Trajectories of psychological symptoms and resilience in conflict-affected children in low- and middle-income countries

Global, regional, and national burden of major depressive disorder and alcohol use disorder attributed to childhood sexual abuse in 204 countries and territories, 1999-2019: An analysis for the global burden of disease study 2019

AIM

This study aims to elucidate the impact of childhood sexual abuse (CSA) on major depressive disorder (MDD) and alcohol use disorder (AUD) globally, regionally, and nationally, informing targeted public health interventions and policy.

METHODS

Using data from the Global Burden of Disease (GBD) Study 2019, we assessed the impact of CSA on MDD and AUD, analyzing disability-adjusted life years (DALYs) per 100,000 population. Our analysis included age, sex, geographic locations, temporal trends in age-standardized rates (ASR), and examined the relationship between the social development index (SDI) and the burden of these disorders.

RESULTS

From 1990 to 2019, the global ASR for MDD attributable to CSA increased by 1.9 %, while AUD decreased by 17.1 %. Significant gender disparities emerged, with females showing higher ASRs for MDD and males for AUD. The highest burden was observed in the 35-44 age group. Geographical analysis revealed the highest ASRs for MDD in Sub-Saharan Africa and for AUD in Eastern Europe, Central Europe, and High-income North America. A U-shaped relationship between SDI and disorder burdens was also identified.

CONCLUSIONS

Our findings indicate a slight increase in MDD and a significant decrease in AUD burdens globally due to CSA, underscoring the need for targeted interventions considering gender, geographical, and developmental differences. This calls for strategies tailored to each country's unique development, culture, and regional specifics.

Assessment of factors leading to resilience among adults in violence-affected area of Kashmir: an exploratory study employing content analysis and best-worst method

Exposure to violence can have profound and lasting effects on individuals and communities, impacting various aspects of their lives. Understanding the relationship between exposure to violence and resilience is crucial for designing effective interventions and support systems. This study aims to identify resilience factors among adults living in such areas and rank them from most to least important. Two staged mixed-method approaches, including face-to-face interviews and the best-worst method, were used to identify factors, assign weights, and rank them. A total of twenty-three sub-factors classified under seven broader factors were identified and ranked by triangulating the opinions of victims, experts, and scholars. Out of twenty-three sub-factors, the top-ranked six factors included family support, trusting higher powers, peer support, better interpersonal relationships, engaging in regular prayers, and better role models, which contributes fifty two percent to resilience formation. By promoting these factors, individuals and communities can better cope with the stress and trauma of violence, promote positive adaptation and growth, and build social support networks to help promote recovery and healing. Implications for practice, policy, and future directions are discussed.

Harbingers of Hope: Scientists and the Pursuit of World Peace

The ongoing wars in many regions-such as the conflict between Israel and Hamas-as well as the effects of war on communities, social services, and mental health are covered in this special editorial. This article emphasizes the need for international efforts to promote peace, offer humanitarian aid, and address the mental health challenges faced by individuals and communities affected by war and violence.

Bosnian Paternal War Orphans: Mental Health in Postwar Time

ABSTRACT

More research on the medium- and long-term effects of childhood exposure to war, including orphanhood, is needed. We compared 50 orphans 1 who lost their father during the war in Bosnia and Herzegovina (1992-1995) and 50 age- and sex-matched adolescents from two-parent families during 2011-2012 in terms of sociodemographic characteristics, behavioral/emotional problems, depression, resilience, maternal mental health, and perceived social support. The two groups differed on sociodemographic factors, that is, number of children, family composition, income, school grades, and refugeehood. Paternal war orphans did not differ in terms of adolescent mental health and resilience from their nonorphaned peers, controlling for sociodemographic variables. The mothers of orphans had comparably more posttraumatic psychopathology. As for perceived resources for social support, orphans identified those comparably more often among distant relatives and in the community, that is, religious officials and mental health professionals, and less often among siblings, paternal grandparents, paternal and maternal uncles/aunts, school friends and teachers. Our findings suggest that contextual factors may play an important role in orphans' postwar mental health.

