1
|
Bosqui T, Mayya A, Farah S, Shaito Z, Jordans MJD, Pedersen G, Betancourt TS, Carr A, Donnelly M, Brown FL. Parenting and family interventions in lower and middle-income countries for child and adolescent mental health: A systematic review. Compr Psychiatry 2024; 132:152483. [PMID: 38631272 DOI: 10.1016/j.comppsych.2024.152483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/31/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Given the protective effect of nurturing caregivers and families for child and adolescent mental health, there is a need to review and synthesize research evidence regarding the effectiveness of parenting and family interventions in low and middle-income countries, including humanitarian settings. To advance practice, further understanding of the active ingredients of such interventions and implementation factors that lead to effectiveness are essential. METHOD This systematic review, an update from a previous review, included studies on any parenting or family intervention for children and adolescents aged 0-24, living in a low- or middle-income country, that quantitatively measured child or adolescent mental health outcomes. We searched Global Health, PubMed, PsychINFO, PILOTS and the Cochrane Library databases on the 9th July 2020, and updated on the 12th August 2022. Risk of bias was assessed using an adapted version of the NIH Quality Assessment Tool. We extracted data on: effectiveness outcomes, practice elements included in effective interventions, and implementation challenges and successes. MAIN FINDINGS We found a total of 80 studies (n = 18,193 participants) representing 64 different family or parenting interventions, 43 of which had evidence of effect for a child or adolescent mental health outcome. Only 3 studies found no effect on child, adolescent or caregiver outcomes. The most common practice elements delivered in effective interventions included caregiver psychoeducation, communication skills, and differential reinforcement. Key implementation strategies and lessons learned included non-specialist delivery, the engagement of fathers, and integrated or multi-sector care to holistically address family needs. PRELIMINARY CONCLUSIONS Despite a high level of heterogeneity, preliminary findings from the review are promising and support the use of parenting and family interventions to address the wider social ecology of children in low resource and humanitarian contexts. There are remaining gaps in understanding mechanisms of change and the empirical testing of different implementation models. Our findings have implications for better informing task sharing from specialist to non-specialist delivery, and from individual-focused to wider systemic interventions.
Collapse
Affiliation(s)
- Tania Bosqui
- Department of Psychology, American University of Beirut, Beirut, Lebanon; Trinity Centre for Global Health, Trinity College Dublin, Republic of Ireland.
| | - Anas Mayya
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Sally Farah
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Zahraa Shaito
- Department of Psychology, American University of Beirut, Beirut, Lebanon.
| | - Mark J D Jordans
- War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gloria Pedersen
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, the George Washington University School of Medicine and Health Sciences, Washington D.C., United States
| | | | - Alan Carr
- University College Dublin, Dublin, Republic of Ireland.
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.
| | - Felicity L Brown
- War Child Alliance, Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Backhaus S, Blackwell A, Gardner F. The effectiveness of parenting interventions in reducing violence against children in humanitarian settings in low- and middle-income countries: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2024:106850. [PMID: 38880688 DOI: 10.1016/j.chiabu.2024.106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/23/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Violence against children is a global phenomenon, yet children living in humanitarian settings are at elevated risk of experiencing violent parenting. Parenting interventions are a recommended prevention strategy. OBJECTIVE To conduct a systematic review and meta-analysis on the effectiveness of parenting interventions in preventing violence against children and related parent and child outcomes. PARTICIPANTS AND SETTING Primary caregivers in humanitarian settings in low- and middle-income countries (LMICs). METHODS A highly sensitive multi-language systematic search in electronic and grey-literature database. Studies were appraised for risk of bias, summary effects by certainty of effect, and effect estimates pooled using robust variance estimation. RESULTS Twenty-three randomized trials were meta-analyzed finding a small effect on physical and psychological violence (n = 14, k = 21, d = -0.36, 95 % CI [-0.69, -0.04]), positive parenting (n = 16, k = 43, d = 0.48, 95 % CI [0.29, 0.67]), negative parenting (n = 17, k = 37, d = -0.42, 95 % CI [-0.67, -0.16]), parental poor mental health (n = 9, k = 15, d = -0.34, 95 % CI [-0.66, -0.02]), and internalizing behaviors (n = 11, k = 29, d = -0.38, 95 % CI [-0.70, -0.05]); a non-significant effect on externalizing child behaviors (n = 9, k = 17, d = -0.12, 95 % CI [-0.50, 0.27]). Too few studies reported intimate partner violence, sexual violence, and parenting stress outcomes. CONCLUSIONS Our findings suggest that parenting interventions in humanitarian settings in LMICs may be an effective strategy to reduce physical and psychological violence, and numerous related parent and child outcomes. However, findings need to be interpreted in light of the limited number of available studies and imprecise statistical significance for selected outcomes.
