Children exposed to warfare: a longitudinal study

Mental health screening and assessment tools for forcibly displaced children: a systematic review

Background: An unprecedentedly large number of people worldwide are forcibly displaced, of which more than 40 percent are under 18 years of age. Forcibly displaced children and youth have often been exposed to stressful life events and are therefore at increased risk of developing mental health issues. Hence, early screening and assessment for mental health problems is of great importance, as is research addressing this topic. However, there is a lack of evidence regarding the reliability and validity of mental health assessment tools for this population. Objective: The aim of the present study was to synthesise the existing evidence on psychometric properties of patient reported outcome measures [PROMs] for assessing the mental health of asylum-seeking, refugee and internally displaced children and youth. Method: Systematic searches of the literature were conducted in four electronic databases: MEDLINE, PsycINFO, Embase and Web of Science. The methodological quality of the studies was examined using the COSMIN Risk of Bias checklist. Furthermore, the COSMIN criteria for good measurement properties were used to evaluate the quality of the outcome measures. Results: The search yielded 4842 articles, of which 27 met eligibility criteria. The reliability, internal consistency, structural validity, hypotheses testing and criterion validity of 28 PROMs were evaluated. Conclusion: Based on the results with regard to validity and reliability, as well as feasibility, we recommend the use of several instruments to measure emotional and behavioural problems, PTSD symptoms, anxiety and depression in forcibly displaced children and youth. However, despite a call for more research on the psychometric properties of mental health assessment tools for forcibly displaced children and youth, there is still a lack of studies conducted on this topic. More research is needed in order to establish cross-cultural validity of mental health assessment tools and to provide optimal cut-off scores for this population. HIGHLIGHTS Research on the psychometric properties of mental health screening and assessment tools for forcibly displaced children and youth is slowly increasing.However, based on the current evidence on the validity and reliability of screening and assessment tools for forcibly displaced children, we are not able to recommend a core set of instruments. Instead, we provide suggestions for best practice.More research of sufficient quality is important in order to establish crsoss-cultural validity and to provide optimal cut-off scores in mental health screening and assessment tools for different populations of forcibly displaced children and youth.

Individual Resilience: A Major Protective Factor in Peer Bullying and Victimization of Elementary School Children in Israel

Peer violence in school has become a major issue for schools around the world. The present study examined the impacts of cultural settings and of protective individual attributes on peer bullying and victimization in school. These protective attributes were self-esteem, sense of autonomy, emotional regulation, and individual resilience. Participants were 112 Jewish and 55 Arab Bedouin pupils 10 to 11 years old. It was hypothesized that Jewish pupils would score lower than Bedouin pupils on bullying and on victimization, and will score higher than them on these protective individual attributes. It was also hypothesized that despite these differences, the investigated attributes would correlate with reduced peer violence in both groups. It was hypothesized further that individual resilience will be the major predictor of both bullying and victimization in both groups. Results have generally supported these hypotheses, suggesting alternative ways for curtailing peer aggression in school.

Prevalence of post-traumatic stress disorder among Palestinian children and adolescents exposed to political violence: A systematic review and meta-analysis

Objective

We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population.

Methods

PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted.

Results

The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I² 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures.

Conclusion

We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine.

Psychological Impact of the Quarantine-Induced Stress during the Coronavirus (COVID-19) Outbreak among Italian Athletes

The 2019 Coronavirus (COVID-19) outbreak caused home confinement, as well as training and sport competitions withdrawals. The prolonged inactivity impact, and lack of in-person interactions among teammates-coaches, could negatively affect athletes. Total of 1508 self-selected Italian athletes, 338 children (aged 10.52 ± 1.31), 499 adolescents (aged 14.17 ± 1.13), and 671 adults (aged 27.59 ± 10.73), completed the Impact of Event Scale (IES-8, IES-15, and IES-R, respectively). Differences by gender, type of sport (individual vs. team), and competitive level (elite vs. amateur) were examined. One-way ANOVAs showed, in adults, significant differences between genders for perceived stress impact total score (TS; p = 0.017) and avoidance behavior, with higher scores in women (p = 0.045). Between individual and team sport, significant differences were found in TS (p = 0.038) and hyperarousal (p = 0.030), with higher results in individual. Adult elite athletes showed significantly higher scores in hyperarousal (p = 0.020) than amateurs. Significant differences were found between gender in adolescents for avoidance (p = 0.011), and between competitive levels in children, for intrusion (p = 0.020). These evidences may raise awareness on distress effects of COVID-19 lockdown among athletes and suggested applying specific well-being protocols during the activity resumption, considering gender, type of sport, and competitive level.

A Renewed Outbreak of the COVID-19 Pandemic: A Longitudinal Study of Distress, Resilience, and Subjective Well-Being

Considering the potential impact of COVID-19 on the civil society, a longitudinal study was conducted to identify levels of distress, resilience, and the subjective well-being of the population. The study is based on two repeated measurements conducted at the end of the pandemic's "first wave" and the beginning of the "second wave" on a sample (n = 906) of Jewish Israeli respondents, who completed an online questionnaire distributed by an Internet panel company. Three groups of indicators were assessed: signs of distress (sense of danger, distress symptoms, and perceived threats), resilience (individual, community, and national), and subjective well-being (well-being, hope, and morale). Results indicated the following: (a) a significant increase in distress indicators, with effect sizes of sense of danger, distress symptoms, and perceived threats (Cohen's d 0.614, 0.120, and 0.248, respectively); (b) a significant decrease in resilience indicators, with effect sizes of individual, community, and national resilience (Cohen's d 0.153, 0.428, and 0.793, respectively); and (c) a significant decrease in subjective well-being indicators with effect sizes of well-being, hope, and morale (Cohen's d 0.116, 0.336, and 0.199, respectively). To conclude, COVID-19 had a severe, large-scale impact on the civil society, leading to multidimensional damage and a marked decrease in the individual, community, and national resilience of the population.

