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Fayyad J, Cordahi-Tabet C, Yeretzian J, Salamoun M, Najm C, Karam EG. Resilience-promoting factors in war-exposed adolescents: an epidemiologic study. Eur Child Adolesc Psychiatry 2017; 26:191-200. [PMID: 27312537 DOI: 10.1007/s00787-016-0871-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/20/2016] [Indexed: 12/01/2022]
Abstract
Studies of war-exposed children have not investigated a comprehensive array of resilience-promoting factors, nor representative samples of children and adolescents. A representative sample of N = 710 adolescents was randomly selected from communities recently exposed to war. All those who had experienced war trauma were administered questionnaires measuring war exposure, family violence, availability of leisure activities, school-related problems, interpersonal and peer problems, socialization, daily routine problems, displacement, availability of parental supervision and contact and medical needs as well as coping skills related to religious coping, denial, self-control, avoidance and problem solving. Mental health was measured by the Strengths and Difficulties Questionnaire (SDQ) and the Child-Revised Impact of Events Scale (CRIES). Resilient adolescents were defined as those who experienced war trauma, but did not manifest any symptoms on the SDQ or CRIES. Resilience was related to being male, using problem-solving techniques, having leisure activities, and having parents who spent time with their adolescents and who supported them with school work. Interventions designed for war-traumatized youth must build individual coping skills of children and adolescents, yet at the same time target parents and teachers in an integrated manner.
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Affiliation(s)
- John Fayyad
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.
- Institute for Development Research Advocacy and Applied Care (IDRAAC), P.O. Box: 166227, Ashrafieh, Beirut, 1100 2110, Lebanon.
| | - C Cordahi-Tabet
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), P.O. Box: 166227, Ashrafieh, Beirut, 1100 2110, Lebanon
| | - J Yeretzian
- Institute for Development Research Advocacy and Applied Care (IDRAAC), P.O. Box: 166227, Ashrafieh, Beirut, 1100 2110, Lebanon
| | - M Salamoun
- Institute for Development Research Advocacy and Applied Care (IDRAAC), P.O. Box: 166227, Ashrafieh, Beirut, 1100 2110, Lebanon
| | - C Najm
- Institute for Development Research Advocacy and Applied Care (IDRAAC), P.O. Box: 166227, Ashrafieh, Beirut, 1100 2110, Lebanon
| | - E G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), P.O. Box: 166227, Ashrafieh, Beirut, 1100 2110, Lebanon
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152
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Alto ME, Petrenko CLM. Fostering secure attachment in low- and middle-income countries: Suggestions for evidence-based interventions. EVALUATION AND PROGRAM PLANNING 2017; 60:151-165. [PMID: 27865141 DOI: 10.1016/j.evalprogplan.2016.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 06/06/2023]
Abstract
Children struggling with the effects of trauma in low- and middle-income countries (LMIC) face a substantial mental health resource gap that limits their opportunities for positive psychosocial development. Multidisciplinary interventions working to close this gap may benefit from incorporating an empirically supported treatment (EST) into their approach that targets a universal mechanism implicated in resilience, like attachment. ESTs should be selected based on their level of empirical support and cultural adaptability, and then modified on the basis of qualitative evaluations conducted with the local population and stakeholders. This paper will provide an overview of attachment as a mechanism of resilience, a critical analysis of existing attachment-based ESTs, and recommendations for overcoming EST implementation barriers in LMIC.
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Affiliation(s)
- Michelle E Alto
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh St., Rochester, NY, 14608, United States.
| | - Christie L M Petrenko
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh St., Rochester, NY, 14608, United States.
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153
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The effect of gender norms on the association between violence and hope among girls in the Democratic Republic of the Congo. Glob Ment Health (Camb) 2017; 4:e1. [PMID: 28596902 PMCID: PMC5454793 DOI: 10.1017/gmh.2016.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/14/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Girls at early stages of adolescence are vulnerable to violence victimization in humanitarian contexts, but few studies examine factors that affect girls' hope in these settings. We assessed attitudes toward traditional gender norms as an effect modifier of the relationship between violence exposure and future orientation in displaced girls. METHODS Secondary analysis, using multivariable regression of cross-sectional data from girls ages 10-14 in South Kivu, Democratic Republic of the Congo. Key variables of interest were attitudes toward intimate partner violence (IPV), Children's Hope Scale (CHS) score, and exposure to physical, emotional, and sexual violence within the last 12 months. Additional covariates included age, educational status, and territory. RESULTS The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for physical violence (β = -0.09, p = 0.040) and unwanted sexual touching (β = -0.20, p = 0.003) among girls age 10-14, when adjusting for other covariates. The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for forced sex (β = -0.22, p = 0.016) among girls age 13-14, when adjusting for covariates. Findings for emotional violence, any form of sexual violence, and coerced sex trended toward lower CHS scores for girls who reported higher acceptance of IPV, but did not reach significance. CONCLUSIONS Findings support the utility of gender norms-transformative programming in increasing resilience of girls who have experienced sexual violence in humanitarian contexts.
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154
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Slone M, Mann S. Effects of War, Terrorism and Armed Conflict on Young Children: A Systematic Review. Child Psychiatry Hum Dev 2016; 47:950-965. [PMID: 26781095 DOI: 10.1007/s10578-016-0626-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Millions of children have been maimed, displaced, orphaned and killed in modern warfare that targets civilian populations. Several reviews have documented the impact of political trauma on children's mental health but none has focused specifically on young children (ages 0-6). Since developmental factors influence the young child's perception and experience of traumatic events, this developmental period is characterized by a unique spectrum of responses to political trauma. This systematic review, comprising 35 studies that included a total of 4365 young children, examined the effects of exposure to war, conflict and terrorism on young children and the influence of parental factors on these effects. Results showed that effects include PTSD and post-traumatic stress symptoms, behavioral and emotional symptoms, sleep problems, disturbed play, and psychosomatic symptoms. Correlations emerged between parental and children's psychopathology and, additionally, family environment and parental functioning emerged as moderators of the exposure-outcome association for children.
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Affiliation(s)
- Michelle Slone
- School of Psychological Sciences, Tel Aviv University, PO Box 39040, 6997801, Tel Aviv, Israel.
| | - Shiri Mann
- School of Psychological Sciences, Tel Aviv University, PO Box 39040, 6997801, Tel Aviv, Israel
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155
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Building a translational science on children and youth affected by political violence and armed conflict: A commentary. Dev Psychopathol 2016; 29:79-84. [DOI: 10.1017/s0954579416001164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AbstractArticles in this timely Special Section represent an important milestone in the developmental science on children and youth involved in political violence and armed conflict. With millions of children worldwide affected by past and present wars and conflicts, there is an urgent and growing need for research to inform efforts to understand, prevent, and mitigate the possible harm of such violence to individual children, families, communities, and societies, for present as well as future generations. The four programs of research highlighted in this Special Section illustrate key advances and challenges in contemporary development research on young people growing up in the midst or aftermath of political violence. These studies are longitudinal, methodologically sophisticated, and grounded in socioecological systems models that align well with current models of risk and resilience in developmental psychopathology. These studies collectively mark a critically important shift to process-focused research that holds great promise for translational applications. Nonetheless, given the scope of the international crisis of children and youth affected by political violence and its sequelae, there is an urgent global need for greater mobilization of resources to support translational science and effective evidence-based action.