Impact of the war in Ukraine on resilience, protective, and vulnerability factors

War or armed conflict is one of the most severe human-made adversities. The current study examines the resilience, protective, and vulnerability factors of a sample of Ukrainian civilians, during the current Russian-Ukrainian war. The level of resilience and coping indicators were compared with the responses of an Israeli sample following an armed conflict in May 2021. The data were collected by an internet panel company. A representative sample of Ukrainian residents (N = 1,001) responded to an online questionnaire. A stratified sampling method was employed regarding geographic distribution, gender, and age. The data concerning the Israeli population (N = 647) were also collected by an internet panel company during a recent armed conflict with Gaza (May 2021). Three notable results emerged in this study: (a) The Ukrainian sample reported significantly higher levels of the following: Distress symptoms, sense of danger, and perceived threats, compared with the Israeli sample. However, despite these harsh feelings, the Ukrainian respondents reported substantially higher levels of hope and societal resilience compared, to their Israeli counterparts, and somewhat higher individual and community resilience. (b) The protective factors of the respondents in Ukraine (level of hope, wellbeing, and morale), predicted the three types of resilience (individual, community, and social) better than the vulnerability factors (sense of danger, distress symptoms, and level of threats). (c) The best predictors of the three types of resilience were hope and wellbeing. (d) The demographic characteristics of the Ukrainian respondents hardly added to the prediction of the three types of resilience. It appears that a war that threatens the independence and sovereignty of a country may, under certain conditions, enhance the societal resilience and hope of the population under risk, despite a lower sense of wellbeing and higher levels of distress, sense of danger, and perceived threats.

Adverse childhood experiences and global mental health: avenues to reduce the burden of child and adolescent mental disorders

Mental disorders are one of the largest contributors to the burden of disease globally, this holds also for children and adolescents, especially in low- and middle-income countries. The prevalence and severity of these disorders are influenced by social determinants, including exposure to adversity. When occurring early in life, these latter events are referred to as adverse childhood experiences (ACEs).In this editorial, we provide an overview of the literature on the role of ACEs as social determinants of mental health through the lenses of global mental health. While the relation between ACEs and mental health has been extensively explored, most research was centred in higher income contexts. We argue that findings from the realm of global mental health should be integrated into that of ACEs, e.g. through preventative and responsive psychosocial interventions for children, adolescents and their caregivers. The field of global mental health should also undertake active efforts to better address ACEs in its initiatives, all with the goal of reducing the burden of mental disorders among children and adolescents globally.

The dynamic nature of refugee children's resilience: a cohort study of Syrian refugees in Lebanon

AIMS

Children's responses to war and displacement are varied; many struggle, while others appear resilient. However, research into these outcomes disproportionately focuses on cross-sectional data in high-income countries. We aimed to (1) investigate change in resilience across two timepoints in a highly vulnerable sample of Syrian refugee children in Lebanon, and (2) explore predictors of their mental health problems across time.

METHODS

In total, 982 Syrian child-caregiver dyads living in refugee settlements in Lebanon completed questionnaires via interview at baseline and follow-up one year later. We categorised children into groups based on their risk for mental health problems across both timepoints (stable high risk/SHR, deteriorating, improving, stable low risk) according to locally validated cut-offs on measures of post-traumatic stress disorder (PTSD), depression and behavioural problems. Analyses of covariance identified how the groups differed on a range of individual and socio-environmental predictors, followed up by cross-lagged panel models (CLPMs) to investigate the directionality of the relationships between significantly related predictors and symptoms.

RESULTS

The sample showed a meaningful amount of change in mental health symptoms from baseline to follow-up. Over half (56.3%) of children met SHR criteria and 10.3% deteriorated over time, but almost one-quarter (24.2%) showed meaningful improvement, and 9.2% were consistently at low risk for mental health problems at both timepoints. Several predictors differentiated the groups, particularly social measures. According to CLPMs, maternal acceptance (β = -0.07) predicted child mental health symptoms over time. Self-esteem (β = -0.08), maternal psychological control (β = 0.10), child maltreatment (β = 0.09) and caregiver depression (β = 0.08) predicted child symptoms and vice versa (β_se = -0.11, β_b = 0.07, β_mpc = 0.08, β_cm = 0.1, β_cd = 0.11). Finally, child symptoms predicted loneliness (β = 0.12), bullying (β = 0.07), perceived social support (β = -0.12), parent-child conflict (β = 0.13), caregiver PTSD (β = 0.07), caregiver anxiety (β = 0.08) and the perceived refugee environment (β = -0.09).

CONCLUSIONS

Our results show risk and resilience are dynamic, and the family environment plays a key role in children's response to war and displacement. Conversely, children also have a significant impact on the family environment and caregiver's own mental health. Interventions to promote resilience in refugee children should therefore consider family-wide mechanisms.

Moving beyond a 'one-size-fits-all' rationale in global mental health: prospects of a precision psychology paradigm

Research on the effectiveness of mental health and psychosocial support interventions for common mental disorders in global mental health provides controversial results. These results are based on mean values for different groups, often without due consideration of individual-level characteristics and contextual factors. Against this background, and based on the recent development of a precision theoretical framework in clinical psychology, which is calling for a renewed perspective on the development and implementation of trial designs, we propose to develop a precision psychology paradigm in global mental health, with emphasis not only on individual clinical and socio-demographic data, but also on the social determinants of mental health. A precision psychology paradigm would require a coordinated action of academics, stakeholders and humanitarian workers in planning a global mental health research agenda, including the design of trials aimed at reliably approximate prediction of intervention response at individual level.