Psychiatric symptoms in traumatized Syrian refugee children settled in Hatay

Aim: After the beginning of the Syrian civil war in 2011, its cruelty and violence forced about millions to leave their homes. These experiences might create serious mental problems, especially in children and adolescents who might have an increased risk of developing post-traumatic stress disorder (PTSD) and depression. In this study, we aimed to investigate the mental health status of Syrian refugee children who exposed to a variety of traumatic events.Method: The sample consisted of 1518 drug-naive Syrian refugee children and adolescents aged between 8 and 16 years who were admitted to the Child and Adolescent Psychiatry Department in Hatay State Hospital between June 2016 and December 2018. The CRIES-13 (Children's Revised Impact of Event Scale-13) was used to evaluate PTSD symptoms and CDI (Children's Depression Inventory) was used to examine depressive symptoms. The sample was divided into three groups according to the type of trauma and the CRIES-13 and CDI scores were compared between the groups.Results: The mean age of the children was 12.4 ± 3.1. 46.9% of the children were male and 53.1% were female. The total score and intrusion and arousal subscores of CRIES-13 were significantly different between the three groups. The total CDI score was also significantly different between the three groups. The likelihood rates of PTSD and depression differed significantly between the groups.Conclusion: Traumatized Syrian refugee children may present PTSD symptoms more likely than depressive symptoms. War-related traumatic experiences may have more adverse effects on Syrian children's psychology than other traumas.

Posttraumatic stress disorder and psychosocial difficulties among children living in a conflict area of the Southeastern Anatolia region of Turkey

BACKGROUND

Traumatic events and armed conflicts can lead to many mental disorders, especially posttraumatic stress disorder (PTSD), in children. We investigated the PTSD symptoms, psychosocial difficulties, general health levels of the parents, and direct and indirect effects of trauma on psychological outcomes.

MATERIALS AND METHODS

A total of 482 children were included in the study. Two hundred and eight of those children were from Derik district, where street fights, curfews, and conflict have been experienced, and 274 of those children were from Yeşilli district, where no conflicts have been observed despite being in the same province. All children filled out the child posttraumatic stress disorder reaction index, the strengths and difficulties questionnaire (SDQ), and parents filled out the General Health Questionnaire-12 (GHQ).

RESULTS

All children showed moderate PTSD symptoms; however, no significant difference was observed between the two groups. In the exposed group, children, who had to leave their homes for a while due to conflicts, had worse PTSD symptoms, higher SDQ difficulty scores, and parents' GHQ scores. It was determined that being a female having high maternal GHQ scores and leaving home due to the conflicts significantly increase the risk of occurrence of trauma symptoms.

CONCLUSION

Our findings suggest that children are susceptible to the direct and indirect effects of trauma. It is crucial for intervention programs to be developed for the detection, prevention, and treatment of PTSD symptoms to be applied to all children, regardless of exposure type, in areas affected by conflict.

Serious violent behavior and antisocial outcomes as consequences of exposure to ethnic-political conflict and violence among Israeli and Palestinian youth

We examine whether cumulative-past and concurrent exposure to ethnic-political violence among Israeli and Palestinian youth predict serious violent behavior and antisocial outcomes toward the in-group and the out-group. We collected four waves of data from 162 Israeli Jewish and 400 Palestinian youths (three age cohorts: 8, 11, and 14 years old) and their parents. The first three waves were consecutive annual assessments, and the fourth was conducted 4 years after the third wave, when the three age cohorts were 14, 17, and 20 years old, respectively. Based on social-cognitive-ecological models of the development of aggression (Dubow et al., 2009, Clinical Child and Family Psychology Review, 12, 113-126; Huesmann, 1998) and models of the development of beliefs about the "other," (Bar-Tal, 2004, European Journal of Social Psychology, 34, 677-701; Tajfel & Turner, 1986), we predicted that serious violent outcomes directed toward both the in-group and the out-group would be related to both concurrent and to persistent-past exposure to ethnic political violence. Bivariate regression models (prior to including covariates) indicated that both early cumulative exposure to ethnic-political violence during childhood and adolescence and concurrent exposure during late adolescence/early adulthood predicted all six serious violent and antisocial outcomes. When we added to the models the covariates of ethnic subgroup, age, sex, parents' education, and youths' prior physical aggression, concurrent exposure to ethnic-political violence was still significantly associated with a greater likelihood of concurrently perpetrating all six serious violent and nonviolent forms of antisocial behavior, and earlier cumulative exposure remained significantly related to three of these: severe physical aggression, participating in violent demonstrations, and our overall index of violent/antisocial behavior.

National Resilience: A New Self-Report Assessment Scale

The current paper presents a new self-report national resilience assessment scale (NRAS). The scale was constructed and validated using a sample of 1022 Jewish Israeli adults. The internal structure of the 25-item was determined by a Varimax factor analysis, which emitted four distinct factors pertaining to identifying with the state, solidarity and social justice, trust in national institutions and trust in public justice; which explained 61% of the variance. These factor scores were validated against two national resilience promoting factors (community resilience and sense of coherence), and two national resilience suppressing factors (distress symptoms and sense of danger); as well as four demographic characteristics (level of religiosity, political attitudes, income and level of exposure to terror/ war experiences in the last year). Results supported the validity of the NRAS and its four components, showing that it was consistently correlated with resilience promoting and resilience suppressing factors.

Coping resources and stress reactions among Bedouin Arab adolescents during three military operations

This study aimed to examine coping resources (sense of coherence and hope) and stress reactions among Bedouin Arab adolescents in southern Israel during three periods of escalated political violence. Two main questions were examined: 1) Did adolescents report different coping resources and levels of stress reactions during these three different periods? 2) Were there any differences in the pattern of the associations between coping resources and stress reactions across those periods? Data were gathered from 81, 91, and 192 Bedouin Arab adolescents, who were 14-18 years old, during three periods. Participants completed self-report questionnaires including the sense of coherence (SOC) scale, a hope index, a measure or state anxiety and state anger, a measure of psychological distress, and a demographic questionnaire. Across the three periods, differences were observed in both coping resources and levels of stress reactions. Over time, SOC was found to be a significant predictor of those stress reactions; whereas the association between hope components and stress reactions weakened over time. These findings support the hypothesis that SOC is a significant component of coping with stressful political events and emphasize the importance of addressing differences in the roles of personal resources over time and transition processes.

