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Kapel Lev-Ari R, Aloni R, Ari AB. Children Fleeing War-Exploring the Mental Health of Refugee Children Arriving in Israel after the Ukraine 2022 Conflict. CHILD ABUSE & NEGLECT 2024; 149:106608. [PMID: 38141479 DOI: 10.1016/j.chiabu.2023.106608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/18/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND In February 2022, Ukraine suffered a devastating assault by Russia, leading to destruction, casualties, and mass displacement. Among those displaced were over 1.5 million children. Forced displacement exposes children to a heightened risk of mental health issues. OBJECTIVE This study investigated the prevalence of Post-traumatic stress disorder (PTSD) and other mental health issues among child refugees shortly after their displacement from Ukraine to Israel. It aimed to identify factors influencing PTSD development and explore their associations. METHODS The study included 59 child refugees who had arrived in Israel after fleeing the war in Ukraine. Parents completed self-report questionnaires to assess their children's mental health. RESULTS Only three children met the DSM diagnostic criteria for PTSD, with higher scores in the negative cognition and re-experiencing clusters. Over half of the children exhibited general mental health problems, with approximately 40 % showing internalizing problems, and 30 % showing externalizing problems. The study also found a significant comorbidity between PTSD symptoms and internalizing problems. Additionally, internalizing problems emerged as the sole significant predictor of PTSD levels when considering factors such as age, gender, economic status, parents' work status, internalizing problems, and externalizing problems. CONCLUSIONS Child refugees frequently experience psychological distress, even if they do not meet the formal diagnostic criteria for PTSD. They often exhibit other distress symptoms, primarily internalizing problems, which can be challenging to detect. A deeper understanding of the challenges faced by refugee children can inform the development of targeted assistance programs and the recruitment and training of personnel in host countries.
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Affiliation(s)
| | - Roy Aloni
- Department of Behavioral Sciences, Ariel University, Israel
| | - Amichai Ben Ari
- Department of Behavioral Sciences, Ariel University, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Karnick A, Caulfield NM, Buerke M, Stanley I, Capron D, Vujanovic A. Clinical and psychological implications of post-traumatic stress in firefighters: a moderated network study. Cogn Behav Ther 2024; 53:171-189. [PMID: 37960947 DOI: 10.1080/16506073.2023.2282374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023]
Abstract
Firefighters are frequently exposed to trauma and may experience a unique symptom presentation of post-traumatic stress. Prior research has identified stronger associations between certain post-traumatic stress symptoms (e.g. detachment, intrusions, physiological reactivity) using network analysis. However, little is known about the effects of symptom severity and emergency work-related trauma on symptom networks. The present study probed the network structure of post-traumatic stress symptoms in trauma-exposed firefighters (N = 871) to model the dynamic interactions of psychological symptoms. We developed a network of post-traumatic stress symptoms and a network of post-traumatic stress with clinical covariates and used moderated network modelling to assess the effects of having PTSD and experiencing work-related trauma on the networks. We identified high edge correlations between several nodes (e.g. startle/hypervigilance, internal/external cue avoidance, detachment/lack of interest) and high centrality of detachment, external cue avoidance, and flashbacks. Additionally, having PTSD moderated positive network associations between risk-taking and suicidality and between distorted blame and post-traumatic cognitions. Work-related trauma moderated negative associations between appetite gain and loss and appetite loss and suicidality. Findings suggest that targeting specific symptoms of detachment, external cue avoidance, and flashbacks could allow for the development of effective trauma-informed interventions for these populations.
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Affiliation(s)
- Aleksandr Karnick
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | - Ian Stanley
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Anka Vujanovic
- Department of Psychology, University of Houston, Houston, TX, USA
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Scharpf F, Saupe L, Crombach A, Haer R, Ibrahim H, Neuner F, Peltonen K, Qouta S, Saile R, Hecker T. The network structure of posttraumatic stress symptoms in war-affected children and adolescents. JCPP ADVANCES 2023; 3:e12124. [PMID: 37431314 PMCID: PMC10241473 DOI: 10.1002/jcv2.12124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/07/2022] [Indexed: 09/20/2024] Open
Abstract
Background It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.