Collapse
Affiliation(s)
- Sophia Backhaus
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Research Institute Child Development and Education, University of Amsterdam, the Netherlands.
| | - Alexandra Blackwell
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
| | - Frances Gardner
- Centre for Evidence-based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
| |
Collapse
|
3
|
Papola D, Prina E, Ceccarelli C, Cadorin C, Gastaldon C, Ferreira MC, Tol WA, van Ommeren M, Barbui C, Purgato M. Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2024; 5:CD014300. [PMID: 38770799 PMCID: PMC11106803 DOI: 10.1002/14651858.cd014300.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health. OBJECTIVES To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour. MAIN RESULTS We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults. AUTHORS' CONCLUSIONS To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
Collapse
Affiliation(s)
- Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Madalena C Ferreira
- Public Health Unit, Médio Ave Local Health Unit, Vila Nova de Famalicão, Portugal
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mark van Ommeren
- Department of Mental Health, Brain Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| |
Collapse
|
4
|
Nguyen AJ, Murray SM, Rahaman KS, Lasater ME, Barua S, Lee C, Schojan M, Tonon B, Clouin L, Le Roch K. Psychosocial impacts of Baby Friendly Spaces for Rohingya refugee mothers in Bangladesh: A pragmatic cluster-randomized controlled trial. Glob Ment Health (Camb) 2024; 11:e64. [PMID: 38827334 PMCID: PMC11140488 DOI: 10.1017/gmh.2024.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/05/2024] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Background This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports. Methods In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters. Results Significant within-group improvements in BFSIE were observed for distres (-.48, p = .014), functional impairment (-.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = -.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons. Discussion Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.
Collapse
Affiliation(s)
- Amanda J. Nguyen
- Department of Human Services, School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Molly E. Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Suzit Barua
- Action Against Hunger, Cox’s Bazar, Bangladesh
| | - Catherine Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew Schojan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | |
Collapse
|
5
|
Fayaz I, Saharan A. Assessment of factors leading to resilience among adults in violence-affected area of Kashmir: an exploratory study employing content analysis and best-worst method. Med Confl Surviv 2024; 40:5-27. [PMID: 38297973 DOI: 10.1080/13623699.2024.2309189] [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: 03/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
Exposure to violence can have profound and lasting effects on individuals and communities, impacting various aspects of their lives. Understanding the relationship between exposure to violence and resilience is crucial for designing effective interventions and support systems. This study aims to identify resilience factors among adults living in such areas and rank them from most to least important. Two staged mixed-method approaches, including face-to-face interviews and the best-worst method, were used to identify factors, assign weights, and rank them. A total of twenty-three sub-factors classified under seven broader factors were identified and ranked by triangulating the opinions of victims, experts, and scholars. Out of twenty-three sub-factors, the top-ranked six factors included family support, trusting higher powers, peer support, better interpersonal relationships, engaging in regular prayers, and better role models, which contributes fifty two percent to resilience formation. By promoting these factors, individuals and communities can better cope with the stress and trauma of violence, promote positive adaptation and growth, and build social support networks to help promote recovery and healing. Implications for practice, policy, and future directions are discussed.
Collapse
Affiliation(s)
- Irfan Fayaz
- Jindal Institute of Behavioural Sciences (JIBS), O P Jindal Global University, Sonipat, India
| | - Akash Saharan
- Jindal Global Business School (JGBS), O P Jindal Global University, Sonipat, India
| |
Collapse
|
6
|
Bangpan M, Felix L, Soliman F, D’Souza P, Jieman AT, Dickson K. The impact of mental health and psychosocial support programmes on children and young people's mental health in the context of humanitarian emergencies in low- and middle-income countries: A systematic review and meta-analysis. Glob Ment Health (Camb) 2024; 11:e21. [PMID: 38572260 PMCID: PMC10988149 DOI: 10.1017/gmh.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/20/2023] [Accepted: 01/30/2024] [Indexed: 04/05/2024] Open
Abstract
Humanitarian emergencies pose a significant global health challenge for children and young people's mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low- and middle-income countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments.