Risk Factors as Major Determinants of Resilience: A Replication Study

The present study was conducted in the context of current concerns about replication in psychological research. It claims that risk factors should be regarded as an integral part of the definition of individual resilience, which should be defined in terms of the balance between individual strength or protective factors, and individual vulnerability or risk factors (IND-SVR). Five independent samples, including 3457 Israeli participants, were employed to determine the effects of resilience promoting and resilience suppressing variables on the IND-SVR index of resilience, and on its two components: recovery from adversity, and distress symptoms. Five path analyses were employed for determining the role of distress symptoms as a measure of psychological resilience, as compared to other indices of this resilience. Results indicated the major role of risk factors (distress symptoms) as an integral component of resilience. This role was generally replicated in the five investigated samples. Risk factors are legitimate, valid, and useful parts of the definition of psychological resilience. Resilience research has shifted away from studying individual risk factors to investigating the process through which individuals overcome the hardships they experience. The present data seem to suggest that this shift should be reexamined.

Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation

Given the rapid proliferation of trajectory-based approaches to study clinical consequences to stress and potentially traumatic events (PTEs), there is a need to evaluate emerging findings. This review examined convergence/divergences across 54 studies in the nature and prevalence of response trajectories, and determined potential sources of bias to improve future research. Of the 67 cases that emerged from the 54 studies, the most consistently observed trajectories following PTEs were resilience (observed in: n = 63 cases), recovery (n = 49), chronic (n = 47), and delayed onset (n = 22). The resilience trajectory was the modal response across studies (average of 65.7% across populations, 95% CI [0.616, 0.698]), followed in prevalence by recovery (20.8% [0.162, 0.258]), chronicity (10.6%, [0.086, 0.127]), and delayed onset (8.9% [0.053, 0.133]). Sources of heterogeneity in estimates primarily resulted from substantive population differences rather than bias, which was observed when prospective data is lacking. Overall, prototypical trajectories have been identified across independent studies in relatively consistent proportions, with resilience being the modal response to adversity. Thus, trajectory models robustly identify clinically relevant patterns of response to potential trauma, and are important for studying determinants, consequences, and modifiers of course following potential trauma.

Changing Cultures: Enhancing Mental Health and Wellbeing of Refugee Young People through Education and Training

Many refugee people and others entering Australia under the Humanitarian Program, have experienced extremely stressful and disrupted lives prior to arrival. A major difficulty experienced by a significant number of refugee young people is their lack of formal education before arrival. It directly affects their ability to start connecting to their new society and constructing a new life. The level of ease with which young people can move into the education and training system and begin to establish a meaningful career pathway has a huge impact on their successful settlement and stable mental health. This paper describes the Changing Cultures Project, a three-year project, which explored models of appropriate and accessible education and training for refugee and newly arrived young people that would enhance their mental health. The Changing Cultures Project was a partnership between the education, health and settlement sectors. This paper describes the program and system response to the health, settlement, education and vocational issues facing refugee young people using a mental health promotion framework and reflective practice. We discuss how the refugee youth programs met a broad range of needs as well as providing language, literacy and basic education to newly arrived young people. While working in an environment of changing policy and public opinion regarding refugee issues, the Project delivered successful outcomes at the program and organisational levels for refugee young people by addressing issues of program development and delivery, organisational development and capacity building and community development and evaluation.

Bereavement of Israeli Arab Muslim widows: Determinants of adjustment and supporting attributes

Cultural-specific determinants of coping with widowhood were investigated by the Two-Track Model of Bereavement. Participants were 93 middle-aged and middle-class Israeli Arab Muslim widows. Factor analysis emitted 4 factors of adjusting to widowhood. The suffering and resilience factors and the total scale score were consistently correlated with personality attributes, whereas demographics were associated mainly with the suffering factor and the total scale score. The factors differed from the factors characteristic of Israeli Jewish bereaved, which emphasize the need to examine models of bereavement in cross-cultural perspective and to account for the interaction of cultural effects with psychological processes.

Youth in the midst of escalated political violence: sense of coherence and hope among Jewish and Bedouin Arab adolescents

BACKGROUND

During stressful events, individuals (particularly adolescents) from minority groups are often more vulnerable to distress. This claim will be examined in terms of coping resources and stress reactions to escalated political violence. This study aimed to compare coping resources and stress reactions among adolescents from two ethnic groups in southern Israel-Jews and Bedouin Arabs-during a period of escalated political violence (November 2012). The Bedouin Arab group is the ethnic minority of the sample and thus may be more at risk compared to the Jewish group.

METHODS

Data were gathered from 78 Jews and 91 Bedouin Arabs (14-18 years old) by using convenience sampling method. Adolescents were contacted via the Internet or in person by the research team and they completed self-report questionnaires including the Sense Of Coherence Scale (SOC), Hope Index, State Anxiety Inventory, and State Anger Inventory. After a preliminary χ2 analysis of the sample characteristics, three main sets of analyses were conducted including a two-way MANOVA, zero-order correlations between study variables, and hierarchical multiple regressions.

RESULTS

Bedouin Arab adolescents reported lower levels of SOC (F(1, 158) = 3.88, p = 0.04) and higher levels of individual and collective hope (F(1, 158) = 3.94, p = 0.03; F(1, 158) = 17.41, p = 0.001, respectively), as compared to Jewish adolescents. The Bedouin adolescents also reported higher levels of state anger (F(1, 158) = 5.58, p = 0.02). We identified cultural similarities related to the predictive power of coping resources (SOC and individual hope) in explaining state anger (β = -0.29, p = 0.001; β = -0.18, p = 0.045, respectively). However, cultural differences were found to affect the ability of SOC to predict state anxiety; SOC contributed significantly to state anxiety only among the Jewish adolescents (β = -0.45, p < 0.001).