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156
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Purgato M, Gastaldon C, Papola D, van Ommeren M, Barbui C, Tol WA. Psychological and social interventions for the prevention of mental disorders in people living in low- and middle-income countries affected by humanitarian crises. Hippokratia 2016. [DOI: 10.1002/14651858.cd012417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marianna Purgato
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Hampton House Baltimore Maryland USA 21205
- University of Verona; Department of Public Health and Community Medicine, Section of Psychiatry; Piazzale LA Scuro, 10 Verona Italy 37134
| | - Chiara Gastaldon
- University of Verona; Department of Public Health and Community Medicine, Section of Psychiatry; Piazzale LA Scuro, 10 Verona Italy 37134
| | - Davide Papola
- University of Verona; Department of Public Health and Community Medicine, Section of Psychiatry; Piazzale LA Scuro, 10 Verona Italy 37134
| | - Mark van Ommeren
- World Health Organization; Department of Mental Health and Substance Abuse; Avenue Appia Geneva Switzerland CH-1211
| | - Corrado Barbui
- University of Verona; Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry; Verona Italy
| | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Hampton House Baltimore Maryland USA 21205
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Youth resilience makes a difference in mitigating stress. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2016. [DOI: 10.1097/wtf.0000000000000134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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158
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Zuilkowski SS, Collet K, Jambai M, Akinsulure-Smith AM, Betancourt TS. Youth and Resilience in Postconflict Settings: An Intervention for War-Affected Youth in Sierra Leone. Hum Dev 2016. [DOI: 10.1159/000448227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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159
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Cherewick M, Tol W, Burnham G, Doocy S, Glass N. A structural equation model of conflict-affected youth coping and resilience. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2016.1228458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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160
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Rosshandler Y, Hall BJ, Canetti D. An application of an ecological framework to understand risk factors of PTSD due to prolonged conflict exposure: Israeli and Palestinian adolescents in the line of fire. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2016; 8:641-648. [PMID: 26950012 PMCID: PMC4982813 DOI: 10.1037/tra0000124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adolescents living in Israel and the Palestinian authority are exposed to political violence. This review examines psychosocial risk factors for posttraumatic stress disorder (PTSD) organized within an ecological framework. METHOD Relevant articles were identified through PubMed and PsycINFO. Studies measuring risk and/or protective factors for PTSD in the Palestinian and/or Israeli adolescent populations because of conflict exposure from 1990 to present were included. RESULTS A total of 20 studies met inclusion criteria. Greater violence exposure, poor economic resources, living in rural compared with urban areas, poor family and peer relations, and poor coping skills were associated with PTSD symptoms. CONCLUSIONS The ecological framework is a useful approach to understanding factors affecting adolescent PTSD. Future research should focus on socioecological levels that have received limited attention. (PsycINFO Database Record
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Affiliation(s)
- Yasmin Rosshandler
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, USA
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau SAR, People's Republic of China
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daphna Canetti
- Department of Political Science, University of Haifa, Israel
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161
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Cherewick M, Doocy S, Tol W, Burnham G, Glass N. Potentially traumatic events, coping strategies and associations with mental health and well-being measures among conflict-affected youth in Eastern Democratic Republic of Congo. Glob Health Res Policy 2016; 1:8. [PMID: 29202057 PMCID: PMC5693481 DOI: 10.1186/s41256-016-0007-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/12/2016] [Indexed: 11/10/2022] Open
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162
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Arat G, Wong PWC. The relationship between parental involvement and adolescent mental health in six sub-Saharan African countries: findings from Global School-based Health Surveys (GSHS). INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2016. [DOI: 10.1080/14623730.2016.1194305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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163
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Miller KE, Jordans MJD. Determinants of Children's Mental Health in War-Torn Settings: Translating Research Into Action. Curr Psychiatry Rep 2016; 18:58. [PMID: 27091645 DOI: 10.1007/s11920-016-0692-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research on the mental health and psychosocial wellbeing of children in conflict-affected settings has undergone a significant paradigm shift in recent years. Earlier studies based on a war exposure model primarily emphasized the effects of direct exposure to armed conflict; this has gradually given way to a broader understanding of the diverse pathways by which organized violence affects children. A robustly supported comprehensive model includes risk factors at multiple points in time (prior war exposure, ongoing daily stressors) and at all levels of the social ecology. In particular, findings suggest that material deprivation and a set of family variables, including harsh parenting, parental distress, and witnessing intimate partner violence, are important mediators of the relationship between armed conflict and children's wellbeing. To date, however, interventions aimed at supporting war-affected children's wellbeing, both preventive and treatment-focused, have focused primarily on direct work with children, while paying only modest attention to ongoing risk factors in their families and broader environments. Possible reasons for the ongoing prioritization of child-focused interventions are considered, and examples are provided of recent evidence-based interventions that have reduced toxic stressors (harsh parenting and the use of violent discipline by teachers) in conflict-affected communities.
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Affiliation(s)
- Kenneth E Miller
- Department of Research and Development, War Child Holland, Amsterdam, The Netherlands.
| | - Mark J D Jordans
- Department of Research and Development, War Child Holland, Amsterdam, The Netherlands
- Center for Global Mental Health, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
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164
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Rosenberg AR, Yi-Frazier JP. Commentary: Resilience Defined: An Alternative Perspective. J Pediatr Psychol 2016; 41:506-9. [PMID: 27013701 DOI: 10.1093/jpepsy/jsw018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/24/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abby R Rosenberg
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine, Trueman Katz Center for Pediatric Bioethics, and Fred Hutchinson Cancer Research Center
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine
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165
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Cognitive styles and psychological functioning in rural South African school students: Understanding influences for risk and resilience in the face of chronic adversity. J Adolesc 2016; 49:38-46. [PMID: 26994348 DOI: 10.1016/j.adolescence.2016.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 01/22/2023]
Abstract
Adverse childhood experiences can show lasting effects on physical and mental health. Major questions surround how children overcome adverse circumstances to prevent negative outcomes. A key factor determining resilience is likely to be cognitive interpretation (how children interpret the world around them). The cognitive interpretations of 1025 school children aged 10-12 years in a rural, socioeconomically disadvantaged area of South Africa were examined using the Cognitive Triad Inventory for Children (CTI-C). These were examined in relation to psychological functioning and perceptions of the school environment. Those with more positive cognitive interpretations had better psychological functioning on scales of depression, anxiety, somatization and sequelae of potentially traumatic events. Children with more negative cognitions viewed the school-environment more negatively. Children living in poverty in rural South Africa experience considerable adversity and those with negative cognitions are at risk for psychological problems. Targeting children's cognitive interpretations may be a possible area for intervention.
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166
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Affiliation(s)
- Panos Vostanis
- School of Psychology, University of Leicester, Leicester, UK
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167
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Wessells MG. Strengths-based community action as a source of resilience for children affected by armed conflict. Glob Ment Health (Camb) 2016; 3:e1. [PMID: 28596870 PMCID: PMC5314737 DOI: 10.1017/gmh.2015.23] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/18/2015] [Accepted: 12/03/2015] [Indexed: 11/07/2022] Open
Abstract
Psychosocial and mental health supports for war-affected children frequently are limited by a deficits focus. Current research and practice indicate the value of a strengths-based approach that supports children's resilience and supports a positive environment for children and builds on existing strengths. This paper analyzes how community-based child protection mechanisms are a cornerstone of prevention efforts, and views community-based action as a particularly valuable source for strengths-based support for war-affected children. It shows how collective planning and action on behalf of vulnerable children create high levels of community ownership and effective, sustainable supports for children. It suggests that significant work lies ahead in strengthening the evidence base regarding the effectiveness of strengths-based approaches and in transforming practice away from expert-driven approaches toward community-driven action.
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Affiliation(s)
- M. G. Wessells
- Columbia University, Program on Forced Migration and Health, New York, USA
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168
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Sheikh TL, Mohammed A, Eseigbe E, Adekeye T, Nuhu FT, Lasisi M, Muhammad A, Sulaiman ZT, Abdullateef AA, Hayyatudeen N, Akande Y. Descriptive Characterization of Psycho-Trauma, Psychological Distress, and Post-traumatic Stress Disorder among Children and Adolescent Internally Displaced Persons in Kaduna, Nigeria. Front Psychiatry 2016; 7:179. [PMID: 27840613 PMCID: PMC5083839 DOI: 10.3389/fpsyt.2016.00179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/14/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A postelection violent conflict in Kaduna resulted in 800 deaths and 65,000 displaced people leading to setting up of camp for internally displaced persons (IDPs). We set out to determine the prevalence and pattern of psycho-traumatic stressful life events, psychological distress, and post-traumatic stress disorder (PTSD) among child/adolescents IDPs. METHODS A descriptive cross-sectional study of 73 child/adolescent IDPs were selected by total sampling. Stressful life event checklist measured conflict-related trauma and reaction of adolescents to traumatic stress (RATS) measured post-trauma reaction of children/adolescents. Hopkins Symptoms Checklist 37 for Adolescents measured psychological distress associated with trauma. Diagnostic Interview Schedule for Children was used for diagnosis of PTSD. RESULTS Of 73 respondents, 3 (4.1%) had probable PTSD, 2 (2.7%) had definitive PTSD, and mean score of the child/adolescent IDPs on HSCL-37A and RATS was 44.7 (SD = 6.3) and 31.9 (SD = 5.7), respectively. Most frequently occurring psychological distress among female participants was suddenly scared for no reason 7 (19.5%) and becoming angry easily and feeling fearful 5 (13.9%). The average score for female participants were higher than that for males on depressive and anxiety subscale of HSCL-37A. CONCLUSION We concluded that children/adolescent IDPs were exposed to psycho-trauma following postelection violent conflict and developed psychological distress. However, the low prevalence of psychological distress and PTSD suggested that living with parents and psychosocial intervention provided could have led to much lower morbidity.
