croatia were administered a modified version of the War Trauma Questionnaire as well as the Impact of Event Scale (IES). The results showed that a majority of the children had been exposed to armed combat, with displaced children significantly more exposed to destruction of home and school as well as to acts of violence, and loss of family members, than the non-displaced children. Regarding the IES scores, displaced children had significantly higher scores for the total score and for the intrusion and avoidance subscales. For girls the total score and intrusion score were significantly higher than for boys. Different exposure factors were significantly related to the IES scores, especially for the intrusion subscale of the IES.
Article
Despite a growing literature of cross-cultural research on mental illness, little is known about the universality of most psychiatric disorders. This study was designed to determine whether people from a very different culture have the same symptoms in response to traumatic experiences as do trauma survivors in the United States. We were also interested to find out if the severity of the current symptoms is related to the amount of trauma experienced. Furthermore, we gathered information about the perceived severity of traumatic experiences among refugees. Fifty Cambodian refugees living in the U.S. were asked about their traumatic experiences and their current symptoms of posttraumatic stress, dissociation, depression, and anxiety. High levels of all symptoms were found along with statistically significant relationships between each symptom measure and the amount of trauma experienced. We conclude that the basic symptom picture in this group was similar to that observed in U.S. trauma survivors.
Article
This report presents an update of psychosocial research in the traumatic stress field, presenting an overview of recent studies in several areas: the epidemiology of traumatic events and of PTSD in the general adult population, other diagnoses associated with trauma exposure and PTSD, the course and longevity of PTSD symptomatology, and risk factors for the diagnosis. Other areas of increasing interest and focus are briefly noted.
Article
A consecutive cohort of 145 adult Vietnamese refugees were personally interviewed and completed the Symptom Checklist 90 R self-rating scale on arrival in Norway. Sixty-two percent had witnessed bombing, fires and shooting, 48% had witnessed other people being wounded or killed and 36% had been involved in life-threatening situations or had been wounded in the war. Nearly all war trauma variables but none of the escape or refugee camp variables were significantly related to mental health 7 years after the end of the war. War trauma was significantly associated with mental health, also when age, gender and previous mental problems were controlled for. These results and our clinical experience indicate that clinicians treating refugees should address such traumatic experiences specifically.
Article
The psychological trauma associated with war is a topic that has occupied the attention of mental health researchers and practitioners for some time. Most of their attention, though, has focused on the traumatic stress of soldiers, and little attention has been paid to the problems and traumatization of civilians caught in war zones, especially the children. In this paper, the limited research on children of war is reviewed, and themes are extracted. Children suffer from both acute and chronic traumatic stress. The key to determining the amount of suffering has to do with the dynamic interaction among five processes within an ecological framework: the child's psychobiological makeup, the disruption of the family unit, the breakdown of community, and the ameliorating effects of culture. The intensity, suddenness and duration of the war-like experience itself constitute an additional component to this ecological model. In the final section, psychotherapeutic guidelines to help children cope with symptoms associated with war are presented for current and future caregivers. The prevention of war should be the primary task of all.
Article
This preliminary study of Kuwaiti children confirms the significant impact of exposure to war atrocities on children. This pilot sampling provided evidence that: (1) many children who remained in Kuwait during the occupation had multiple war-related exposures; (2) more than 70 per cent of the children reported moderate to severe post-traumatic stress reactions; and (3) witnessing death or injury and the viewing of explicit graphic images of mutilation on television had measurable influence on severity of reaction. The highest mean Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) score was found for those children who reported hurting someone else. Older children had both greater exposure to atrocities and higher CPTSD-RI scores. Findings suggest the need for public policy to minimize children's exposure to graphic depictions of war-related injury, death and mutilation.
Article
This study reports on 170 Israeli school children at risk for missile attack during the Persian Gulf War. The Bar-Ilan Picture Test for Children (Itskowitz & Strauss, 1982, 1986) was specially adapted to the war situation specifically to measure children's affective reactions and coping strategies. Children with a greater sense of control and social support, and more complex defenses, tended to demonstrate better coping strategies. Children who were less defensive showed higher levels of anxiety under stress. Children scoring higher in social support showed greater perceived control over their immediate environment and more verbal expressivity with respect to the crisis situation. Girls scored higher than boys on emotional and verbal expressiveness. These data, elicited through semiprojective procedures, are consistent with much of the prior research based mainly on objective scales or self-report questionnaires. Overall, the results lend additional validity to the nexus of relations (largely established through conventional objective scales) between resources, coping, and outcomes in a naturalistic stressor situation.
Article
The case notes documenting the psychological well-being of 100 survivors of torture and other forms of organised state violence were analysed retrospectively. The most common diagnoses were post-traumatic stress disorder (PTSD), major depression, and somatoform disorders. Of these, PTSD showed the strongest association with experience of torture. It is possible that PTSD has a dimensional nature, and that reactions to different stressors are heterogeneous.