CONCLUSION

These results emphasize the significance of addressing cultural/ethnic factors in attempts to understand mental-health issues among youth during periods of escalated political violence.

Life satisfaction and trauma in clinical and non-clinical children living in a war-torn environment: A discriminant analysis

The aim of this work was to discriminate between healthy children and children at risk of developing mental impairments by evaluating the impact on contextual and individual factors of a context characterized by war. We tested the hypothesis that a linear discriminant function composed of trauma, life satisfaction, and affect balance has the power to classify the children as community or clinical referred. Membership of the clinical-referred group was associated with poorer life satisfaction and higher levels of trauma. Community-referred profiles were associated with lesser trauma. Perceived life satisfaction regarding family and school was the main contributor to the discriminant function.

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents

Background: Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective: This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children's mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers (N = 325) and their children (one per family; 49.4% girls; 10-13 years old; mean ± SD age = 11.35 ± 0.57 years) after the Gaza War of 2008-2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child's internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children's Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children's Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n = 44). Further, families with discrepant experiences (23.0%; n = 65) and moderate security and neutral relationships (25.2%; n = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic interventions for children should, thus, also involve parents and siblings. Knowledge of unique family attachment patterns is fruitful for tailoring therapeutic treatments and preventive interventions for war-affected children and families.

Modelling life satisfaction and adjustment to trauma in children exposed to ongoing military violence: An exploratory study in Palestine

Exposure to war and ongoing political violence increases mental health risks among children, especially in terms of posttraumatic stress disorder (PTSD), and depressive or somatic symptoms. However, an exclusive focus on negative functioning can lead to underestimating the coping abilities and natural potential for adjusting to trauma of war-affected children at different developmental phases. Using structural equation modelling, we tested the extent to which data gathered in a predominantly nonclinical sample of Palestinian children (N=1276) living in refugee camps supported a conceptual model in which the relationship between subjective wellbeing and the effects of trauma is mainly top-down in direction. The cross-sectional design adopted showed that feelings of life satisfaction contributed to better affect balance in children (aged 6-11 years), which in turn, mitigated the impact of traumatic events. These findings point up the importance of dimensions of subjective well-being in children involved in traumatic events and may inspire intervention and treatment focused on the ability to activate positive emotions as a crucial resource for dealing with traumatic reactions.

An Exploratory Study of Post-Traumatic Stress Disorder Symptoms among Bereaved Children

Purpose:

This study reports on the incidence of post-traumatic stress disorder (PTSD) symptoms among a sample ( n = 46) of bereaved children. PTSD symptoms in children who have experienced loss due to an expected death through illness have not been previously studied.

Method:

An exploratory cross-sectional design was used to compare Impact of Event Scale (IES) scores between two groups of bereaved children. One group experienced the sudden, unexpected death of a family member; the second group experienced the expected death of a family member following protracted illness.

Findings:

Overall, almost two-thirds of the children were found to be experiencing moderate to severe levels of PTSD related symptoms of intrusion and avoidance as measured by the IES. Additionally, there was no significant difference in the IES scores of the two groups of children.

Implications:

Findings are discussed in relation to current practice with and research on bereaved children.

Effects of witnessing or exposure to community violence on mental health of Iraqi men

Background: Iraq is consistently exposed to large-scale traumatic events such as successive wars since 1980 to the present day, economic sanctions, sustained organized violence, and terrorism. These unsafe circumstances have negatively impacted the psychosocial status of the Iraqi community. Objective: To study the prevalence of witnessing or exposure to various types of violence, and its association with mental health problems in a sample of Iraqi men. Methods: This is a cross-sectional study that was conducted from April to September 2014. The target population were men from different age groups that were collected through a convenience sampling technique from two large cities; Baghdad (the capital city) and Mosul (the second largest city in Iraq). The source of data was from different institutions, colleges and lay people. The data collection process was done using the Self-Reporting Questionnaire 20 which is recommended by the World Health Organization for screening psychiatric disturbances. Results: A total of 480 Iraqi males agreed to participate in the study. The main type of violence reported was witnessing violence (55.4%), followed by exposure of friends or relatives to violence (51.4%), and witnessing or exposure to sexual assault was least reported (3.8%). The most frequent feeling recorded was of worry (72.9%), getting easily upset (65.4%), suffering from headaches (62.7%) and lethargy (59.4%). Severe psychological changes were evident in 68.5% of men, while moderate changes were present in 31.5%. Analysis of the feelings and behavioral changes in relation to the participants' history of exposure to violence revealed a significant association with witnessing shooting or stabbings, displacement, friends or relatives' exposure to violence, and viewing corpses. Conclusion: There is a high prevalence among Iraqi men of exposure to, or witnessing violence that showed an association with their mental condition, which, if proved causally, may be a leading cause for future devastating effects on their health, wellbeing and quality of life.

Effect of adverse childhood experiences on physical health in adulthood: Results of a study conducted in Baghdad city

BACKGROUND

Studies have revealed a powerful relationship between adverse childhood experiences (ACEs) and physical and mental health in adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into organic disease later in life.

OBJECTIVE

The aim was to estimate the effect of childhood experiences on the physical health of adults in Baghdad city.

SUBJECTS AND METHODS

A cross-sectional study was conducted from January 2013 to January 2014. The study sample was drawn from Baghdad city. Multistage sampling techniques were used in choosing 13 primary health care centers and eight colleges of three universities in Baghdad. In addition, teachers of seven primary schools and two secondary schools were chosen by a convenient method. Childhood experiences were measured by applying a modified standardized ACEs-International Questionnaire form and with questions for bonding to family and parental monitoring. Physical health assessment was measured by a modified questionnaire derived from Health Appraisal Questionnaire of Centers for Disease Control and Prevention. The questionnaire includes questions on cerebrovascular diseases, diabetes mellitus, tumor, respiratory and gastrointestinal diseases.