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Affiliation(s)
- Florian Scharpf
- Department of PsychologyBielefeld UniversityBielefeldGermany
- Institute for Interdisciplinary Research on Conflict and ViolenceBielefeld UniversityBielefeldGermany
| | - Laura Saupe
- Department of PsychologyUniversity Eichstätt‐IngolstadtEichstättGermany
| | - Anselm Crombach
- Department of PsychologyKonstanz UniversityKonstanzGermany
- Department of PsychologySaarland UniversitySaarbrückenGermany
| | - Roos Haer
- Institute of Political ScienceLeiden UniversityLeidenNetherlands
| | - Hawkar Ibrahim
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Frank Neuner
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Kirsi Peltonen
- Research Center for Child PsychiatryUniversity of TurkuTurkuFinland
| | - Samir Qouta
- School of Social Sciences and HumanitiesDoha Instiute for Graduate StudiesAl DaayenQatar
| | - Regina Saile
- Treatment Center for Victims of TortureUlmGermany
| | - Tobias Hecker
- Department of PsychologyBielefeld UniversityBielefeldGermany
- Institute for Interdisciplinary Research on Conflict and ViolenceBielefeld UniversityBielefeldGermany
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Andrade AS, Roca JS, Pérez SR. Children's Emotional and Behavioral Response Following a Migration: A Scoping Review. J Migr Health 2023; 7:100176. [PMID: 37034241 PMCID: PMC10074795 DOI: 10.1016/j.jmh.2023.100176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/03/2023] [Accepted: 03/08/2023] [Indexed: 03/22/2023] Open
Abstract
Background Migration is a present and pressing global phenomenon, as climate change and political instability continue to rise, more populations will be forced to relocate. Efficient strategies must be in place to aid the transition of vulnerable populations - such as children - and strategic interventions designed based on an understanding of their particular needs and risks. Aim of the review This article reviewed recent research regarding the mental health of migrant children identifying a wide array of common characteristics to their emotional and behavioral responses following a migration, and compiled an extensive list of protective and risk factors. 48 studies were selected from Proquest, WOS, SCOPUS, and Pubpsych published between 2015 and 2022 covering studies of children around the world. Findings The migration-related factors that most negatively impacted children's mental health were experiences such as discrimination, loss of access to governmental and educational resources, premigration trauma, loss of community, cultural distance and acculturation, the burden on the family unit, and socioeconomic difficulties. Thus, with the right interventions and policy changes, it is possible to make migration a non-traumatic experience in order to avoid the common emergence of depressive symptoms, PTSS (post-traumatic stress symptoms), anxiety, and other mental health issues. Supporting the family unit's transition, encouraging peer connections, and directing government aid to expedite resources upon arrival will serve as protective factors for children while they integrate into their new environment.
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Affiliation(s)
- Alejandra Salazar Andrade
- Universitat Autònoma de Barcelona Department of Basic, Developmental and Educational Psychology, Spain
- Corresponding author.
| | - Josefina Sala Roca
- Department of Educational Theories and Social Pedagogy, Universitat Autònoma de Barcelona, Spain
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Kvestad I, Bøe T, Sayyad N, Skogen JC, Randal S, Lehmann S. Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care. Eur Child Adolesc Psychiatry 2023; 32:439-449. [PMID: 34537879 PMCID: PMC10038941 DOI: 10.1007/s00787-021-01876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.
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Affiliation(s)
- Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Sølve Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health Promotion and development, Faculty of Psychology, University of Bergen, Bergen, Norway
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Veeser J, Barkmann C, Schumacher L, Zindler A, Schön G, Barthel D. Post-traumatic stress disorder in refugee minors in an outpatient care center: prevalence and associated factors. Eur Child Adolesc Psychiatry 2023; 32:419-426. [PMID: 34524524 DOI: 10.1007/s00787-021-01866-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Due to their likelihood for experiencing a number of traumatic events, refugee minors have an increased risk of developing post-traumatic stress disorder (PTSD). However, the prevalence of PTSD in refugee children varies widely between studies, and it remains somewhat unclear what factors increase children's risk of PTSD. This study aimed to assess the prevalence of PTSD in a clinical outpatient sample of refugee minors, and to evaluate the association of different risk factors with a PTSD diagnosis. N = 417 refugee minors were recruited from an outpatient clinical center in Hamburg, Germany. The median age was 15.4 years and 74.6% of the minors were male. As part of the standard diagnostic process, their social history and a potential PTSD diagnosis using the Module K of the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was assessed. The predictive value of age, gender, number of interpersonal traumatic events, un-/accompanied status, presence of family member in the host country, flight duration, residence status, and time since arrival in the host country were investigated using logistic regression analysis. The prevalence of PTSD among the young refugee patients was 61.6%. Significant predictors of a PTSD diagnosis were number of interpersonal traumatic life events, age, residence status, and time since arrival in the host country. The prediction model explained 33.8% of variance of the outcome with the number of interpersonal traumatic events having the largest contribution (20.8%). The high prevalence of PTSD among refugee minors in outpatient care emphasizes the need to establish appropriate care structures and train specialists in the treatment of PTSD.