A Naturalistic Evaluation of Group Integrative Adapt Therapy (IAT-G) with Rohingya Refugees During the Emergency Phase of a Mass Humanitarian Crisis in Cox's Bazar, Bangladesh

Background: Studies of scalable psychological interventions in humanitarian setting are usually carried out when the acute emergency has stabilized. We report the first evaluation of an evidence-based group psychological intervention, Group Integrative Adapt Therapy (IAT-G), during the emergency phase of a mass humanitarian crisis amongst Rohingya refugees in Cox's Bazar, Bangladesh. Methods: We did a pragmatic naturalistic evaluation (2018-2020) of a seven-session group intervention with adult Rohingya refugees with elevated symptoms of depression (≥10 on the Patient Health Questionnaire) and/or posttraumatic stress disorder, PTSD, (≥3 on the Posttraumatic Stress Disorder-8), and functional impairment (≥17 on WHO Disability Assessment Schedule or WHODAS-brief). Screening was done across the most densely populated campsites. Blind assessments were completed at baseline, posttreatment, and at 3-month follow-up using culturally adapted measures of depression, anxiety, posttraumatic stress symptoms, complicated bereavement, adaptive stress associated with disrupted psychosocial support systems, functional impairment, and resilience. Findings: 383 persons were screened and of the 144 persons who met inclusion criteria all participated in the group intervention. Compared to baseline scores, IAT-G participants recorded significantly lower mean scores on key outcome indices (mental health symptoms, adaptive stress, and functional impairment) at posttreatment and 3-month follow-up (all pairwise tests significant Ps<.05). From baseline to 3-month follow-up, score changes were greatest for functional impairment (d = 2.24), anxiety (d = 2.15) and depression (d = 1.9), followed by PTSD symptoms (d = 1.17). Interpretation: A group-based intervention designed specifically to reflect the refugee experience and adapted to the language and culture, showed positive outcomes in the context of a pragmatic, naturalistic trial implemented in a mass humanitarian emergency. Funding: United Nations High Commissioner for Refugees; National Health and Medical Research Council Australia.

Rapid mental health screening in conflict zones: a translation and cross-cultural adaptation into Arabic of the shortened Revised Child Anxiety and Depression Scale (RCADS-25)

Background

During conflict, children and adolescents are at increased risk of mental health problems and in particular, anxiety and depression. However, mental health screening in conflict settings is problematic and carries risk making the need for fast, easy-to-administer, screening instruments paramount. The shortened version of the Revised Child Anxiety and Depression Scale (RCADS-25) is one method of rapidly assessing anxiety and depressive symptoms in youths. This self-report questionnaire demonstrates good internal consistency and diagnostic capacity in clinical and non-clinical populations. Nevertheless, few studies have tested the psychometric properties of translated versions of the RCADS-25 limiting its applicability worldwide.

Objectives

To expand the reach and utility of the RCADS-25, the present study sought to develop an Arabic version of the instrument (RCADS25-Arabic) and to explore its reliability and underlying factor structure. In light of changes to DSM classification, the effects of removing indicator variables for obsessive-compulsive disorder on the psychometrics of the RCADS25-Arabic were also explored.

Method

The scale was back translated into Modern Standard Arabic and administered to 250 Arabic speaking schoolchildren between 8 and 15 years of age in Syria. Mean and standard deviation were used to characterise the sample and summarize scores. The reliability and factor structure of the RCADS25-Arabic was explored using confirmatory factor analysis.

Results

Females were 127 and mean age was 12.11 ± SD 2.35. Males scored lower on anxiety (M 15.05 SD ± 8.0, t(248) = − 3.15, p = .003, d = 0.39) and internalizing factors (M 26.1 SD ± 13.1, t(248) = − 2.36, p = .0160, d = 0.31) with no statistical gender difference recorded for depression (t(248) = − 1.27, p = .202). Fit statistics were good for two- and one-factor solutions (χ²/df = 1.65, RMSEA 0.051, CFI .91, TLI .90 and χ²/df = 1.64 and RMSEA 0.051, CFI .91 and TLI .89 respectively). DIFFTEST showed no significant difference between models (χ²_diff (1) = 0.03, p < 0.86) indicating a one-factor (internalizing) solution was preferable. No improvement in scale integrity was found after deleting obsessive-compulsive disorder items.

Conclusion

The RCADS25-Arabic is useful for rapid screening of depression and anxiety but is better used to identify a one-factor internalizing construct. Obsessive-compulsive disorder items should be retained in the RCADS-25.