RESULTS

Logistic regression model showed that a higher level of bonding to family (fourth quartile) is expected to reduce the risk of chronic physical diseases by almost the half (odds ratio = 0.57) and exposure to a high level of household dysfunction and abuse (fourth quartile) is expected to increase the risk of chronic physical diseases by 81%.

CONCLUSION

Childhood experiences play a major role in the determination of health outcomes in adulthood, and early prevention of ACEs. Encouraging strong family bonding can promote physical health in later life.

Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: Trauma, family- and child-related predictors

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).

Childhood adversities and traumata in Lebanon: a national study

BACKGROUND

The goal of this paper is to map the total occurrence and evaluate the risk of co-occurrence of childhood adversities (CA) and a wide variety of childhood traumatic events (including war) in a national sample.

METHOD

The nationally representative sample included 2,857 respondents and the instrument used was the Composite International Diagnostic Interview which screened for all CAs and traumatic events.

RESULTS

27.9% experienced CAs; the most common were parental death and parental mental/substance use disorder. 70.6% experienced a war-related traumatic event during their lifetime, and around half of them (38.1%) experienced it below the age of 18 years. 51.3% of the subjects experienced a traumatic event not related to war during their lifetime, and 19.2% experienced it before the age of 18 years. Sexual abuse, being a refugee during war, and experiencing a natural disaster were associated with female gender. Having any CA was associated with active war exposure (OR: 4.2, CI: 2.0-8.6); war-related direct personal trauma (OR: 3.9, CI: 1.5-10.0); war-related trauma to others (OR: 2.4, CI: 1.3-4.4); non-war direct personal trauma (OR: 3.8, CI: 2.0-7.4); and any non-war childhood traumatic event (OR: 1.9, CI: 1.1-3.1).

CONCLUSION

Childhood is awash with adversities and traumatic events that co-occur and should be measured simultaneously; otherwise, the effects of a subset of traumata or adversities could be wrongly thought to be the contributor to negative outcomes under study.

Assessment of prevalence and determinants of posttraumatic stress disorder and depression symptoms in adults survivors of earthquake in Haiti after 30 months

BACKGROUND

On January 12, 2010, a powerful 7.0 magnitude earthquake struck the Republic of Haiti and destroyed Port-au-Prince, the capital and others cities across the country. While some studies have examined the long-term traumatic effects of the seismic event on children and adolescents victims, so far no study has examined the consequences on adults generally. As such, this study aims to investigate the traumatic consequences of the earthquake among adults related to degree of exposure, peritraumatic distress, depressive symptoms and sociodemographic factors two and a half years after. In addition, predictive factors of PTSD and depressive symptoms were also identified.

METHODS

From June to July 2012, a total of 1355 adults (660 women) was assessed by means the traumatic exposure questionnaire, the Life Events Checklist subscale, the Peritraumatic Distress Inventory (PDI), the Impact of Event Scale - Revised (IES-R) and the Beck Depression Inventory (BDI), in addition to social demographic characteristics.

RESULTS

The prevalence rates of PTSD and depressive symptoms were 36.75% (498 cases) and 25.98% (352 cases) respectively. The risk factors for PTSD and depressive symptoms were young and old age, female gender, unemployed status and low level of education. The bests predictives variables were peritraumatic distress for PTSD (β=.57, p<.0001) and for depressive symptoms (β=.21, p<.0001). The commorbidity between PTSD and depression was 13.36%.

CONCLUSIONS

This study found that psychological symptoms are frequent event 30 months after the earthquake. The different mental health care providers, the public health ministry, NGOs working on the ground in Haiti should design programmes in order to aid the psychological wellbeing of the population focussing on youth, older and retired adults, females, people with low levels of education and those who do not work.

Outcome of depression and anxiety after war: a prospective epidemiologic study of children and adolescents

Prospective studies of children exposed to war have not investigated disorders other than posttraumatic stress disorder (PTSD) and have methodological limitations. From a stratified random sample of 386 children and adolescents who had been interviewed 3 weeks after war exposure (Phase 1) a random subsample (N = 143) was interviewed a year later (Phase 2). PTSD, major depressive disorder (MDD), separation anxiety disorder (SAD), overanxious disorder (OAD), and psychosocial stressors were assessed using structured interviews administered to both children and adolescents and their parents. The prevalence of disorders among the 143 at Phase 1 was MDD 25.9%, SAD 16.1%, OAD 28.0%, and PTSD 26.0%, with 44.1% having any disorder. At Phase 2 the prevalence was MDD, 5.6%; SAD, 4.2%; OAD, 0%; and PTSD, 1.4%, with 9.2% having any disorder. Occurrence of disorders at Phase 1 was associated with older age, prewar disorders, financial problems, fear of being beaten, and witnessing any war event (ORs ranged from 2.5 to 28.6). Persistence of disorders to Phase 2 was associated with prewar disorders (OR = 6.0) and witnessing any war event (OR = 14.3). There are implications for detection of at-risk cases following wars by screening for adolescents exposed to family violence, those with prewar disorders, and those who directly witnessed war events to target them for specific interventions.

Prevalence of traumatic events and PTSD symptoms among secondary school students in Baghdad

BACKGROUND

People in Iraq have been more or less continually exposed to war for more than three decades. Studies with Iraqi participants report high prevalence rates of posttraumatic stress disorder (PTSD) and related problems.

METHODS

The aim of this study is to measure the prevalence of traumatic events and to screen the prevalence of PTSD symptoms among Iraqi secondary school students. Four self-report scales were administered to 403 secondary school students, aged 16-19 (61% male and 31% female). These scales were Baghdad Trauma History Screen, the Scale of Posttraumatic Stress Symptoms (SPTSS), Social Support Scale, and Scale of Religious Coping.