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Affiliation(s)
- Jakob Veeser
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
| | - Lea Schumacher
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Areej Zindler
- Outpatient Center GmbH, Refugee Outpatient Clinic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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Chierici DK, Hamdan AC. Cognitive evaluation in unaccompanied refugee children: a systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022079. [PMID: 37194839 DOI: 10.1590/1984-0462/2023/41/2022079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/30/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aims to identify what existing literature has shown about possible cognitive alterations in unaccompanied refugee children. DATA SOURCES The search was performed in the Web of Science, PsycInfo, Scopus, and PubMed databases, including articles published in any year and in any language. The research was submitted to the Prospero protocol (ID: CRD42021257858), and the quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. DATA SYNTHESIS Memory and attention are the main topics identified, largely because they are related to symptoms of post-traumatic stress disorder. However, low specificity was observed in the conduction of cognitive assessments, leading to relevant inconsistencies in the collected data. CONCLUSIONS The use of psychological assessment instruments that are either poorly adapted or not adapted at all to the populations studied casts doubt on the validity of the data produced so far.
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Hodes M. Thinking about young refugees' mental health following the Russian invasion of Ukraine in 2022. Clin Child Psychol Psychiatry 2023; 28:3-14. [PMID: 36071016 DOI: 10.1177/13591045221125639] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Russian invasion of Ukraine on 24th February 2022 has prompted this article to summarise some of the salient mental health issues experienced by young asylum seekers and refugees focussing on resettlement countries, drawing on the substantial literature, for Child and Adolescent Mental Health Practitioners. Firstly, the various UNHCR categories of persons affected by war and persecution and statistics are described. By July 2022, over 100 million people globally were of concern to UNHCR, a number increased by the many millions of refugees fleeing Ukraine to neighbouring countries. Selected findings on the psychiatric epidemiology of young refugees are summarised, and some principles of Child and Adolescent Mental Health Service delivery and treatments are outlined. The research on Ukrainian refugees' mental health is limited and this is an area that requires further investigation alongside active attempts to meet their mental health needs.
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Affiliation(s)
- Matthew Hodes
- Division of Psychiatry, Imperial College London, London, UK; Westminster Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
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Catani C, Wittmann J, Schmidt TL, Wilker S, Neldner S, Neuner F. School-based mental health screenings with Ukrainian adolescent refugees in Germany: Results from a pilot study. Front Psychol 2023; 14:1146282. [PMID: 37143592 PMCID: PMC10151552 DOI: 10.3389/fpsyg.2023.1146282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Abstract
Since the Russian invasion of Ukraine in February 2022, high numbers of Ukrainians, mostly women and children, have left the country. As of today, Germany has accepted more than one million refugees fleeing from Ukraine including ~200,000 children and adolescents registered in German schools. Since refugee minors are typically affected by high rates of mental health issues, the identification of potential psychological problems at an early stage after arrival is essential in order to make timely referrals for vulnerable youth to diagnostic or treatment services possible. The aim of the present study was to test the feasibility of a classroom-based mental health screening procedure and to assess symptoms of PTSD, depression, and anxiety in a small sample of adolescents who had fled to Germany. Forty-two adolescents (n = 20 girls) took part in the study. Screening results showed that more than half of the sample had elevated ratings in the Refugee Health Screener (RHS) and about 45% reported clinically significant levels of PTSD. Overall, the amount of both mental health problems and current worries related to the war was significantly higher in girls compared to boys. In general, screenings were well received by the adolescents. The findings of this pilot study point to a considerable level of mental health problems and distress in adolescent refugees affected by the recent war in Ukraine. Brief psychological screenings within the school setting might represent a promising approach to identifying potential mental health disorders as early as possible in newly arriving refugee youth.
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Bürgin D, Anagnostopoulos D, Vitiello B, Sukale T, Schmid M, Fegert JM. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry 2022; 31:845-853. [PMID: 35286450 PMCID: PMC9209349 DOI: 10.1007/s00787-022-01974-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.
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Affiliation(s)
- David Bürgin
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | | | - Benedetto Vitiello
- Division of Child Neurology and Psychiatry, Department of Public Health and Pediatric Sciences, Regina Margherita Pediatric Hospital, University of Turin, Turin, Italy
| | - Thorsten Sukale
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany.