Collapse
Affiliation(s)
- Mukdarut Bangpan
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, United Kingdom
| | - Lambert Felix
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, United Kingdom
| | - Farida Soliman
- Linguistics Department, Queen Mary University of London, London, United Kingdom
| | - Preethy D’Souza
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, United Kingdom
| | - Anna-Theresa Jieman
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, United Kingdom
| | - Kelly Dickson
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, United Kingdom
| |
Collapse
|
7
|
Haar K, Urlicic M, El-Khani A, Martinelli G, Maalouf W. Why do we Need to go Digital? Process of Developing an Online Facilitator Training Platform for a Global Family Skills Programme for Drug Use Prevention. JOURNAL OF PREVENTION (2022) 2024; 45:159-175. [PMID: 38127224 PMCID: PMC10844452 DOI: 10.1007/s10935-023-00754-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/23/2023]
Abstract
Strong Families is a programme developed for families living in challenged or stressful settings to prevent poor mental health and developmental outcomes, violence, and substance use. Facilitators are conventionally trained in person over two full days, by experienced international trainers. During the COVID-19 pandemic and due to travel restrictions, we developed an online course to deliver the content of the training manual electronically, with videos explaining the most difficult exercises, note taking functions and click and reveal activities to check their understanding. We further blended synchronous and asynchronous course formats to accommodate facilitators' different time zones and work schedules. We tied two educational theories (Malcom Knowles theory of andragogy and Blooms taxonomy) into the Strong Families online course, to ensure learners are easily able to understand content, remember it and implement the gained skills within their communities. The aim of this paper is to discuss the process of the development of the Learning Management System and the Strong Families online course, as well as its benefits, key tools and essential considerations for replication through the UNODC multi-country and inter-disciplinary experience in digitalizing the Strong Family skills prevention tool to support other institutions interested in such a process, including in anticipation of future similar circumstances. To date, our online course has been made available in 10 languages, benefitting facilitators from 11 countries and the respective beneficiary families. Further impact evaluation, fidelity of implementation during national scale up and return on investment of integration of blended-learning concepts still need to be assessed.
Collapse
Affiliation(s)
- Karin Haar
- United Nations Office On Drugs and Crime (UNODC), Wagramer Strasse 5, 1400, Vienna, Austria
| | - Mara Urlicic
- United Nations Office On Drugs and Crime (UNODC), Wagramer Strasse 5, 1400, Vienna, Austria
| | - Aala El-Khani
- United Nations Office On Drugs and Crime (UNODC), Wagramer Strasse 5, 1400, Vienna, Austria
| | - Giulia Martinelli
- United Nations Office On Drugs and Crime (UNODC), Wagramer Strasse 5, 1400, Vienna, Austria
| | - Wadih Maalouf
- United Nations Office On Drugs and Crime (UNODC), Wagramer Strasse 5, 1400, Vienna, Austria.
| |
Collapse
|
8
|
Abstract
The population of sub-Saharan children and adolescents is substantial and growing. Even though most of this population is vulnerable, there is no comprehensive understanding of the social-ecological factors that could be leveraged by mental health practitioners to support their resilience. The present study undertakes a narrative scoping review of empirical research (quantitative, qualitative, and mixed) on the resilience of children and adolescents living in sub-Saharan Africa to determine what enables their resilience and what may be distinctive about African pathways of child and adolescent resilience. Online databases were used to identify full-text, peer-reviewed papers published 2000-2018, from which we selected 59 publications detailing the resilience of children and/or adolescents living in 18 sub-Saharan countries. Studies show that the resilience of sub-Saharan children and adolescents is a complex, social-ecological process supported by relational, personal, structural, cultural, and/or spiritual resilience-enablers, as well as disregard for values or practices that could constrain resilience. The results support two insights that have implications for how mental health practitioners facilitate the resilience of sub-Saharan children and adolescents: (i) relational and personal supports matter more-or-less equally; and (ii) the capacity for positive adjustment is complexly interwoven with African ways-of-being and -doing.