RESULTS

The results showed that 84% of participants experienced at least one traumatic event. Of these, 61% fully met the criteria for PTSD; 65% of the females and 58% of the males. PTSD symptoms were correlated with 20 positive religious coping but not with social support.

CONCLUSION

It's clear that traumatic events were speared widely among the participants and the result showed that the vast majority of participants were exposed to different types of traumatic events. In addition, many of the participants have met full PTSD criteria and others had partial PTSD.

Relation between childhood experiences and adults' self-esteem: A sample from Baghdad

Background: Adverse childhood experiences are associated with significant functional impairments and loss of life in adolescence and adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into psychological disorders later in life. The family is one of the most critical risks and resilient factors for mental health in adolescence and emerging adulthood. Objective: To estimate the effect of childhood experiences on self-esteem during adulthood in a sample from Baghdad city. Methods: This cross-sectional study was conducted in Baghdad city during the period from January 2013 through to January 2014. Multistage sampling techniques were used to choose 13 primary healthcare centers and eight colleges from three universities in Baghdad. Childhood experiences were measured by applying a modified standardized Adverse Childhood Experiences International Questionnaire (ACE-IQ) form. Results: A total of 1040 subjects were surveyed and 1000 responded giving a response rate of 96.2%. The results revealed that 82.7% of the participants were confident within themselves, 14.9% (149) reported to feel a failure, while 28.3% of subjects expressed feeling useless at times. The score for family bonding is expected to significantly increase the score for self-esteem by a mean of 21.48. University, diploma and higher education are expected to significantly decrease the self-esteem score by a mean of − 6.31 compared to those with less than secondary school education. Parents education show statistically insignificant association with the mean score for self-esteem. Conclusion: The findings of this study give an insight into the essential role of childhood experiences in building self-esteem and adaptation later in their life. National health programs are suggested for intervention targeting early adverse childhood experiences and their consequences.

Relations between political violence and child adjustment: a four-wave test of the role of emotional insecurity about community

This study further explored the impact of sectarian violence and children's emotional insecurity about community on child maladjustment using a 4-wave longitudinal design. The study included 999 mother-child dyads in Belfast, Northern Ireland (482 boys, 517 girls). Across the 4 waves, child mean age was 12.19 (SD = 1.82), 13.24 (SD = 1.83), 13.61 (SD = 1.99), and 14.66 years (SD = 1.96), respectively. Building on previous studies of the role of emotional insecurity in child adjustment, the current study examines within-person change in emotional insecurity using latent growth curve analyses. The results showed that children's trajectories of emotional insecurity about community were related to risk for developing conduct and emotion problems. These findings controlled for earlier adjustment problems, age, and gender, and took into account the time-varying nature of experience with sectarian violence. Discussion considers the implications for children's emotional insecurity about community for relations between political violence and children's adjustment, including the significance of trajectories of emotional insecurity over time.

Integrating Psychodynamic Treatment and Trauma Focused Intervention in the Case of an Unaccompanied Minor With PTSD

The United States is facing the challenge of a growing number of migrating unaccompanied minors. These children have often witnessed and experienced severe traumatic events before and during their journey to a foreign country. In addition, they face cultural shock, loss of social network, and language barriers while navigating complicated asylum procedures and the possibility of being returned back to their country of origin. As a result, they present with several emotional and behavioral difficulties, but also profound amounts of resiliency. This case study presents the treatment of a young unaccompanied minor experiencing severe post-traumatic stress disorder. A relational psychodynamic approach, integrated with trauma focused intervention, is illustrated.

Mental health problems of young refugees: duration of settlement, risk factors and community-based interventions

Little is known about the characteristics of young psychologically-distressed refugees in mental health services, and how they vary according to the duration of settlement. This study of 102 young refugees referred to a community-based mental health service describes past adversities and current circumstances, referral problems, service utilization and treatment outcomes using the Strengths and Difficulties Questionnaire (SDQ). The more recently-arrived refugees had significantly higher levels of close exposure to war and violence, were more likely to have suffered separation from immediate family and to have insecure legal status. Those refugees settled longer were significantly more likely to be referred because of conduct problems while there was a trend in recent arrivals to present with internalizing pathology. A comparison of the teachers' and parents' mean SDQ scores of the study's young refugees sample and a national study representative of Great Britain as a whole showed that young refugees have higher scores in total problem and all subscales scores than the British scores. Community-based mental health services for young refugees appeared effective - significant improvement was found in SDQ scores for the sub-group (n = 24) who took up the treatments offered. The implications are discussed for service development and practitioners.

Psychological distress in young adults exposed to war-related trauma in childhood

We tested a conceptual model of the effect of war-trauma exposure in childhood on psychological distress in young adulthood. Participants included 151 urban Kuwaiti children (51% female; M age = 10.62 years) exposed to the 1990-1991 Gulf crisis (assessed in 1993); participants also included 140 parents (81% female; M age mothers = 36.50 years; M age fathers = 41 years). In 2003, 120 participants were reassessed as young adults (50% female; M age = 21.19 years). The conceptual model was evaluated with structural equations. War-trauma exposure was associated with psychological distress in children and parents, but parents reported larger effects than children. Parents' psychological distress did not contribute to children's psychological distress. Children's psychological distress did not dissipate over time. Social support may function as a potential mediator of the effect of war-trauma exposure on psychological distress. Findings support the importance of early detection and treatment of children exposed to war trauma. Findings also implicate social support as a factor to consider in clinical interventions for children exposed to war trauma.

Psychosocial research with children in Iraq: current health practice and policy in a context of armed conflict

There is a need to show how psychosocial issues affect children in conflict areas like Iraq. Raising knowledge and awareness of children's mental health status in Iraq has been difficult and the knowledge base has been limited by the shortage of resources, international sanctions and the isolation of Iraqi scholars. Many obstacles to research in Iraq exist but an agenda should be developed emphasising the need for high-quality contextualised psychosocial research. Health researchers in the country need to clarify basic population parameters and to provide culturally appropriate, evidence-based interventions for practitioners.