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Makhubela M. The Network Structure of Trauma Symptoms of Abuse-exposed Children and Adolescents in South Africa. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP7803-NP7824. [PMID: 33140670 DOI: 10.1177/0886260520969239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Network theory promises new ways for conceptualizing, methods for investigating, and state-of-the-art lines of research that will improve our knowledge of mental health in high-risk children and adolescents. This study constructed a symptom network to examine associations between a wide range of trauma symptoms in a sample of children and adolescents (N = 270; Mage = 12.55 yrs, SD = 1.19; 67% = Female) who experienced different forms of abuse (i.e., sexual, physical, emotional and neglect). Symptom-pairs regularized partial correlations, with the Extended Bayesian Information Criterion Graphical Least Absolute Shrinkage and Selection Operator (EBICglasso), were computed to estimate the network structure and centrality measures of the TSCC-SF items. Results show sadness, dissociative amnesia, and sexual arousal to be the most central symptoms in the network, while suicidality was found to be the shortest pathway across all other symptoms (domains). By providing clinicians with specific symptoms to target in interventions, the network framework has the potential to guide and enhance the effectiveness of psychological therapies in high-risk populations.
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13
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Screening for Posttraumatic Stress Symptoms in Young Refugees: Comparison of Questionnaire Data with and without Involvement of an Interpreter. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136803. [PMID: 34202802 PMCID: PMC8297356 DOI: 10.3390/ijerph18136803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Background: The substantial number of young refugees who have arrived in Europe since 2015 requires rapid screening to identify those in need of treatment. However, translated versions of screening measures are not always available, necessitating the support of interpreters. The Child and Adolescent Trauma Screen (CATS) is a validated questionnaire for posttraumatic stress symptoms. Here, we report on the psychometric properties of the CATS in a sample of young refugees as a function of interpreter involvement. Methods: A total of N = 145 (Mage = 16.8, SD = 1.54; 93% male) were assessed with the CATS, with half of the screenings conducted with and half without interpreters. Post hoc analyses included calculating internal consistency using Cronbach’s α. We used confirmative factor analysis to investigate the factor structure. Results: The CATS total scale showed good reliability (α = 0.84). Differences in psychometric properties between the interpreter vs. the no interpreter group were minor and tended to be in favor of the interpreter group. Results of a confirmatory factor analysis were acceptable after the exclusion of items with low item-scale correlations. Conclusions: The sample and the administration of the assessment represent the situation of young refugees in Germany, where resources are low and translated versions not always available. The CATS may be a helpful screening tool for clinicians working with young refugees, even when administered with an interpreter. Limitations include the post hoc design of the analysis without randomization of participants and the lack of a third comparison group using translated questionnaire versions.
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Schumacher L, Burger J, Zoellner F, Zindler A, Epskamp S, Barthel D. Using clinical expertise and empirical data in constructing networks of trauma symptoms in refugee youth. Eur J Psychotraumatol 2021; 12:1920200. [PMID: 34178294 PMCID: PMC8205066 DOI: 10.1080/20008198.2021.1920200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. Objective: The present study aimed to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assessed clinicians' perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network. Methods: Empirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N = 366 refugee youth were collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians' perceived symptom relations (PSR). Results: Both the network based on empirical data and the network based on clinicians' PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster (connected mainly via sleeping problems), externalizing symptoms were somewhat related to PTSD symptoms and intrusions were central. Some differences were found within the clinicians' PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data. Conclusion: Our results suggest that sleeping problems and intrusions play a central role in the symptomatology of refugee children, which has tentative implications for diagnostics and treatment. Further, externalizing symptoms might be an indicator for PTSD-symptoms. Finally, using clinicians' PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity.