Collapse
Affiliation(s)
- Linda Theron
- Department of Educational Psychology/Centre for the Study of Resilience, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
9
|
Panter-Brick C. Pathways to resilience and pathways to flourishing: Examining the added-value of multisystem research and intervention in contexts of war and forced displacement. Dev Psychopathol 2023; 35:2214-2225. [PMID: 37766475 DOI: 10.1017/s095457942300113x] [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] [Indexed: 09/29/2023]
Abstract
This paper examines the added-value that multisystem approaches bring to research and intervention in contexts of war and forced displacement. I highlight what is useful and truly innovative about systems-level work, aware that providing data-related evidence is only part of the story when connecting research to policy and practice. I discuss four types of added-value: these are conceptual, instrumental, capacity-building, and connectivity impacts that, respectively, aim to change current knowledge, improve implementation, build research skills, and strengthen network connectivity. Specifically, systems-based research can help transform the key frames of humanitarian work, fostering the more integrated and distributive models of professional assistance known as resilience and network humanitarianism. I argue that systems-level approaches on resilience and flourishing in war-affected and refugee populations help to articulate new mindsets, methodologies, partnerships, and ways of working relevant for humanitarian research, policy and practice. I focus attention on interdisciplinary, interventionist, prospective, transgenerational, and network-building initiatives. My specific examples cover the family context of mental health and trauma memory in Afghanistan, as well as program evaluation with Syrian refugees in Jordan, connecting stress biology to human experience, and social networks to psychological empowerment. The paper suggests future directions to support more effective and impactful systems-level work in protracted humanitarian crises.
Collapse
Affiliation(s)
- Catherine Panter-Brick
- Department of Anthropology, Yale University, New Haven, CT, USA
- Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| |
Collapse
|
10
|
Smeeth D, May AK, Karam EG, Rieder MJ, Elzagallaai AA, van Uum S, Pluess M. Risk and resilience in Syrian refugee children: A multisystem analysis. Dev Psychopathol 2023; 35:2275-2287. [PMID: 37933522 DOI: 10.1017/s0954579423000433] [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] [Indexed: 11/08/2023]
Abstract
Refugee children are often exposed to substantial trauma, placing them at increased risk for mental illness. However, this risk can be mitigated by a capacity for resilience, conferred from multiple ecological systems (e.g., family, community), including at an individual biological level. We examined the ability of hair cortisol concentrations and polygenic scores for mental health to predict risk and resilience in a sample of Syrian refugee children (n = 1359). Children were categorized as either at-risk or resilient depending on clinical thresholds for posttraumatic stress disorder, depression, and externalizing behavior problems. Logistic regression was used to examine main and interacting effects while controlling for covariates. Elevated hair cortisol concentrations were significantly associated with reduced resilience (odds ratio (OR)=0.58, 95%CI [0.40, 0.83]) while controlling for levels of war exposure. Polygenic scores for depression, self-harm, and neuroticism were not found to have any significant main effects. However, a significant interaction emerged between hair cortisol and polygenic scores for depression (OR=0.04, 95%CI [0.003 0.47]), suggesting that children predisposed to depression were more at risk for mental health problems when hair cortisol concentrations were high. Our results suggest that biomarkers (separately and in combination) might support early identification of refugee children at risk for mental health problems.
Collapse
Affiliation(s)
- Demelza Smeeth
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Andrew K May
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, St Georges Hospital University Medical Center, Beirut, Lebanon
| | - Michael J Rieder
- Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Abdelbaset A Elzagallaai
- Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Stan van Uum
- Division of Endocrinology and Metabolism, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Michael Pluess
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Department of Psychological Sciences, School of Psychology, University of Surrey, Guildford, UK
| |
Collapse
|
11
|
Metzler J, Zhang Y, Saw T, Leu CS, Landers C. Measuring hope: psychometric properties of the children's Hope Scale among South Sudanese refugee children. Child Psychiatry Hum Dev 2023; 54:1452-1458. [PMID: 35389148 PMCID: PMC10435397 DOI: 10.1007/s10578-022-01327-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
We investigated the psychometric properties of the Children's Hope Scale among a sample of 1,118 South Sudanese refugee children (570 girls, 548 boys) aged 9 to 14 years displaced in Uganda. We assessed the underlying factor structure and model fit through exploratory and confirmatory factor analyses and measurement invariance by sex and developmental stage. Confirmatory factor analysis revealed good fit for a one-factor model with the error terms of items 1 and 3 and items 4 and 6 allowed to covary. There was no evidence of differential item functioning by group. Evidence from this study supports the use of a unidimensional model of hopefulness across groups and signifies the importance of confirming these properties for measures used to evaluate humanitarian interventions.