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Affiliation(s)
- Taiwo Lateef Sheikh
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Kaduna, Nigeria; Department of Psychiatry, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Abdulaziz Mohammed
- Department of Clinical Services, Federal Neuropsychiatric Hospital , Kaduna, Kaduna , Nigeria
| | - Edwin Eseigbe
- Department of Paediatrics, Ahmadu Bello University , Zaria, Kaduna , Nigeria
| | - Tosin Adekeye
- Department of Psychiatry, Ahmadu Bello University , Zaria, Kaduna , Nigeria
| | | | - Modupe Lasisi
- Department of Clinical Services, Federal Neuropsychiatric Hospital , Kaduna, Kaduna , Nigeria
| | - Asiya Muhammad
- Department of Clinical Services, Federal Neuropsychiatric Hospital , Kaduna, Kaduna , Nigeria
| | | | | | - Nafisatu Hayyatudeen
- Department of Clinical Services, Federal Neuropsychiatric Hospital , Kaduna, Kaduna , Nigeria
| | - Yusuf Akande
- Department of Clinical Services, Federal Neuropsychiatric Hospital , Kaduna, Kaduna , Nigeria
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169
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Theron LC. The everyday ways that school ecologies facilitate resilience: Implications for school psychologists. SCHOOL PSYCHOLOGY INTERNATIONAL 2015. [DOI: 10.1177/0143034315615937] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Linda C. Theron
- Optentia Research Focus Area, North-West University, South Africa
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170
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Schiltz J, Vindevogel S, Broekaert E, Derluyn I. Dealing with Relational and Social Challenges After Child Soldiering: Perspectives of Formerly Recruited Youth and Their Communities in Northern Uganda. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2015. [DOI: 10.1002/casp.2264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Julie Schiltz
- Ghent University; Department of Special Needs Education/Centre for Children in Vulnerable Situations; Henri Dunantlaan 2 B-9000 Gent Belgium
| | - Sofie Vindevogel
- Ghent University College; Faculty of Education, Health & Social Work/Centre for Children in Vulnerable Situations; Valentin Vaerwyckweg 1 B-9000 Gent Belgium
| | - Eric Broekaert
- Ghent University; Department of Special Needs Education/Centre for Children in Vulnerable Situations; Henri Dunantlaan 2 B-9000 Gent Belgium
| | - Ilse Derluyn
- Ghent University; Department of Social Work and Social Pedagogy/Centre for Children in Vulnerable Situations; Henri Dunantlaan 2 B-9000 Gent Belgium
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171
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Ungar M, Theron L, Liebenberg L, Tian GX, Restrepo A, Sanders J, Munford R, Russell S. Patterns of individual coping, engagement with social supports and use of formal services among a five-country sample of resilient youth. Glob Ment Health (Camb) 2015; 2:e21. [PMID: 28596868 PMCID: PMC5269622 DOI: 10.1017/gmh.2015.19] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/19/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although resilience among victims of child abuse is commonly understood as a process of interaction between individuals and their environments, there have been very few studies of how children's individual coping strategies, social supports and formal services combine to promote well-being. METHOD For this study, we conducted a multi-phase analysis of a qualitative dataset of 608 interviews with young people from five countries using grounded theory strategies to build a substantive theory of young people's service and support use patterns. We started with an analysis of ten interviews (two from each country) and then compared these findings to patterns found in each country's full dataset. RESULTS The substantive theory that emerged explains young people's transience between individual coping strategies (cognitive and behavioral), reliance on social supports (family members, peers and teachers), and engagement with formal service providers whose roles are to provide interventions and case management. Young people's patterns of navigation were shown to be contingent upon the individual's risk exposure, his or her individual capacity to cope, and the quality of the formal and informal supports and services that are available and accessible. CONCLUSION Differing amounts of formal resources in low-, middle- and high-income countries influence patterns of service use. Implications for better coordination between formal mental health services and social supports are discussed.
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Affiliation(s)
- M. Ungar
- Resilience Research Centre, Dalhousie University, Halifax, Canada
| | - L. Theron
- Optentia Research Focus Area, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa
| | - L. Liebenberg
- School of Social Work, Dalhousie University, Halifax, Canada
| | - Guo-Xiu Tian
- Political Science, Capital Normal University, Beijing, China
| | - A. Restrepo
- School of Public Health, University of Antioquia, Medellin, Colombia
| | - J. Sanders
- School of Social Work, Massey University, Palmerston North, New Zealand
| | - R. Munford
- School of Social Work, Massey University, Palmerston North, New Zealand
| | - S. Russell
- Resilience Research Centre, Dalhousie University, Halifax, Canada
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172
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Assessing Resilience in War-Affected Children and Adolescents: A Critical Review. JOURNAL OF EUROPEAN PSYCHOLOGY STUDENTS 2015. [DOI: 10.5334/jeps.dc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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173
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Sriskandarajah V, Neuner F, Catani C. Parental care protects traumatized Sri Lankan children from internalizing behavior problems. BMC Psychiatry 2015; 15:203. [PMID: 26302824 PMCID: PMC4549083 DOI: 10.1186/s12888-015-0583-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in war-torn regions has mainly focused on the impact of traumatic experiences on individual mental health and has found high prevalence rates of psychiatric disorders in affected adults and children. However, little is known about the possible protective factors occurring in children's environments in the aftermath of mass trauma. Therefore, we conducted a cross-sectional study with families in Northern Sri Lanka, a region that had been shattered by a long-lasting civil war and devastated by the Asian tsunami in 2004. METHODS Schoolchildren aged 7 to 11 (N = 359) were interviewed on the basis of standardized measures to assess children's exposure to traumatic events, mental health symptoms, and parenting behavior as perceived by children. All interviews were carried out by local senior counselors. RESULTS Linear regression analyses identified exposure to mass trauma and family violence as significant risk factors of child mental health whereas parental care emerged as a significant factor associated with fewer behavior problems. In addition, parental care significantly moderated the relationship between mass trauma and internalizing behavior problems. CONCLUSIONS Family characteristics seem to be strongly associated with children's mental health even in regions severely affected by mass trauma. This finding is particularly relevant for the development of targeted psychosocial interventions for children and families living in war torn areas.
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Affiliation(s)
| | - Frank Neuner
- Department of Psychology, Bielefeld University, PO Box 100131, , D-33501, Bielefeld, Germany.
| | - Claudia Catani
- Department of Psychology, Bielefeld University, PO Box 100131, , D-33501, Bielefeld, Germany.
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174
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Correa-Velez I, Gifford SM, McMichael C. The persistence of predictors of wellbeing among refugee youth eight years after resettlement in Melbourne, Australia. Soc Sci Med 2015; 142:163-8. [PMID: 26310592 DOI: 10.1016/j.socscimed.2015.08.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
Abstract
This short report assesses the predictors of subjective health and happiness among a cohort of refugee youth over their first eight years in Australia. Five waves of data collection were conducted between 2004 (n = 120) and 2012-13 (n = 51) using mixed methods. Previous schooling, self-esteem, moving house in the previous year, a supportive social environment, stronger ethnic identity and perceived discrimination were significant predictors of wellbeing after adjusting for demographic and pre-migration factors. When compared with a previous analysis of this cohort over their first three years of settlement, experiences of social exclusion still have a significant impact on wellbeing eight years after arriving in Australia. This study contributes to mounting evidence in support of policies that discourage discrimination and promote social inclusion and cultural diversity and which underpin the wellbeing of resettled refugee youth.