Article
Seventy-three percent of a sample of 46 Cambodian youth interviewed in 1984 and 1987 were reinterviewed in 1990 as part of a pretest for a multisite study of Cambodian refugee trauma now under way. An additional sample of convenience of 38 youth were also interviewed to determine reliability and validity of the diagnostic instruments chosen for the larger study. The DSM-III-R diagnosis of post-traumatic stress disorder (PTSD) was found to persist, but the symptoms appeared less intense over time. In contrast, the prevalence of depression dropped markedly since 1987. Subjects remained largely free of comorbid conditions. Diagnostic reliability and validity were satisfactory. The follow-up sample appeared to be functioning well despite their PTSD profiles. The findings are discussed in light of several current controversies surrounding the concept and measurement of PTSD.
Article
This study deals with the psychological reactions of Kuwaiti children to war-related stresses in the early period of the Gulf crisis following the summer 1990 Iraqi invasion of Kuwait. A sample of 106 children was drawn from Kuwaiti displaced families and a comparable control sample was obtained from Saudi families in Riyadh, Saudi Arabia. An interview checklist of symptoms of physical and psychological distress was administered to the index child and a female key informant in each household of cases and controls. Most Kuwaiti children were exposed to unpleasant war experiences. It was found that Kuwaiti children exhibited a substantially greater degree of dysfunctional social and emotional behaviour. The types of adverse behaviours were a function of the child's age, sex and experience of aggression. The findings support the notion that a negative relationship exists between armed conflict and the health and behaviour of the children. The complex needs of children exposed to violence require professionals to seek ways of combining psychodynamic interventions and relief programmes.
Article
To evaluate the psychometric properties of the Impact of Event Scale (IES scale) in children a study was conducted on 1787 children exposed to the warfare in Croatia, Bosnia and Herzegovina. The study group comprised 877 girls and 910 boys ranging in age from 6 to 15 years attending 28 arbitrary selected schools in Zagreb. High levels of posttraumatic reactions were found in the group of children. The pattern of endorsement and the factor structure of the IES scale were similar to that found in other samples. This supports the use of the IES in the assessment of posttraumatic stress reactions in children. Two factors emerged from a Principal Component Analysis, labeled intrusion (9 items), and avoidance (4 items). As in other studies, this study documented problems with several items (items 2, 12 and 15), items that should be considered omitted from the IES. Girls reported significantly more distress on 13 out of the 15 items. Both the overall IES score as well as the intrusion and avoidance score were significantly higher in girls than boys. The factor structure for boys and girls were very similar, and the reliability of the scale was adequate across different age groups and for subgroups of displaced and refugee children.
Article
To determine whether the factor structure of the posttraumatic stress disorder (PTSD) syndrome in Cambodian refugee youth resembles earlier reported factor studies in Caucasian samples. 194 Khmer adolescent refugees who reported prior significant trauma (most of it massive war trauma as children) were administered the PTSD module of the Diagnostic interview for Children and Adolescents, as part of an epidemiological study on the effects of war on this group of refugees. The following four factors were found: arousal, avoidance, intrusion, and numbing. A confirmatory factor analysis using data from the parents of this sample yielded a good fit for the four-factor solution based on the youth data. The four-factor solution from this sample resembled earlier studies on traumatized Caucasian and African-American adults. These results lend further credibility to the veracity of this diagnosis with refugee samples. PTSD as a result of prior war trauma appears to surmount the barriers of culture and language in this sample.
Is the culture always right? Paper presented at the 12th Annual Meeting of the International Society for Traumatic Stress Studies Factor analysis of the Impact of Event Scale with children in war
  • A Dyregrov
  • L Gupta
  • R Gjestad
  • M Raundalen
Dyregrov, A., Gupta, L., Gjestad, R., & Raundalen, M. (1996). Is the culture always right? Paper presented at the 12th Annual Meeting of the International Society for Traumatic Stress Studies, San Francisco, Nov. 9–13. r20 Dyregrov, Gupta, Gjestad, and Mukanoheli Dyregrov, A., Kuterovac, G., & Barath, A. (1996). Factor analysis of the Impact of Event Scale with children in war. Scandinavian Journal of Psychology, 37, 339–350
Restoring playfulness
  • D Tolfree
Is the cuIture always right? Paper presented at the 12th Annual Meeting of the International Society for Traumatic Stress Studies
  • A Dyregrov
  • L Gupta
  • R Cjestad
Dyregrov, A., Gupta, L., Cjestad, R., & Raundalen, hi. (1996). Is the cuIture always right? Paper presented at the 12th Annual Meeting of the International Society for Traumatic Stress Studies, San Francisco, Nov. 9-13.
Children and war in the contemporary world
  • A Dyregrov
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