Two decades later: The resilience and post-traumatic responses of Indigenous Quechua girls and adolescents in the aftermath of the Peruvian armed conflict

OBJECTIVES

In comparison to other traumatic events, the impact of a childhood during war on resilience later in life has been seldom examined. The aim of this study was therefore to examine the long term outcomes of post-traumatic responses and resilience of a sample of adult Indigenous Quechua women, who were girls or adolescents during the Peruvian armed conflict (1980-1995).

METHODS

The study instruments (Harvard trauma questionnaire part I and IV; Connor-Davidson resilience scale; life stress questionnaire) were translated to Quechua and cross-culturally validated. A cross sectional survey design was used in 2010 to collect data from a convenience sample of 75 participants (25-45 years old) in Ayacucho, Peru, the region most affected by the conflict. Data was examined using hierarchical regression analyses.

RESULTS

Participants reported extreme exposure to violence (e.g., sexual violence, torture, combat, death of family members, and forced displacement) during the armed conflict, but surprisingly, only 5.3% reported a current level of symptoms that may indicate a possible post-traumatic stress disorder (PTSD). Resilience scores and number of years exposed to conflict as a child were not associated with PTSD symptoms; instead only the degree of exposure to violence, and current level of stress contributed to the variance of PTSD-related symptoms. Conversely, resilience and current stress contributed to the variance of trauma symptoms when measured by local idioms of distress.

CONCLUSIONS

Findings should be interpreted with caution, due to limitations in the content validity of instruments, risk of inaccurate recall, use of individual explanations of distress (such as PTSD) for collective experiences of violence, use of non-indigenous frameworks to examine Indigenous resilience, and other methodological concerns. The study however highlights the high degree of traumatic exposure of these former war children. While the prevalence of potential PTSD was astonishingly low in this sample, a number of women still suffer from significant distress two decades after the traumatic events. Therefore, post-conflict interventions should renew efforts to foster the resilience of marginalized populations disproportionately targeted by violence and advocate for enhanced protection of women and children in current armed conflicts.

In the shadow of terror: posttraumatic stress and psychiatric co-morbidity following bombing in Iraq: the role of shattered world assumptions and altered self-capacities

Whilst research has looked at posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among civilians exposed to bombing, there is a lack of longitudinal data on the development of these outcomes and the psychological factors associated with them, particularly among Iraqi civilians. This study aimed to: investigate 1) the trajectory of PTSD and psychiatric co-morbidity following bombing among civilians in Iraq and 2) the link between shattered world assumptions, altered self-capacities and identified health outcomes. One hundred and eighty (F = 90, M = 90) Iraqi civilians exposed to first time bombing were recruited approximately one month (time 1) after the bombing and five months (time 2) after the baseline assessment. A control group data (178, F = 91, M = 87) from people who were not exposed to bombing was also collected. They completed the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the World Assumptions Questionnaire and the Inventory of Altered Self-Capacities. The results showed that there was a significant decline in the proportion of people meeting the screening criteria for PTSD and psychiatric co-morbidity symptoms over time. For the cross-sectional analysis, controlling for demographic variables, regression analysis showed that severity of the bombing (β = .16), controllability of events (β = -.21), safety and vulnerability (β=.31) and affect dysregulation (β = .37) significantly predicted PTSD time 1. Controllability of events (β = -.20) and affect dysregulation (β = .37) also predicted psychiatric co-morbidity at time 1. For the prospective analysis, controlling for PTSD and psychiatric co-morbidity at time 1, none of these dimensions predicted PTSD and psychiatric co-morbidity at time 2. Findings are discussed in terms of individual resilience. It can be concluded that following bombing, civilians developed PTSD and psychiatric co-morbidity which declined over time. Civilians' perceptions of their ability to control events in the world and regulate their affect had a short term impact on the severity of these symptoms.

The validity of the DSM-IV PTSD criteria in children and adolescents: a review

OBJECTIVE

DSM-V is on its way and doubts have been raised regarding the validity of pediatric PTSD. It is the goal of the current review to critically review the empirical literature on PTSD in youth.

METHOD

A search of PsycINFO, PubMed and reference lists was conducted. Empirical information considered relevant regarding the validity of the criteria was collected.

RESULTS/CONCLUSIONS

The validity of the symptom criteria and clusters varies, with the Avoidance/Numbing cluster outperforming the Re-experiencing-and Arousal cluster. Factor analytic findings suggest that Arousal criterion D4 should be placed within the Re-experiencing cluster, and that the Avoidance/Numbing cluster should be split up. Some non-DSM-IV PTSD symptoms, among which guilt, have considerable validity in trauma-exposed youth and their inclusion in DSM-V PTSD should be considered. As for preschool children, alternative criteria are recommended that are more developmentally sensitive.

Trajectories of internalizing problems in war-affected Sierra Leonean youth: examining conflict and postconflict factors

Three waves of data from a prospective longitudinal study in Sierra Leone were used to examine internalizing trajectories in 529 war-affected youth (ages 10-17 at baseline; 25% female). Latent class growth analyses identified 4 trajectories: A large majority of youth maintained lower levels of internalizing problems (41.4%) or significantly improved over time (47.6%) despite very limited access to care, but smaller proportions continued to report severe difficulties 6 years postwar (4.5%) or their symptoms worsened (6.4%). Continued internalizing problems were associated with loss of a caregiver, family abuse and neglect, and community stigma. Despite the comparative resilience of most war-affected youth in the face of extreme adversity, there remains a compelling need for interventions that address family- and community-level stressors.

Structure of the Children's Revised Impact of Event Scale (CRIES) with children and adolescents exposed to debris flood

AIM

PTSD symptoms were pervasive among children and adolescents after experiencing or exposure to traumatic events. Screening and diagnosis of PTSD symptoms is crucial in trauma-related research and practice. The 13-item Children's Revised Impact of Event Scale (CRIES) has been demonstrated to be a valid and reliable tool to achieve this goal. This study was designed to examine the psychometric properties of the 13-item CRIES in a sample of Chinese debris flood victims.