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Affiliation(s)
- Ignacio Correa-Velez
- School of Public Health and Social Work, Faculty of Health, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia.
| | - Sandra M Gifford
- The Swinburne Institute for Social Research, Swinburne University of Technology, PO Box 218 Hawthorn, Victoria 3122, Australia.
| | - Celia McMichael
- School of Social Sciences, La Trobe University, Bundoora, Victoria 3086, Australia.
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175
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Jordans MJD, Tol WA. Mental health and psychosocial support for children in areas of armed conflict: call for a systems approach. BJPsych Int 2015; 12:72-75. [PMID: 29093863 PMCID: PMC5618929 DOI: 10.1192/s2056474000000490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper focuses on the question of whether separate attention to children who have faced specific conflict-related events is justified, or whether the scarce resources for mental health should be spent on the development of services for children more broadly in low- and middle-income countries (where most contemporary armed conflicts are taking place). It is argued that a systems approach to mental health and psychosocial support for children is warranted.
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Affiliation(s)
- M J D Jordans
- Senior Lecturer, Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK, email
| | - W A Tol
- Dr Ali & Rose Kawi Assistant Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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176
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Panter-Brick C, Grimon MP, Kalin M, Eggerman M. Trauma memories, mental health, and resilience: a prospective study of Afghan youth. J Child Psychol Psychiatry 2015; 56:814-825. [PMID: 25384553 DOI: 10.1111/jcpp.12350] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Studies of war-affected youth have not yet examined how trauma memories relate to prospective changes in mental health and to subjective or social experiences. METHODS We interviewed a gender-balanced, randomly selected sample of Afghan child-caregiver dyads (n = 331, two waves, 1 year apart). We assessed lifetime trauma with a Traumatic Event Checklist, past-year events with a checklist of risk and protective events, and several child mental health outcomes including posttraumatic distress (Child Revised Impact of Events Scale, CRIES) and depression. We examined the consistency of trauma recall over time, identified mental health trajectories with latent transition modeling, and assessed the predictors of posttraumatic distress and depression trajectories with multinomial logistic regressions. RESULTS From baseline to follow-up, reports of lifetime trauma significantly changed (p ≤ 0.01). A third of the cohort reported no trauma exposure; only 10% identified the same event as their most distressing experience. We identified four CRIES trajectories: low or no distress (52%), rising distress (15%), declining distress (21%), and sustained high distress (12%). Youth with chronic posttraumatic distress were more likely to be girls (OR = 5.78, p ≤ 0.01), report more trauma exposure at baseline (OR = 1.55, p ≤ 0.05) and follow-up (OR = 5.96, p ≤ 0.01), and experience ongoing domestic violence (OR = 4.84, p ≤ 0.01). The risks of rising distress and sustained distress showed a steady increase for youth recalling up to four traumatic experiences. Depression and CRIES trajectories showed weak comorbidity. CONCLUSIONS Memories of violent events are malleable, embedded in social experiences, and present heterogeneous associations with posttraumatic distress. Our study provides insights on resilience and vulnerability to multiple adverse childhood experiences, highlighting research and clinical implications for understanding trauma in conflict-affected youth.
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Affiliation(s)
| | | | - Michael Kalin
- Department of Political Science, Yale University, New Haven, CT, USA
| | - Mark Eggerman
- MacMillan Center for International and Area Studies, Yale University, New Haven, CT, USA
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177
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de Jong JTVM, Berckmoes LH, Kohrt BA, Song SJ, Tol WA, Reis R. A public health approach to address the mental health burden of youth in situations of political violence and humanitarian emergencies. Curr Psychiatry Rep 2015; 17:60. [PMID: 26021862 PMCID: PMC4452256 DOI: 10.1007/s11920-015-0590-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper describes how socio-ecological theory and a syndemic health systems and public health approach may help address the plight of youth in situations of political violence and humanitarian emergencies. We describe the treatment gap caused by discrepancies in epidemiological prevalence rates, individual and family needs, and available human and material resources. We propose four strategies to develop a participatory public health approach for these youth, based on principles of equity, feasibility, and a balance between prevention and treatment. The first strategy uses ecological and transgenerational resilience as a theoretical framework to facilitate a systems approach to the plight of youth and families. This theoretical base helps to engage health care professionals in a multisectoral analysis and a collaborative public health strategy. The second strategy is to translate pre-program assessment into mental health and psychosocial support (MHPSS) priorities. Defining priorities helps to develop programs and policies that align with preventive and curative interventions in multiple tiers of the public health system. The third is a realistic budgetary framework as a condition for the development of sustainable institutional capacity including a monitoring system. The fourth strategy is to direct research to address the knowledge gap about effective practices for youth mental health in humanitarian settings.
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Affiliation(s)
- Joop T. V. M. de Jong
- />Amsterdam Institute of Social Science Research (AISSR) University of Amsterdam, Nieuwe Achtergracht 166, 1018WV Amsterdam, The Netherlands
- />Boston University School of Medicine, Boston, MA USA
| | - Lidewyde H. Berckmoes
- />Amsterdam Institute of Social Science Research (AISSR) University of Amsterdam, Nieuwe Achtergracht 166, 1018WV Amsterdam, The Netherlands
| | - Brandon A. Kohrt
- />Duke Global Health Institute, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Suzan J. Song
- />Amsterdam Institute of Social Science Research (AISSR) University of Amsterdam, Nieuwe Achtergracht 166, 1018WV Amsterdam, The Netherlands
| | - Wietse A. Tol
- />Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ria Reis
- />Amsterdam Institute of Social Science Research (AISSR) University of Amsterdam, Nieuwe Achtergracht 166, 1018WV Amsterdam, The Netherlands
- />Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- />The Children’s Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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178
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Bonanno GA, Romero SA, Klein SI. The Temporal Elements of Psychological Resilience: An Integrative Framework for the Study of Individuals, Families, and Communities. PSYCHOLOGICAL INQUIRY 2015. [DOI: 10.1080/1047840x.2015.992677] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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179
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Vindevogel S, Ager A, Schiltz J, Broekaert E, Derluyn I. Toward a culturally sensitive conceptualization of resilience: Participatory research with war-affected communities in northern Uganda. Transcult Psychiatry 2015; 52:396-416. [PMID: 25586738 DOI: 10.1177/1363461514565852] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Resilience research with war-affected populations has long conceptualized resilience as the absence of psychopathology and operationalized it by use of standardized measures. However, literature on resilience increasingly highlights the importance of also including indicators of positively valued functioning as well as contextually sensitive indicators of resilience. This study used a participatory approach to examine the contextual conceptualization of youth resilience in the aftermath of war in northern Uganda, as defined by groups of stakeholders (youths, parents, elders, leaders, teachers) in four communities. The results identify 40 indicators covering a multiplicity of domains of functioning. The rationales behind these indicators were clustered into the broad themes: progress, self-reliance, social connectedness, morality, health, and comfort. The findings suggest that positively and negatively valued aspects of functioning are both key to conceptualizing resilience, and indicate the importance of including contextually distinguished indicators. The findings further point to the role of individual and collective processes in the construction of resilience, and to the need to take into account the contexts wherein resilience is conceptualized and observed. This study generated contextually sensitive indicators of young people's resilience, which can be used, complementary to existing measures of functioning, to provide a more comprehensive and culturally sensitive view of youths' resilience in the wake of war adversity.
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180
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Newnham EA, McBain RK, Hann K, Akinsulure-Smith AM, Weisz J, Lilienthal GM, Hansen N, Betancourt TS. The Youth Readiness Intervention for war-affected youth. J Adolesc Health 2015; 56:606-11. [PMID: 26003574 DOI: 10.1016/j.jadohealth.2015.01.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/03/2014] [Accepted: 01/28/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Mental disorders are among the largest contributors to the global burden of disease. Since the cessation of the Sierra Leonean civil war in 2002, there have been few mental health resources available for war-affected youth. Co-occurring psychological problems are commonly reported by youth in the post-conflict setting, suggesting a need for evidence-based interventions that cater to comorbid psychological difficulties. This feasibility study outlines the implementation and evaluation of a mixed-methods approach for developing and piloting a culturally grounded group mental health treatment-the Youth Readiness Intervention (YRI)-for war-affected Sierra Leonean youth. METHODS Participating youth (N = 32; 50% female; ages, 15-24 years) were allocated to one of four gender- and age-stratified groups, facilitated by gender-matched Sierra Leonean interventionists. The intervention comprised adapted cognitive behavioral therapy techniques to address issues pertinent to war-affected youth. Analyses comprised assessments of reliable symptom change, mental health, functional adaptation, and interventionist fidelity outcomes. RESULTS The YRI was found to be acceptable, feasible and associated with reliable changes in internalizing and externalizing symptoms and improvements in functional impairments and emotion regulation (mean effect size, d = .64). CONCLUSIONS Youth struggling with the mental health consequences of past trauma due to war merit special attention. The YRI presents a feasible and acceptable intervention for use in this low resource setting. A randomized controlled trial is planned to further test intervention effectiveness and scalability.