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Affiliation(s)
- Lea Schumacher
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Julian Burger
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Center Psychiatry (UCP), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Fionna Zoellner
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Areej Zindler
- Ambulanzzentrum des UKE GmbH, Flüchtlingsambulanz, Hamburg, Germany
| | - Sacha Epskamp
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Ambulanzzentrum des UKE GmbH, Flüchtlingsambulanz, Hamburg, Germany
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15
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Sun R, Qi J, Huang J, Zhou X. Network analysis of PTSD in college students across different areas after the COVID-19 epidemic. Eur J Psychotraumatol 2021; 12:1920203. [PMID: 34104353 PMCID: PMC8158277 DOI: 10.1080/20008198.2021.1920203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Various studies have examined the psychological 'typhoon eye' and 'ripple' effects in mental disorders following COVID-19. However, these studies only considered the disorders as entities and assessed severity, and overlooked the differences in specific symptoms of disorders. Objectives: This aim of the study is to assess the psychological typhoon eye and ripple effects at the symptom-level in posttraumatic stress disorder (PTSD), which is considered as a common psychopathology following the COVID-19 epidemic. Method: In total, 1150 undergraduates, including 271 students from the Hubei province (e.g. epidemic centre) and 879 students from other provinces, completed the self-report questionnaire. The networks were estimated and compared using the R packages. Results: Although the PTSD networks of Hubei and non-Hubei undergraduates were similarly connected and shared some symptoms with high centrality (e.g. flashbacks, irritability and anger), there were differences across the networks. Distorted cognition and no positive emotion only exhibited high centrality in the Hubei network. Physiological responses and exaggerated startle only exhibited high centrality in the non-Hubei network. Conclusion: These findings suggested that the psychological typhoon eye and ripple effects may co-exist at the symptom level. Targeted and distinct psychological services for college students in Hubei and non-Hubei provinces should be emphasized following COVID-19.
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Affiliation(s)
- Rui Sun
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Junjun Qi
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Jiali Huang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, P.R. China
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16
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A network analysis of posttraumatic stress symptoms among help-seeking refugees in Kenya. J Anxiety Disord 2021; 78:102358. [PMID: 33476983 DOI: 10.1016/j.janxdis.2021.102358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/10/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
We analyzed the network structure of DSM-IV PTSD symptoms among 2792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses. Our networks did not reproduce the common finding of particularly low centrality of amnesia. We further noted substantive similarities in network structure, but also differences, between refugees living in an urban environment and in refugee camps. Concentration problems were most central among mainly Somali refugees at a refugee camp, and associated with amnesia and sense of foreshortened future, while emotional numbing was the most central symptom among majority Congolese refugees in Nairobi. Our findings highlight the importance of contextual and cultural factors for PTSD symptomatology, and are informative for assessment and treatment among help-seeking refugees.
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17
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Gossmann K, Eilers R, Rosner R, Barke A. How do licensed psychotherapists in Germany feel about treating patients with posttraumatic stress symptoms? - an experimental study based on case vignettes. Eur J Psychotraumatol 2021; 12:1995265. [PMID: 34868487 PMCID: PMC8635540 DOI: 10.1080/20008198.2021.1995265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous research indicates that not all children, adolescents and adults suffering from PTSD receive psychotherapy and if they do, trauma is not always considered during therapy. One reason for this undertreatment might be a limited readiness of licenced psychotherapists (LPTs) to treat patients who have experienced a trauma and thus suffer from PTSD symptoms. OBJECTIVE The aim of this study is to explore the association between the readiness of LPTs to treat patients with PTSD symptoms and different patients' and therapists' characteristics. METHOD We used case vignettes to assess the readiness of LPTs in Germany in a nationwide online survey (N = 768). The vignettes described patients with PTSD and were adapted to the age group mainly treated by the therapists (children/adolescents vs. adults). The patients' characteristics in the otherwise identical vignettes were randomized for patient gender (female vs. male) and symptom cluster (internalizing vs. externalizing). Rating scales were used to assess readiness. Additionally, therapists' characteristics (age, trauma-specific training, perceived fears/doubts, and objective barriers to treating the vignette patient) were assessed. RESULTS The patients' characteristics did not influence the treatment readiness of the LPTs. Regarding therapists' characteristics, LPTs working mainly with children and adolescents, and those who had completed trauma-specific training reported a higher readiness to treat the vignette patient. CONCLUSIONS Regarding the treatment of patients suffering from PTSD symptoms of different ages, our study indicated that the assessed therapists' characteristics were more relevant for the treatment readiness of LPTs than the patients' characteristics of age or symptom type.