Collapse
Affiliation(s)
- Janna Metzler
- Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, 10032, New York, NY, United States.
| | - Yuan Zhang
- Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, 10032, New York, NY, United States
| | - Terry Saw
- Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, 10032, New York, NY, United States
| | - Cheng-Shiun Leu
- Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, 10032, New York, NY, United States
| | - Cassie Landers
- Columbia University Mailman School of Public Health, 60 Haven Ave., B-2, 10032, New York, NY, United States
| |
Collapse
|
12
|
Albala D, Shapira S. Parent-adolescent coping with prolonged geopolitical conflict: A qualitative analysis focusing on distress and resilience. FAMILY PROCESS 2023. [PMID: 37647893 DOI: 10.1111/famp.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023]
Abstract
Adolescents who were raised in conflict-ridden areas may face unique challenges that may also impact their transition to adulthood. We explored coping processes, distress symptoms, and resilience resources of late adolescents and their parents residing in Israeli communities bordering Gaza and exposed to ongoing conflict-related violence. We conducted in-depth interviews with late adolescents and one of their parents (n = 8 dyads, 16 individual interviews). Four main themes emerged: (a) dynamic adaptation - complex movement between coping styles; (b) distress symptoms; (c) siblingship - the central role of siblings in shaping adolescent resilience; and (d) community impacts - the ways in which social and physical environment can foster resilience. The findings broaden existing coping theories and offer practical implications for practitioners providing support to populations exposed to prolonged conflicts.
Collapse
Affiliation(s)
- Dafna Albala
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Stav Shapira
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
13
|
Terrana A, Al-Delaimy W. A systematic review of cross-cultural measures of resilience and its promotive and protective factors. Transcult Psychiatry 2023; 60:733-750. [PMID: 37097913 PMCID: PMC10504813 DOI: 10.1177/13634615231167661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
As psychological resilience has been increasingly recognized as contextually constructed, mixed methods studies that map out local ecologies of resilience have become increasingly common. However, the direct adaptation of quantitative tools for cross-cultural use based on qualitative findings has been relatively lacking. The current review aims to provide an overview of existing measures of resilience used cross-culturally and to synthesize the protective and promotive factors and processes (PPFP) of resilience identified within these measures into a single resource. A January 2021 search of PubMed for studies of the development of psychological resilience measures that excluded studies of non-psychological resilience yielded 58 unique measures. These measures contain 54 unique PPFP of resilience, ranging from individual to communal-level characteristics. This review is intended to serve as a complementary tool for adapting standardized measures for stakeholders requiring an assessment tool that is attuned to their context for mental health risk assessment and intervention evaluation.
Collapse
Affiliation(s)
- Alec Terrana
- School of Medicine, University of California San Diego
| | - Wael Al-Delaimy
- Herbert Wertheim School of Public Health, University of California San Diego
| |
Collapse
|
14
|
Liebenberg L, Reich J, Denny JF, Gould MR, Hutt-MacLeod D. Two-eyed Seeing for youth wellness: Promoting positive outcomes with interwoven resilience resources. Transcult Psychiatry 2023; 60:613-625. [PMID: 35818776 DOI: 10.1177/13634615221111025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the challenges facing Indigenous youth and their communities due to historical and contemporary institutionalised racism in Canada, communities are drawing on the richness of their own histories to reassert their cultural heritage. Doing so supports mental health outcomes of young people in particular, as highlighted in a compelling body of research. The question facing many communities, however, is how they can facilitate such child and youth engagement in order to support related positive mental health outcomes. This article reports on findings from a Participatory Action Research (PAR) study conducted in a First Nations community in Unama'ki (Cape Breton), Atlantic Canada. The study, Spaces & Places, was a partnership between the community-based mental health service provider (Eskasoni Mental Health Services, EMHS), eight community youth (14-18 years old), and a team of academics. Situated within a resilience framework, the team explored the ways in which the community facilitated, or restricted, youth civic and cultural engagement. Foregrounded against a strong legacy of cultural reassertion within the community, findings highlight the core resilience-promoting resources that support positive youth development. Additionally, findings demonstrate how these resources provide meaningful support for youth because of the way in which they are intertwined with one another. Furthermore, cultural engagement is underpinned by the Two-eyed Seeing model, supporting youth to integrate their own culture with settler culture in ways that work best for them. Findings support community-based service structures, and underscore the importance of community resilience in the effective support of Indigenous children and youth.