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Affiliation(s)
- Elizabeth A Newnham
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; School of Psychology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ryan K McBain
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katrina Hann
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - John Weisz
- Department of Psychiatry, Harvard University, Boston, Massachusetts
| | - Grace M Lilienthal
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nathan Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Theresa S Betancourt
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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181
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Burkey MD, Hosein M, Purgato M, Adi A, Morton I, Kohrt BA, Tol WA. Psychosocial interventions for disruptive behavioural problems in children living in low- and middle-income countries: study protocol of a systematic review. BMJ Open 2015; 5:e007377. [PMID: 25995239 PMCID: PMC4442205 DOI: 10.1136/bmjopen-2014-007377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Disruptive behaviour disorders (DBDs) are among the most common forms of child psychopathology and have serious long-term academic, social, and mental health consequences worldwide. Psychosocial treatments are the first line of evidence-based treatments for DBDs, yet their effectiveness often varies according to patient sociodemographic characteristics, practice setting, and implementation procedures. While a large majority of the world's children live in low- and middle-income countries (LMIC), most studies have evaluated psychosocial treatments for DBDs in high-income Anglo countries. METHODS AND ANALYSIS The primary objective of this systematic review is to assess the effects of psychosocial treatments for DBDs in children and adolescents (under age 18) diagnosed with oppositional defiant disorder, conduct disorder, or other disruptive behavioural problems living in LMIC. The secondary objectives are to: (1) describe the range and types of psychosocial treatments used to address DBDs in LMIC and (2) identify key dissemination and implementation factors (adaptation processes, training/supervision processes, and financial costs). All controlled trials comparing psychosocial treatments versus waiting list, no treatment, or treatment as usual in children living in LMIC will be included. Studies will be identified using the methods outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines without restrictions on language, publication type, status, or date of publication. The primary outcome measures will be disruptive behavioural problems (eg, oppositionality, defiance, aggression or deceit). Secondary outcomes will be positive mental health outcomes (eg, prosocial behaviour), function impairment, institutionalisation (or hospitalisation), academic outcomes and caregiver outcomes. ETHICS AND DISSEMINATION This study uses data from published studies; therefore ethical review is not required. Findings will be presented in a published manuscript. TRIAL REGISTRATION NUMBER PROSPERO CRD42014015334.
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Affiliation(s)
- Matthew D Burkey
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Megan Hosein
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marianna Purgato
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Section of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Ahmad Adi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Isabella Morton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brandon A Kohrt
- Duke University Global Health Institute, Durham, North Carolina, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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182
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Song SJ, Kaplan C, Tol WA, Subica A, de Jong J. Psychological distress in torture survivors: pre- and post-migration risk factors in a US sample. Soc Psychiatry Psychiatr Epidemiol 2015; 50:549-60. [PMID: 25403567 DOI: 10.1007/s00127-014-0982-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/10/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors. METHODS Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning. RESULTS Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21). CONCLUSION Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.
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Affiliation(s)
- Suzan J Song
- Center for Survivors of Torture, Asian Americans for Community Involvement, 2400 Moorpark Ave, San Jose, CA, 95128, USA,
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183
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Grigorenko EL. Genomic sciences for developmentalists: a merge of science and practice. New Dir Child Adolesc Dev 2015; 2015:5-12. [PMID: 25732010 DOI: 10.1002/cad.20083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The etiological forces of development have been a central question for the developmental sciences (however defined) since their crystallization as a distinct branch of scientific inquiry. Although the history of these sciences contains examples of extreme positions capitalizing on either the predominance of the genome (i.e., the accumulation of genetic factors driving development) or the environmentome (i.e., the accumulation of environmental factors driving development), the moderate view of development as the emergence of a person from a particular genome and within a specific context has settled into the driver's seat and is disputed no longer. Yet, although there is a converging theoretical perspective, a gap between this perspective and practice remains. In other words, society needs to translate this position into praxis. This opinion exemplifies the current state of corresponding knowledge in the developmental sciences, with a particular emphasis on the understanding of the role of the genome in child and adolescent development, and offers a set of comments on how this translation is being shaped by the newest technologies in the genomic sciences.
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Affiliation(s)
- Elena L Grigorenko
- Child Study Center, Yale University, New Haven, CT, USA; Laboratory of Translational Science of Early Childhood, St. Petersburg State University, St. Petersburg, Russian Federation
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184
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Siriwardhana C, Abas M, Siribaddana S, Sumathipala A, Stewart R. Dynamics of resilience in forced migration: a 1-year follow-up study of longitudinal associations with mental health in a conflict-affected, ethnic Muslim population. BMJ Open 2015; 5:e006000. [PMID: 25687898 PMCID: PMC4336461 DOI: 10.1136/bmjopen-2014-006000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The concept of 'resilience' is of increasing interest in studies of mental health in populations facing adversity. However, lack of longitudinal data on the dynamics of resilience and non-usage of resilience-specific measurements have prevented a better understanding of resilience-mental health interactions. Hence, the present study was conducted to investigate the stability of levels of resilience and its associations with sociodemographic and mental health exposures in a conflict-affected internal-migrant population in Sri Lanka. DESIGN A prospective follow-up study of 1 year. SETTING Puttalam district of North Western province in postconflict Sri Lanka (baseline in 2011, follow-up in 2012). PARTICIPANTS An ethnic Muslim population internally displaced 20 years ago (in 1990) from Northern Sri Lanka, aged 18 or above and currently in the process of return migration. MEASURES It was hypothesised that levels of resilience would be associated with mental health outcomes. Resilience was measured on both occasions using the 14-item Resilience Scale (RS-14), social support by the Multidimensional Social Support Scale and Lubben Social Network Scale and common mental disorders by the Patient Health Questionnaire (PHQ). RESULTS Of 450 participants interviewed at baseline in 2011, 338 (75.1%) were re-interviewed in 2012 after a 1-year follow-up. The mean resilience scores measured by RS-14 were 80.2 (95% CI 78.6 to 81.9) at baseline and 84.9 (83.5 to 86.3) at follow-up. At both time points, lower resilience was independently associated with food insecurity, lower social support availability and social isolation. At both time points, there were significant associations with common mental disorders (CMDs) in unadjusted analyses, but they only showed independence at baseline. The CMD prevalence, maintenance and incidence at follow-up was 8.3%, 28.2% and 2.2%, respectively. CONCLUSIONS In this displaced population facing a potential reduction in adversity, resilience was more strongly and robustly associated with economic and social factors than with the presence of mental disorder.
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Affiliation(s)
- Chesmal Siriwardhana
- King's College London (Institute of Psychiatry), London, UK
- Institute for Research & Development, Colombo, Sri Lanka
- Faculty of Medical Science, Anglia Ruskin University, UK
| | - Melanie Abas
- King's College London (Institute of Psychiatry), London, UK
| | | | | | - Robert Stewart
- King's College London (Institute of Psychiatry), London, UK
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185
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Diab M, Peltonen K, Qouta SR, Palosaari E, Punamäki RL. Effectiveness of psychosocial intervention enhancing resilience among war-affected children and the moderating role of family factors. CHILD ABUSE & NEGLECT 2015; 40:24-35. [PMID: 25534065 DOI: 10.1016/j.chiabu.2014.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
The study examines, first, the effectiveness of a psychosocial intervention based on Teaching Recovery Techniques (TRT) to increase resiliency among Palestinian children, exposed to a major trauma of war. Second, it analyses the role of family factors (maternal attachment and family atmosphere) as moderating the intervention impacts on resilience. School classes in Gaza were randomized into intervention (N=242) and control (N=240) groups. The percentage of girls (49.4%) and boys (50.6%) were equal, and the child age was 10-13 years in both groups. Children reported positive indicators of their mental health (prosocial behaviour and psychosocial well-being) at baseline (T1), post-intervention (T2) and at a six-month follow-up (T3). At T1 they accounted their exposure to war trauma. Mothers reported about their willingness to serve as an attachment figure, and the child reported about the family atmosphere. Resilience was conceptualized as a presence of positive indications of mental health despite trauma exposure. Against our hypothesis, the intervention did not increase the level of resilience statistically significantly, nor was the effect of the intervention moderated by maternal attachment responses or family atmosphere.