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Affiliation(s)
- Katharina Gossmann
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rebekka Eilers
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Antonia Barke
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
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18
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Rosner R, Sachser C, Hornfeck F, Kilian R, Kindler H, Muche R, Müller LRF, Thielemann J, Waldmann T, Ziegenhain U, Unterhitzenberger J, Pfeiffer E. Improving mental health care for unaccompanied young refugees through a stepped-care approach versus usual care+: study protocol of a cluster randomized controlled hybrid effectiveness implementation trial. Trials 2020; 21:1013. [PMID: 33298126 PMCID: PMC7724616 DOI: 10.1186/s13063-020-04922-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/19/2020] [Indexed: 11/11/2022] Open
Abstract
Background More than half of the unaccompanied young refugees (UYRs) resettled in Europe report elevated levels of posttraumatic stress symptoms (PTSS) and comorbid symptoms. Earlier studies have highlighted the effectiveness of the trauma-focused preventive group intervention “Mein Weg” (English “My Way”), and the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for UYRs. Both interventions are deemed to be empirically supported treatments (ESTs). However, UYRs seldom receive ESTs or, in fact, any treatment at all. In view of the high need and the limited treatment resources available, a stepped-care approach is indicated but has not been evaluated so far. The purpose of this trial is to compare the stepped-care approach BETTER CARE with usual care enhanced with screening and indication (usual care+). Methods In a cluster randomized controlled trial involving N = 540 UYRs living in up to N = 54 child and youth welfare service (CYWS) facilities, BETTER CARE will be compared with usual care+. We will randomize clusters comprising a CYWS facility with at least one eligible psychotherapist. BETTER CARE consists of step (1) screening and indication and either step (2) preventive trauma-focused group intervention “Mein Weg” delivered by trained CYWS staff or step (3) TF-CBT delivered by trained community therapists and supported by trained translators if necessary. Participants will be assessed 6 and 12 months after randomization. The primary outcome is the severity of PTSS after 12 months. Secondary outcomes are depressive and anxiety symptoms, quality of life, and proxy reported PTSS. Furthermore, drug use, health costs, benefits, and long-term effects on integration/acculturation will be assessed. Discussion The trial will directly integrate a stepped-care approach into existing structures of the German child welfare and (mental) health system. It could, therefore, serve as a blueprint for how to implement ESTs for UYRs. If successful, screening, prevention, and intervention will be sustainably implemented in CYWS in southern Germany. Trial registration German Clinical Trials Register DRKS00017453. Registered on 11 December 2019. Supplementary information The online version contains supplementary material available at 10.1186/s13063-020-04922-x.
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Affiliation(s)
- Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071, Eichstätt, Germany
| | - Cedric Sachser
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhövelstr. 1, 89075, Ulm, Germany
| | | | - Reinhold Kilian
- Clinic for Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str., 89312, Günzburg, Germany
| | - Heinz Kindler
- German Youth Institute, Nockherstr. 2, 81541, Munich, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstr. 13, 89075, Ulm, Germany
| | | | - Jonathan Thielemann
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071, Eichstätt, Germany
| | - Tamara Waldmann
- Clinic for Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str., 89312, Günzburg, Germany
| | - Ute Ziegenhain
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhövelstr. 1, 89075, Ulm, Germany
| | - Johanna Unterhitzenberger
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071, Eichstätt, Germany
| | - Elisa Pfeiffer
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhövelstr. 1, 89075, Ulm, Germany.
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19
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Fuel to the fire: The escalating interplay of attachment and maltreatment in the transgenerational transmission of psychopathology in families living in refugee camps. Dev Psychopathol 2020; 33:1308-1321. [DOI: 10.1017/s0954579420000516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent–child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.
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20
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A network analysis of posttraumatic stress disorder and dissociation in trauma-exposed adolescents. J Anxiety Disord 2020; 72:102222. [PMID: 32272318 DOI: 10.1016/j.janxdis.2020.102222] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/08/2020] [Accepted: 03/21/2020] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and dissociation have long been recognized to co-occur, leading the DSM-5 to introduce a dissociative subtype of PTSD into its nomenclature. Most research to date on the dissociative subtype has focused on adults. The current study aimed to extend this research to an adolescent sample and to examine symptom-level associations between PTSD and dissociation using network analysis. The analysis was conducted with 448 trauma-exposed detained US adolescents (24.55% female; mean age 15.98 ± 1.25 years). A network consisting of 20 DSM-5 PTSD symptoms was constructed, followed by a network consisting of 20 PTSD symptoms and five dissociative items. Expected influence bridge centrality was estimated to examine items with the most/strongest cross-construct connections (i.e. between PTSD and dissociation). The PTSD symptoms concentration problems, amnesia and recurrent memories and the dissociative items depersonalization, derealisation and can't remember things that happened had the highest bridge centrality values. These symptom-level associations extend our understanding of the PTSD-dissociation relationship by pointing to specific symptoms of PTSD and dissociation that may drive the co-morbidity between the two constructs. These findings may inform future intervention efforts.
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