METHODS

A total of 268 participants (145 girls, 123 boys) aged 8-18 years were recruited from an integral part of a service oriented project, supported by the Institute of Psychology, Chinese Academy of Sciences following the debris flood. The participants were given the 13-item CRIES 3 months after the debris flood.

RESULTS

The results of confirmatory factor analysis indicated that a two-factor structure (intrusion+arousal vs avoidance) emerged as the model best fit in total sample, boys and girls subsamples, respectively. The scale was also demonstrated to have good internal consistency (Cronbach's alpha = 0.83).

CONCLUSION

The study confirmed the good psychometric properties of the CRIES and its' applicability to Chinese children and adolescents. Moreover, these findings imply that the CRIES factor structure is stable across age, gender, and different types of trauma.

Risk factors for PTSD, anxiety, and depression among adolescents in Gaza

The present study examined among adolescents in Gaza the relationship between exposure to war stressors and psychological distress as well as the effects of age, gender, and socioeconomic status. Data were collected from a sample of 139 adolescents 12 to 17 years old. Results showed that adolescents reported elevated levels of intrusion, avoidance, and depression compared to levels in communities not affected by war in the recent past. The proportion scoring within the clinical range of posttraumatic stress disorder (PTSD) was 56.8% compared to 6.3% in peacetime populations, reflecting a Hedges's g of 1.29 (p < .001). Significant risk factors for PTSD were exposure (β = .377, p < .001), female gender (β = -.257, p < .001), older age (β = .280, p < .01), and an unemployed father (β = -.280, p < .01). Risk factors for anxiety were exposure (β = .304, p < .001), female gender (β = -.125, p < .01), and older age (β = 272, p < .01), whereas female gender (β = <.238, p < .001) was the only significant risk factor for depression. The present study suggests large individual differences in how adolescents are affected by war stressors.

Assessment of prevalence and determinants of posttraumatic stress disorder in survivors of earthquake in Pakistan using Davidson Trauma Scale

INTRODUCTION

Pakistan's 2005 earthquake claimed almost 87,000 lives and displaced millions. The present study sought to assess PTSD prevalence among earthquake survivors, to evaluate its determinants, and to identify protective factors that suggest future interventions in the aftermath of disasters.

METHODS

In a cross-sectional survey, three districts were selected based on their proximity to the epicenter and the presence, accessibility, and security of refugees, 300 earthquake survivors were enrolled.

RESULTS

Analysis revealed that after 30months, PTSD prevalence was high. Being female, older, unmarried, head of the family, and currently unemployed and having low income and living in temporary housing confer higher risks of PTSD. Having a high social capital and religious inclination seem to have protective, buffer effect and increase resilience against PTSD.

CONCLUSION

This is the first post-quake study in Pakistan that has utilized, adapted and validated Davidson Trauma Scale in the local context. Results imply the significance of continued psychological support, of drawing on resilience factors in PTSD management. Implications and directions for future research are discussed.

Mental health and childhood adversities: a longitudinal study in Kabul, Afghanistan

OBJECTIVE

To identify prospective predictors of mental health in Kabul, Afghanistan.

METHOD

Using stratified random-sampling in schools, mental health and life events for 11-to 16-year-old students and their caregivers were assessed. In 2007, 1 year after baseline, the retention rate was 64% (n = 115 boys, 119 girls, 234 adults) with no evidence of selection bias. Self- and caregiver-rated child mental health (Strengths and Difficulties Questionnaire), depressive (Depression Self-Rating Scale), and posttraumatic stress (Child Revised Impact of Events Scale) symptoms and caregiver mental health (Self-Report Questionnaire) were assessed. Lifetime trauma and past-year traumatic, stressful, and protective experiences were assessed.

RESULTS

With the exception of posttraumatic stress, one-year trajectories for all mental health outcomes showed significant improvement (p < .001). Family violence had a striking impact on the Strengths and Difficulties Questionnaire data, raising caregiver-rated scores by 3.14 points (confidence interval [CI] 2.21-4.08) or half a standard deviation, and self-rated scores by 1.26 points (CI 0.50-2.03); past-year traumatic beatings independently raised self-rated scores by 1.85 points (CI 0.03-3.66). A major family conflict raised depression scores by 2.75 points (CI 0.89-4.61), two thirds of a standard deviation, whereas improved family life had protective effects. Posttraumatic stress symptom scores, however, were solely contingent on lifetime trauma, with more than three events raising scores by 5.38 points (CI 1.76-9.00).

CONCLUSIONS

Family violence predicted changes in mental health problems other than posttraumatic stress symptoms in a cohort that showed resilience to substantial socioeconomic and war-related stressors. The importance of prospectively identifying impacts of specific types of childhood adversities on mental health outcomes is highlighted to strengthen evidence on key modifiable factors for intervention in war-affected populations.

A Meta-Analysis of Coefficient Alpha for the Impact of Event Scales: A Reliability Generalization Study

We conducted a score reliability meta-analysis across studies using the Impact of Event Scales. Five hundred and ninety-four studies using the measure were located through electronic database searches and then separated to identify studies that had calculated and reported reliability coefficients from their own data. The 66 articles that remained were then coded to identify potential study characteristics that might influence the variation in reliability estimates. Results indicate adequate internal consistency estimates for all subscales across both scale versions. Furthermore, coefficient alpha was positively correlated with studies involving war and abuse victims for the IES Avoidance subscale. The alpha coefficient was also positively correlated with the percentage of female participants for the Intrusion subscale and negatively correlated to journal type for the composite reliability estimate. Results from this study provide useful information, in terms of scale performance, for researchers interested in using the scale for future academic pursuits and for school psychologists. In particular, implications for school psychologists are considered.