Collapse
Affiliation(s)
- Linda Liebenberg
- Faculty of Graduate Studies, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | |
Collapse
|
15
|
Bruno W, Dehnel R, Al-Delaimy W. The impact of family income and parental factors on children's resilience and mental well-being. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2052-2064. [PMID: 36623257 DOI: 10.1002/jcop.22995] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 06/14/2023]
Abstract
Although there is robust evidence on the intergenerational transmission of trauma-related distress, much less is known about the relation of family income and parental resilience on the resilience and mental well-being of traumatized children. We aimed to determine the association between parental resilience and perceived financial stability, and the resilience and depression of their children among Syrian refugees in Jordan. We carried out a survey of 363 parent-child dyads from a refugee clinic in Northern Jordan. Measures of resilience, trauma, symptoms of mental illnesses, and demographics were reported by the mother and child. We evaluated the associations between parental resilience and their children's mental health. Resilience was highest among parents who reported that their income met their financial needs, (65.77 [standard deviation (SD) 15.96]), and lower for those who reported less income or who stated that their income met their needs only fairly well (62.77 [SD 17.56]). Resilience was lowest for those who reported that that income met their needs poorly (48.02 [SD 23.24]). Parent resilience was positively correlated with child resilience (β = 0.076 [95% confidence interval 0.035-0.12], p < 0.001). Depression and resilience of parents were most closely correlated with the depression and resilience scores of their children, among parents who reported the highest financial stability. Income plays a modifying role in the parent-child resilience and depression associations, with this association being least pronounced within those families who were financially less secure. These findings can help develop interventions to target parental transgenerational impacts according to income status.
Collapse
Affiliation(s)
- William Bruno
- Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Rebecca Dehnel
- Long Beach Memorial Medical Center, Long Beach, California, USA
| | - Wael Al-Delaimy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
16
|
Kravić N, Pajević I, Hasanović M, Karahasanović N, Voracek M, Baca-Garcia E, Dervic K. Bosnian Paternal War Orphans: Mental Health in Postwar Time. J Nerv Ment Dis 2023; 211:486-495. [PMID: 36996318 DOI: 10.1097/nmd.0000000000001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
ABSTRACT More research on the medium- and long-term effects of childhood exposure to war, including orphanhood, is needed. We compared 50 orphans 1 who lost their father during the war in Bosnia and Herzegovina (1992-1995) and 50 age- and sex-matched adolescents from two-parent families during 2011-2012 in terms of sociodemographic characteristics, behavioral/emotional problems, depression, resilience, maternal mental health, and perceived social support. The two groups differed on sociodemographic factors, that is, number of children, family composition, income, school grades, and refugeehood. Paternal war orphans did not differ in terms of adolescent mental health and resilience from their nonorphaned peers, controlling for sociodemographic variables. The mothers of orphans had comparably more posttraumatic psychopathology. As for perceived resources for social support, orphans identified those comparably more often among distant relatives and in the community, that is, religious officials and mental health professionals, and less often among siblings, paternal grandparents, paternal and maternal uncles/aunts, school friends and teachers. Our findings suggest that contextual factors may play an important role in orphans' postwar mental health.
Collapse
Affiliation(s)
| | | | | | - Nejla Karahasanović
- Department of Neurology, Imaging Based Functional Brain Diagnostics and Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin Voracek
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Kanita Dervic
- Division of Child Psychosomatics, Department of Pediatrics and Adolescent Medicine/University Hospital, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
17
|
Gómez-Restrepo C, Sarmiento-Suárez MJ, Alba-Saavedra M, Calvo-Valderrama MG, Rincón-Rodríguez CJ, González-Ballesteros LM, Bird V, Priebe S, van Loggerenberg F. Mental health problems and resilience in adolescents during the COVID-19 pandemic in a post-armed conflict area in Colombia. Sci Rep 2023; 13:9743. [PMID: 37328494 PMCID: PMC10276040 DOI: 10.1038/s41598-023-35789-y] [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: 10/18/2022] [Accepted: 05/24/2023] [Indexed: 06/18/2023] Open
Abstract