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Affiliation(s)
- Marwan Diab
- University of Tampere, Finland; Gaza Community Mental Health Programme, Gaza, Palestine
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186
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Punamäki RL, Palosaari E, Diab M, Peltonen K, Qouta SR. Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: Trauma, family- and child-related predictors. J Affect Disord 2015; 172:133-40. [PMID: 25451407 DOI: 10.1016/j.jad.2014.09.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/12/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Research shows great individual variation in changes in posttraumatic stress symptoms (PTSSs) after major traumas of terrorist attacks, military combat, and natural disasters. Earlier studies have identified specific mental health trajectories both in children and adults. This study aimed, first, to identify potential PTSS-related trajectories by using latent class growth analyses among children in a three-wave assessment after the 2008/2009 War on Gaza, Palestine. Second, it analyzed how family- and child related factors (e.g., attachment relations, posttraumatic cognitions (PTCs), guilt, and emotion regulation) associate with the trajectory class membership. METHODS The sample consisted of 240 Palestinian children (49.4% girls and 50.6% boys) of 10-13 years of age (M=11.29, SD=0.68), who completed PTSS (CRIES) assessments at 3 (T1), 5 (T2), and 11 (T3) months after the war. Children reported their personal exposure to war trauma, attachment style, cognitive trauma processing, and emotion regulation, and their parents reported family war trauma exposure and attachment style. RESULTS Results revealed a three-trajectory solution, a majority of children belonging to the Recovery trajectory (n=183), and a minority belonged either to Resistant trajectory (n=29) or to Increasing symptoms trajectory (n=28). Low levels of negative posttraumatic cognitive appraisals, feelings of guilt and emotion regulation were characteristic of children in the Resistant trajectory as compared to Increasing symptoms trajectory. Father׳s attachment security was further associated with the Resistant trajectory membership. Children׳s attachment avoidance and high parental trauma were typical to children in Recovery trajectory (as compared to the Increasing symptoms trajectory).
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Affiliation(s)
| | - Esa Palosaari
- University of Tampere, Finland; Aalto University, Finland
| | - Marwan Diab
- University of Tampere, Finland; Gaza Community Mental Health Programme, Gaza, Palestine
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187
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Abstract
The authors review naturalistic studies of short-term processes that appear to promote resilience in children in the context of everyday family life and argue that warm and supportive family interactions foster resilience through their cumulative impact on children's emotional and physiological stress response systems. In the short-term, these family interactions promote the experience and expression of positive emotion and healthy patterns of diurnal cortisol. Over time, these internal resources - a propensity to experience positive emotion and a well-functioning hypothalamic-pituitary-adrenal axis system -enhance a child's capacity to avoid, or limit, the deleterious effects of adversity. This article highlights naturalistic research methods that are well suited to the study of these short-term resilience processes and points to clinical applications of our conceptual and methodological approach.
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Stemming the tide: promoting mental health and preventing mental disorders in low- and middle-income countries. Glob Ment Health (Camb) 2015; 2:e11. [PMID: 28596859 PMCID: PMC5269625 DOI: 10.1017/gmh.2015.9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/18/2015] [Accepted: 05/07/2015] [Indexed: 01/05/2023] Open
Abstract
The first World Health Organization's global action plan for mental health recognizes the importance of mental health promotion and prevention of mental disorders, through the inclusion of one of four objectives focused on this crucial area of research and practice. This paper aims to provide an 'aerial view' of the field of mental health promotion and prevention of mental disorders with a focus on low- and middle-income countries. Starting with reasons why promotion and prevention need to take center stage in global mental health efforts, the paper provides a framework and four general principles to guide such efforts: a socio-ecological perspective (place); an inter-sectoral and interdisciplinary approach (collaboration), a developmental perspective (timing), and a participatory and empowerment approach (strengths), or PaCTS. Evidence-based examples of mental health promotion, universal, selective, and indicated prevention are described.
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189
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Ungar M. Practitioner Review: Diagnosing childhood resilience--a systemic approach to the diagnosis of adaptation in adverse social and physical ecologies. J Child Psychol Psychiatry 2015; 56:4-17. [PMID: 25130046 DOI: 10.1111/jcpp.12306] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND With growing interest in resilience among mental health care providers globally, there is a need for a simple way to consider the complex interactions that predict adaptive coping when there is exposure to high levels of adversity such as family violence, mental illness of a child or caregiver, natural disasters, social marginalization, or political conflict. METHODS This article presents diagnostic criteria for assessing childhood resilience in a way that is sensitive to the systemic factors that influence a child's wellbeing. The most important characteristics of children who cope well under adversity and avoid problems like depression, PTSD, and delinquency are highlighted. RESULTS A multidimensional assessment of resilience is presented that examines, first, the severity, chronicity, ecological level, children's attributions of causality, and cultural and contextual relevance of experiences of adversity. Second, promotive and protective factors related to resilience are assessed with sensitivity to the differential impact these have on outcomes depending on a child's level of exposure to adversity. These factors include individual qualities like temperament, personality, and cognitions, as well as contextual dimensions of positive functioning related to the available and accessibility of resources, their strategic use, positive reinforcement by a child's significant others, and the adaptive capacity of the environment itself. Third, an assessment of resilience includes temporal and cultural factors that increase or decrease the influence of protective factors. A decision tree for the diagnosis of resilience is presented, followed by a case study and diagnosis of a 15-year-old boy who required treatment for a number of mental health challenges. CONCLUSIONS The diagnostic criteria for assessing resilience and its application to clinical practice demonstrate the potential usefulness of a systemic approach to understanding resilience among child populations.
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Affiliation(s)
- Michael Ungar
- Resilience Research Centre, Dalhousie University, Halifax, NS, Canada
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190
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Wessells MG. Commentary: A social environment approach to promotive and protective practice in childhood resilience--reflections on Ungar (2014). J Child Psychol Psychiatry 2015; 56:18-20. [PMID: 25409758 DOI: 10.1111/jcpp.12367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
The field of mental health and psychosocial support for children in humanitarian emergencies has been evolving rapidly. A decade ago, researchers and practitioners frequently took a deficits approach that emphasized problems such as trauma, particularly post-traumatic stress disorder (PTSD), in zones of armed conflict. Assessments focused on PTSD and typically led to the provision of curative responses such as Western psychotherapies as the first response for the affected population. Practitioners expressed diverse concerns about this approach, including its narrow, medicalized definition of the problem (mental disorder), the unsustainability of the programs it generated, the relative inattention to the context, the privileging of individual over systemic approaches, and the lack of cultural sensitivity. For these and other reasons, humanitarian practitioners have increasingly favored a resilience approach that features the agency of children, families, and communities and seeks to build upon existing assets or strengths. Already there is evidence of the effectiveness of numerous interventions that embody a resilience approach. Yet resilience approaches have been limited by a lack of conceptual clarity and ongoing questions about how to assess and measure it. In this context, Michael Ungar's Practitioner Review is an important contribution to practice.
