Childhood abuse and community violence: Risk factors for youth violence

Local understandings of PTSD and complex PTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city, Brazil

BACKGROUND

Adolescents in low-resource urban settings in Brazil are often exposed to high levels of trauma that can result in post-traumatic stress disorder (PTSD). However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Additionally, little is known about the perceived applicability among clinicians of the new ICD-11 diagnosis of complex PTSD (CPTSD), despite its potential relevance for contexts of chronic trauma. The current study investigated local understandings of PTSD and CPTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city.

METHODS

Semi-structured interviews were conducted with 58 health professionals working at both the primary care and specialized mental health levels in two areas of São Paulo city with high levels of community violence.

RESULTS

Most participants knew about PTSD, but most did not know about CPTSD. There were mixed views concerning the commonality of PTSD among adolescents exposed to community violence. Many participants reported having no experience working with patients with the PTSD diagnosis. According to some, community violence was normalized by adolescents and health professionals, and did not result in PTSD. Others highlighted how they did not use psychiatric diagnoses in their practice, had critical perspectives towards psychiatric diagnoses and/or PTSD, or simply knew little about PTSD. Furthermore, many highlighted how the chronic nature of multiple traumas experienced by adolescents often resulted in complex clinical presentations characterised by many symptoms beyond PTSD. The diagnosis of CPTSD was considered appropriate to the context by many participants as it captured the complex traumatic histories and symptom presentations of adolescents exposed to community violence in Brazil.

CONCLUSIONS

These findings have important implications for the assessment and treatment of mental health among adolescents exposed to community violence in Brazil.

Pilot Randomized Control Trial: Efficacy of a Group-Based Psychosocial Program for Youth with PTSD in the Brazilian Favelas

The study aimed to evaluate Teaching Recovery Techniques (TRT) delivered to Brazilian youth who experienced drug violence in one Favela. Thirty children, 8 to 14 years, were randomly assigned to TRT (n = 14) or to a treatment as usual group (n = 16) involving boxing/martial arts. Youth received five 90-min sessions over successive weeks. Standardized measures assessed Posttraumatic Stress and Depression at 2 weeks pre and post-test. An exploratory assessment of posttraumatic growth was also utilized. An interview with group leaders explored perceptions of delivering TRT within the favela. Medium effect sizes were found for PTSD and Depression, and a small effect size for posttraumatic growth. Group leaders emphasized understanding the favela context for program adaptation. In conclusion, TRT was found to be effective for children with PTSD and Depression who experienced drug violence in a Brazilian favela. TRT is recommended for future delivery. Larger scale RCTs are needed in Brazilian favelas.

The potential influence of criminological rationales in considering childhood abuse as mitigating to sentencing

BACKGROUND

U.S. courts currently show no coherent approach with regard to how evidence of childhood abuse is considered in sentencing. Existing state and federal caselaw suggests that courts rarely place significant consideration on evidence of childhood abuse during sentencing, but the reasons why offenders who have been subjected to childhood abuse rarely receive mitigated or alternative sentences remain unknown. Yet literature has suggested it might be because no convincing rationales have been yet developed for the court in contending that penalties of offenders who were subjected to childhood abuse should be mitigated.

OBJECTIVE

This research examines if and how criminological theoretical perspectives linking childhood abuse and later offending (Social Control Theory, Social Learning Theory, General Strain Theory) are persuasive in arguing childhood abuse (neglect, witnessing trauma, sexual abuse, physical abuse) as mitigating to criminal sentencing.

PARTICIPANTS

A national sample of U.S. adults (N = 521).

METHODS

A multi-factorial, vignette-based experiment was conducted, utilizing OLS and mediation analyses.

RESULTS

Evidence on childhood abuse, and particularly sexual abuse, reduced support for incapacitation (B = -0.13, p ≤ 0.05) and increased support for rehabilitation (B = 0.16, p ≤ 0.01). Social Control Theory was particularly persuasive in arguing childhood abuse as mitigating to prison time and in relation to support for rehabilitative sentencing (mediated by beliefs regarding what the theory conveys about future dangerousness and reduced responsibility).

CONCLUSIONS

Criminological theories appear to be persuasive rationales for arguing childhood abuse as mitigating to sentencing contexts involving incapacitation and rehabilitation. Implications for sentencing guidelines and systems are discussed.