The impact of COVID-19 pandemic on mental health of adolescents are emerging and require particular attention in settings where challenges like armed conflict, poverty and internal displacement have previously affected their mental wellbeing. This study aimed to determine the prevalence of anxiety symptoms, depressive symptomatology, probable post-traumatic stress disorder and resilience in school-attending adolescents in a post-conflict area of Tolima, Colombia during the COVID-19. A cross-sectional study was carried out with 657 adolescents from 12 to 18 years old, recruited by convenience sampling in 8 public schools in the south of Tolima, Colombia, who completed a self-administered questionnaire. Mental health information was obtained through screening scales for anxiety symptoms (GAD-7), depressive symptomatology (PHQ-8), probable post-traumatic stress disorder (PCL-5) and resilience (CD-RISC-25). The prevalence observed for moderate to severe anxiety symptoms was 18.9% (95% CI 16.0-22.1) and for moderate to severe depressive symptomatology was 30.0% (95% CI 26.5-33.7). A prevalence of probable post-traumatic stress disorder (PTSD) of 22.3% (95% CI 18.1-27.2) was found. The CD-RISC-25 results for resilience had a median score of 54 [IQR 30]. These results suggest that approximately two-thirds of school-attending adolescents in this post-conflict area experienced at least one mental health problem such as anxiety symptoms, depressive symptomatology or probable PTSD during the COVID-19 pandemic. Future studies are of interest to establish the causal relationship between these findings and the impact of the pandemic. These findings highlight the challenge that schools have after pandemic to address the mental health of their students in order to promoting adequate coping strategies and implement prompt multidisciplinary interventions to reduce the burden of mental health problems in adolescents.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Victoria Bird
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | | |
Collapse
|
18
|
Tol WA, Le PD, Harrison SL, Galappatti A, Annan J, Baingana FK, Betancourt TS, Bizouerne C, Eaton J, Engels M, Hijazi Z, Horn RR, Jordans MJD, Kohrt BA, Koyiet P, Panter-Brick C, Pluess M, Rahman A, Silove D, Tomlinson M, Uribe-Restrepo JM, Ventevogel P, Weissbecker I, Ager A, van Ommeren M. Mental health and psychosocial support in humanitarian settings: research priorities for 2021-30. Lancet Glob Health 2023; 11:e969-e975. [PMID: 37116530 PMCID: PMC10188364 DOI: 10.1016/s2214-109x(23)00128-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 04/30/2023]
Abstract
We describe an effort to develop a consensus-based research agenda for mental health and psychosocial support (MHPSS) interventions in humanitarian settings for 2021-30. By engaging a broad group of stakeholders, we generated research questions through a qualitative study (in Indonesia, Lebanon, and Uganda; n=101), consultations led by humanitarian agencies (n=259), and an expert panel (n=227; 51% female participants and 49% male participants; 84% of participants based in low-income and middle-income countries). The expert panel selected and rated a final list of 20 research questions. After rating, the MHPSS research agenda favoured applied research questions (eg, regarding workforce strengthening and monitoring and evaluation practices). Compared with research priorities for the previous decade, there is a shift towards systems-oriented implementation research (eg, multisectoral integration and ensuring sustainability) rather than efficacy research. Answering these research questions selected and rated by the expert panel will require improved partnerships between researchers, practitioners, policy makers, and communities affected by humanitarian crises, and improved equity in funding for MHPSS research in low-income and middle-income countries.
Collapse
Affiliation(s)
- Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - PhuongThao D Le
- Peter C Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA; School of Global Public Health, New York University, New York, NY, USA
| | - Sarah L Harrison
- International Federation of Red Cross Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Ananda Galappatti
- Mental Health and Psychosocial Support Network (MHPSS.net), Colombo, Sri Lanka
| | - Jeannie Annan
- Airbel Impact Lab, The International Rescue Committee, New York, NY, USA
| | | | - Theresa S Betancourt
- Boston College, School of Social Work, Research Program on Children and Adversity, Chestnut Hill, MA, USA
| | - Cecile Bizouerne
- Mental Health, PsychoSocial Support and Protection Sector, Action Contre la Faim, Paris, France
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK; CBM Global, Amstelveen, Netherlands
| | | | - Zeinab Hijazi
- Mental Health Unit, Programme Division, UNICEF, New York, NY, USA
| | - Rebecca R Horn
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK
| | - Mark J D Jordans
- Centre for Global Mental Health, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | | | - Catherine Panter-Brick
- Department of Anthropology and Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Peter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Inka Weissbecker
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alastair Ager
- Institute for Global Health & Development, Queen Margaret University, Edinburgh, UK; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| |
Collapse
|
19
|
Cherewick M, Dahl RE, Bertomen S, Hipp E, Shreedar P, Njau PF, Leiferman JA. Risk and protective factors for mental health and wellbeing among adolescent orphans. Health Psychol Behav Med 2023; 11:2219299. [PMID: 37274749 PMCID: PMC10234133 DOI: 10.1080/21642850.2023.2219299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Background Research has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing. Study objective The purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health. Methods The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures. Results Results of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (β = -0.53, p = 0.015) and mental wellbeing (β = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (β = -0.34, p = 0.108) and mental wellbeing (β = -0.24, p = 0.405) were not significant. Conclusion In a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.