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191
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Jensen TK, Skårdalsmo EMB, Fjermestad KW. Development of mental health problems - a follow-up study of unaccompanied refugee minors. Child Adolesc Psychiatry Ment Health 2014; 8:29. [PMID: 25780387 PMCID: PMC4361195 DOI: 10.1186/1753-2000-8-29] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/28/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Studies have shown that unaccompanied refugee children have elevated symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and externalizing problems. Few studies have examined change in this group's mental health symptoms after resettlement in a new country, particularly for those who arrive to a host country when being under the age of 15. METHOD The sample included 75 unaccompanied refugee children (mean age 16.5 years, SD =1.6; 83% boys) who settled in Norway. We examined change in the number of stressful life events, symptoms of PTSD (Child PTSD Symptom Scale; CPSS), and symptoms of anxiety, depression and externalizing problems (Hopkins Symptom Checklist; HSCL-37A) from 6 months after arrival (T1) to 1.9 years (SD =0.6) later (T2) using paired samples t-tests. Linear regression models were used to examine whether length of stay, level of education or change in the number of experienced stressful life events predicted symptom change. RESULTS There was a small and non-significant change in the mean scores of both symptom scales between T1 and T2, although there was considerable variation among the participants. The number of children who remained above the clinical cut-off value from T1 to T2 was as follows: 28 of 47 (59.6%) on the CPSS and eight of 16 (50.0%) on the HSCL-37A. There was a significant increase in the number of reported stressful life events from T1 to T2. An increase in reported stressful life events predicted an increase in PTSS (β =1.481, 95% CI .552 to 2.411). Length of stay, increase in stressful life events and level of education did not predict changes in the HSCL-37A. CONCLUSIONS There was no average change in the level of PTSS, depression, anxiety, or externalizing problems in this group of unaccompanied refugee children from shortly after arrival to nearly two years later. The large variation in change scores across informants indicates a need for monitoring the development of mental health problems and securing that the youth's primary psychosocial needs are met. The high rate of children above clinical cut-off on the symptoms scales and with suicidal ideation indicates that many may be in need of treatment.
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Affiliation(s)
- Tine K Jensen
- Department of Psychology, University of Oslo, Forskningsveien 3a, 0372 Oslo, Norway ,Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1-3, 0484 Oslo, Norway
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192
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Fazel M, Patel V, Thomas S, Tol W. Mental health interventions in schools in low-income and middle-income countries. Lancet Psychiatry 2014; 1:388-98. [PMID: 26361001 DOI: 10.1016/s2215-0366(14)70357-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Increasing enrolment rates could place schools in a crucial position to support mental health in low-income and middle-income countries. In this Review, we provide evidence for mental health interventions in schools in accordance with a public mental health approach spanning promotion, prevention, and treatment. We identified a systematic review for mental health promotion, and identified further prevention and treatment studies. Present evidence supports schools as places for promotion of positive aspects of mental health using a whole-school approach. Knowledge of effectiveness of prevention and treatment interventions is more widely available for conflict-affected children and adolescents. More evidence is needed to identify the many elements likely to be associated with effective prevention and treatment for children exposed to a range of adversity and types of mental disorders. Dissemination and implementation science is crucial to establish how proven effective interventions could be scaled up and implemented in schools.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, India; Sangath, Goa, India
| | | | - Wietse Tol
- Johns Hopkins Bloomberg School of Public Health, MD, USA
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193
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Siriwardhana C, Ali SS, Roberts B, Stewart R. A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants. Confl Health 2014; 8:13. [PMID: 25177360 PMCID: PMC4149800 DOI: 10.1186/1752-1505-8-13] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/12/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. However, resilience, defined as the ability of a person to successfully adapt to or recover from stressful and traumatic experiences, has been highlighted as a key potential protective factor. This study aimed to review systematically the global literature on the impact of resilience on the mental health of adult conflict-driven forced migrants. METHODOLOGY Both quantitative and qualitative studies that reported resilience and mental health outcomes among forcibly displaced persons (aged 18+) by way of exploring associations, links, pathways and causative mechanisms were included. Fourteen bibliographic databases and seven humanitarian study databases/websites were searched and a four stage screening process was followed. RESULTS Twenty three studies were included in the final review. Ten qualitative studies identified highlighted family and community cohesion, family and community support, individual personal qualities, collective identity, supportive primary relationships and religion. Thirteen quantitative studies were identified, but only two attempted to link resilience with mental disorders, and three used a specific resilience measure. Over-reliance on cross-sectional designs was noted. Resilience was generally shown to be associated with better mental health in displaced populations, but the evidence on this and underlying mechanisms was limited. DISCUSSION The review highlights the need for more epidemiological and qualitative evidence on resilience in forcibly displaced persons as a potential avenue for intervention development, particularly in resource-poor settings.
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Affiliation(s)
- Chesmal Siriwardhana
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, PO Box 92, De Crespigny Park, London SE5 8AF, UK
| | | | - Bayard Roberts
- London School of Hygiene and Tropical Medicine, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, PO Box 92, De Crespigny Park, London SE5 8AF, UK
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Rasmussen A, Ventevogel P, Sancilio A, Eggerman M, Panter-Brick C. Comparing the validity of the self reporting questionnaire and the Afghan symptom checklist: dysphoria, aggression, and gender in transcultural assessment of mental health. BMC Psychiatry 2014; 14:206. [PMID: 25034331 PMCID: PMC4107970 DOI: 10.1186/1471-244x-14-206] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/10/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The relative performance of local and international assessment instruments is subject to ongoing discussion in transcultural research on mental health and psychosocial support. We examined the construct and external validity of two instruments, one developed for use in Afghanistan, the other developed by the World Health Organization for use in resource-poor settings. METHODS We used data collected on 1003 Afghan adults (500 men, 503 women) randomly sampled at three sites in Afghanistan. We compared the 22-item Afghan Symptom Checklist (ASCL), a culturally-grounded assessment of psychosocial wellbeing, with Pashto and Dari versions of the 20-item Self-Reporting Questionnaire (SRQ-20). We derived subscales using exploratory and confirmatory factor analyses (EFA and CFA) and tested total and subscale scores for external validity with respect to lifetime trauma and household wealth using block model regressions. RESULTS EFA suggested a three-factor structure for SRQ-20--somatic complaints, negative affect, and emotional numbing--and a two-factor structure for ASCL--jigar khun (dysphoria) and aggression. Both factor models were supported by CFA in separate subsamples. Women had higher scores for each of the five subscales than men (p < 0.001), and larger bivariate associations with trauma (rs .24 to .29, and .10 to .19, women and men respectively) and household wealth (rs -.27 to -.39, and .05 to -.22, respectively). The three SRQ-20 subscales and the ASCL jigar khun subscale were equally associated with variance in trauma exposures. However, interactions between gender and jigar khun suggested that, relative to SRQ-20, the jigar khun subscale was more strongly associated with household wealth for women; similarly, gender interactions with aggression indicated that the aggression subscale was more strongly associated with trauma and wealth. CONCLUSIONS Two central elements of Afghan conceptualizations of mental distress--aggression and the syndrome jigar khun--were captured by the ASCL and not by the SRQ-20. The appropriateness of the culturally-grounded instrument was more salient for women, indicating that the validity of instruments may be gender-differentiated. Transcultural validation processes for tools measuring mental distress need to explicitly take gender into account. Culturally relevant measures are worth developing for long-term psychosocial programming.
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Affiliation(s)
- Andrew Rasmussen
- Fordham University, Dealy Hall 226, 441 East Fordham Rd, Bronx, NY 11215, USA
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195
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Hall BJ, Tol WA, Jordans MJD, Bass J, de Jong JTVM. Understanding resilience in armed conflict: social resources and mental health of children in Burundi. Soc Sci Med 2014; 114:121-8. [PMID: 24922609 DOI: 10.1016/j.socscimed.2014.05.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/30/2014] [Accepted: 05/25/2014] [Indexed: 11/30/2022]
Abstract
Little is known about the role of cognitive social capital among war-affected youth in low- and middle-income countries. We examined the longitudinal association between cognitive social capital and mental health (depression and posttraumatic stress disorder (PTSD) symptoms), functioning, and received social support of children in Burundi. Data were obtained from face-to-face interviews with 176 children over three measurement occasions over the span of 4-months. Cognitive social capital measured the degree to which children believed their community was trustworthy and cohesive. Mental health measures included the Depression Self-Rating Scale (DSRS) (Birleson, 1981), the Child Posttraumatic Symptom Scale (Foa et al., 2001), and a locally constructed scale of functional impairment. Children reported received social support by listing whether they received different types of social support from self-selected key individuals. Cross-lagged path analytic modeling evaluated relationships between cognitive social capital, symptoms and received support separately over baseline (T1), 6-week follow-up (T2), and 4-month follow-up (T3). Each concept was treated and analyzed as a continuous score using manifest indicators. Significant associations between study variables were unidirectional. Cognitive social capital was associated with decreased depression between T1 and T2 (B = -.22, p < .001) and T2 and T3 (β = -.25, p < .001), and with functional impairment between T1 and T2 (β = -.15, p = .005) and T2 and T3 (β = -.14, p = .005); no association was found for PTSD symptoms at either time point. Cognitive social capital was associated with increased social support between T1 and T2 (β = .16, p = .002) and T2 and T3 (β = .16, p = .002). In this longitudinal study, cognitive social capital was related to a declining trajectory of children's mental health problems and increases in social support. Interventions that improve community relations in war-affected communities may alter the trajectories of resource loss and gain with conflict-affected children.
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Affiliation(s)
- Brian J Hall
- Macau (SAR), People's Republic of China; Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Mark J D Jordans
- Healthnet TPO, 1072 RG Amsterdam, The Netherlands; Kings College, Institute of Psychiatry, Strand, London WC2R 2LS, United Kingdom
| | - Judith Bass
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Joop T V M de Jong
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA; Cultural and International Psychiatry VU University Medical Center, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands; Rhodes University, Drosty Rd, Grahamstown 6139, South Africa
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196
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Tol WA, Komproe IH, Jordans MJD, Ndayisaba A, Ntamutumba P, Sipsma H, Smallegange ES, Macy RD, de Jong JTVM. School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial. BMC Med 2014; 12:56. [PMID: 24690470 PMCID: PMC3994237 DOI: 10.1186/1741-7015-12-56] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 02/25/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). METHODS We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. RESULTS No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes. CONCLUSIONS Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings. TRIAL REGISTRATION The study was registered as ISRCTN42284825.
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Affiliation(s)
- Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House R863, Baltimore, MD 21205-1996, USA
- Department of Research & Development, HealthNet TPO, Amsterdam, the Netherlands
| | - Ivan H Komproe
- Department of Research & Development, HealthNet TPO, Amsterdam, the Netherlands
- Faculty for Behavioral & Social Sciences, Utrecht University, Utrecht, the Netherlands
| | - Mark JD Jordans
- Department of Research & Development, HealthNet TPO, Amsterdam, the Netherlands
- Centre for Global Mental Health, Institute of Psychiatry, Kings College London, London, UK
| | | | | | - Heather Sipsma
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Eva S Smallegange
- Department of Childhood and Educational Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Robert D Macy
- International Trauma Center & Harvard School of Medicine, Boston, MA, USA
| | - Joop TVM de Jong
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
- Boston University School of Medicine, Boston, USA
- Rhodes University, Grahamstown, South Africa
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197
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Abstract
There is a great need to recognize, prevent, reduce, or treat the immediate and long-term effects of childhood trauma. Most children affected by trauma will not develop long-term posttraumatic sequelae due to their resilience, but comorbid psychopathological outcomes occur and are more common after exposure to severe traumatic events. Factors influencing posttraumatic outcomes are numerous. Young dependent children tend to be more susceptible than older children; children with pain or injury are also more susceptible. Psychopathological effects may not be evident until adulthood. Awareness of the range of adverse outcomes underscores the importance of preventive interventions, accurate assessment, diagnosis and where possible, treatment. Advocacy and public policy initiatives are essential to improving outcomes.
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Affiliation(s)
- Frederick J Stoddard
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, SHC 610, Boston, MA 02114, USA.
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198
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Tyrer RA, Fazel M. School and community-based interventions for refugee and asylum seeking children: a systematic review. PLoS One 2014; 9:e89359. [PMID: 24586715 PMCID: PMC3933416 DOI: 10.1371/journal.pone.0089359] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 01/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research for effective psychological interventions for refugee and asylum-seeking children has intensified. The need for interventions in environments more easily accessed by children and families is especially relevant for newly arrived populations. This paper reviews the literature on school and community-based interventions aimed at reducing psychological disorders in refugee and asylum-seeking children. METHODS AND FINDINGS Comprehensive searches were conducted in seven databases and further information was obtained through searching reference lists, grey literature, and contacting experts in the field. Studies were included if they reported on the efficacy of a school or community-based mental health intervention for refugee or asylum-seeking children. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively. The marked heterogeneity of studies excluded conducting a meta-analysis but study effect-sizes were calculated where possible. Twenty one studies met inclusion criteria for the review reporting on interventions for approximately 1800 refugee children. Fourteen studies were carried out in high-income countries in either a school (n = 11) or community (n = 3) setting and seven studies were carried out in refugee camps. Interventions were either primarily focused on the verbal processing of past experiences (n = 9), or on an array of creative art techniques (n = 7) and others used a combination of these interventions (n = 5). While both intervention types reported significant changes in symptomatology, effect sizes ranged from 0.31 to 0.93 and could mainly be calculated for interventions focusing on the verbal processing of past experiences. CONCLUSIONS Only a small number of studies fulfilled inclusion criteria and the majority of these were in the school setting. The findings suggest that interventions delivered within the school setting can be successful in helping children overcome difficulties associated with forced migration.
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Affiliation(s)
- Rebecca A. Tyrer
- Oxford University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
| | - Mina Fazel
- Oxford University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom
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199
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Afectaciones psicológicas de niños y adolescentes expuestos al conflicto armado en una zona rural de Colombia. ACTA COLOMBIANA DE PSICOLOGIA 2014. [DOI: 10.14718/acp.2014.17.1.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Se determinaron las afectaciones psicológicas de 284 niños y adolescentes expuestos al conflicto armado en una zona rural colombiana, seleccionados mediante un muestreo aleatorio por afijación proporcional. Los instrumentos aplicados fueron: la Lista de chequeo de comportamiento infantil, el Auto-reporte de comportamientos de jóvenes, la Lista de síntomas postraumáticos, la Escala de estrategias de afrontamiento para adolescentes y la Escala de resiliencia para escolares. El 72% de la población presentó afectaciones psicológicas: el 64.4%, conductas internalizadas, el 47%, conductas externalizadas en rango clínico. El 32%, problemas somáticos; el 56%, se encontraba en riesgo de estrés postraumático, y el 93% consumía alcohol en grado moderado. La estrategia de afrontamiento más utilizada era dejar que las cosas se arreglaran solas. Se encontró una alta necesidad de atención en salud. Ser hombre constituyó un factor de riesgo de depresión, agresión y problemas sociales en los niños. A su vez, tener hasta doce años y estar cursando un grado escolar bajo, lo fue para los síntomas somáticos en adolescentes. Los resultados evidenciaron la afectación en la salud mental de los participantes.
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200
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Southwick SM, Bonanno GA, Masten AS, Panter-Brick C, Yehuda R. Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur J Psychotraumatol 2014; 5:25338. [PMID: 25317257 PMCID: PMC4185134 DOI: 10.3402/ejpt.v5.25338] [Citation(s) in RCA: 806] [Impact Index Per Article: 80.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 12/17/2022] Open
Abstract
In this paper, inspired by the plenary panel at the 2013 meeting of the International Society for Traumatic Stress Studies, Dr. Steven Southwick (chair) and multidisciplinary panelists Drs. George Bonanno, Ann Masten, Catherine Panter-Brick, and Rachel Yehuda tackle some of the most pressing current questions in the field of resilience research including: (1) how do we define resilience, (2) what are the most important determinants of resilience, (3) how are new technologies informing the science of resilience, and (4) what are the most effective ways to enhance resilience? These multidisciplinary experts provide insight into these difficult questions, and although each of the panelists had a slightly different definition of resilience, most of the proposed definitions included a concept of healthy, adaptive, or integrated positive functioning over the passage of time in the aftermath of adversity. The panelists agreed that resilience is a complex construct and it may be defined differently in the context of individuals, families, organizations, societies, and cultures. With regard to the determinants of resilience, there was a consensus that the empirical study of this construct needs to be approached from a multiple level of analysis perspective that includes genetic, epigenetic, developmental, demographic, cultural, economic, and social variables. The empirical study of determinates of resilience will inform efforts made at fostering resilience, with the recognition that resilience may be enhanced on numerous levels (e.g., individual, family, community, culture).
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Affiliation(s)
- Steven M Southwick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA ; National Center for Post-Traumatic Stress Disorder (NCPTSD), VA Connecticut Healthcare System, West Haven, CT, USA
| | - George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Colombia University, New York, NY, USA
| | - Ann S Masten
- Institute of Child Development, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | | | - Rachel Yehuda
- Division of Traumatic Stress Studies, Department of Psychiatry, James J. Peters Bronx VA and Ichan School of Medicine at Mount Sinai, New York, NY, USA
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