Collapse
Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, USA
| | - Samantha Bertomen
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Emily Hipp
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Priyanka Shreedar
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | | | - Jenn A. Leiferman
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| |
Collapse
|
20
|
Blackwell AH, Agengo Y, Ozoukou D, Wendt JU, Nigane A, Goana P, Kanani B, Falb K. Drivers of 'voluntary' recruitment and challenges for families with adolescents engaged with armed groups: Qualitative insights from Central African Republic and Democratic Republic of the Congo. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001265. [PMID: 37224144 DOI: 10.1371/journal.pgph.0001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/10/2023] [Indexed: 05/26/2023]
Abstract
Globally, armed conflicts have increased threefold since 2010. The number of children voluntarily engaging with armed groups is also rising, despite increasing efforts to prevent this grave human rights violation. However, traditional approaches focusing on the prevention, release, and reintegration of children through forced recruitment do not adequately address the complex and interlinking push and pull factors of voluntary recruitment. This qualitative study sought to deepen understanding of the drivers and consequences of voluntary recruitment from the perspectives of adolescents and their caregivers, as well as to explore how to better support families living in conflict settings. In-depth interviews were conducted with 74 adolescents (44 boys and 30 girls) ages 14 to 20 years and 39 caregivers (18 men and 21 women) ages 32 to 66 years in two distinct conflict settings: North Kivu, Democratic Republic of Congo and Ouham-Pendé, Central African Republic. Interviews with adolescents utilized a visual narrative technique. The findings examine the unique perspectives of adolescents engaged with armed groups and their caregivers to understand how conflict experiences, economic insecurity, and social insecurity influence adolescent's engagement with armed groups and reintegration with their families. The study found that families living in conflict settings are subject to traumatic experiences and economic hardship that erode protective family relationships, leaving adolescent boys and girls particularly vulnerable to the systemic and overlapping factors that influence them to engage with and return to armed groups. The findings illustrate how these factors can disrupt protective social structures, and inversely how familial support can act as a potential protective factor against recruitment and break the cycle of reengagement. By better understanding the experiences of adolescents enduring recruitment and how to support caregivers of those adolescents, more comprehensive programming models can be developed to adequately prevent voluntary recruitment and promote successful reintegration, enabling children to reach their full potential.
Collapse
Affiliation(s)
- Alexandra H Blackwell
- Airbel Impact Lab, International Rescue Committee, Washington, DC, United States of America
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
| | - Yvonne Agengo
- Violence Prevention & Response Unit, International Rescue Committee, Geneva, Switzerland
| | - Daniel Ozoukou
- Airbel Impact Lab, International Rescue Committee, Washington, DC, United States of America
- Zolberg-IRC Fellow, The New School, New York City, New York, United States of America
| | - Julia Ulrike Wendt
- Violence Prevention & Response Unit, International Rescue Committee, Goma, North Kivu, Democratic Republic of Congo
| | - Alice Nigane
- Violence Prevention & Response Unit, International Rescue Committee, Bangui, Central African Republic
| | - Paradis Goana
- Violence Prevention & Response Unit, International Rescue Committee, Bangui, Central African Republic
| | - Bertin Kanani
- Violence Prevention & Response Unit, International Rescue Committee, Goma, North Kivu, Democratic Republic of Congo
| | - Kathryn Falb
- Airbel Impact Lab, International Rescue Committee, Washington, DC, United States of America
| |
Collapse
|
21
|
Wentz B, Miller-Graff LE, Merrilees CE, Cummings EM. A Developmental Psychopathology Perspective on Political Violence and Youth Adjustment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105864. [PMID: 37239590 DOI: 10.3390/ijerph20105864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
According to the United Nations (2021), [...].
Collapse
Affiliation(s)
- Bethany Wentz
- Department of Psychology, William J. Shaw Center for Children and Families, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Laura E Miller-Graff
- Department of Psychology, William J. Shaw Center for Children and Families, University of Notre Dame, Notre Dame, IN 46556, USA
- Kroc Institute for International Peace Studies, University of Notre Dame, Notre Dame, IN 46556-5677, USA
| | | | - E Mark Cummings
- Department of Psychology, William J. Shaw Center for Children and Families, University of Notre Dame, Notre Dame, IN 46556, USA
| |
Collapse
|
22
|
Wiedermann CJ, Barbieri V, Plagg B, Marino P, Piccoliori G, Engl A. Fortifying the Foundations: A Comprehensive Approach to Enhancing Mental Health Support in Educational Policies Amidst Crises. Healthcare (Basel) 2023; 11:healthcare11101423. [PMID: 37239709 DOI: 10.3390/healthcare11101423] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
In recent times, global crises such as the COVID-19 pandemic, climate change, and geopolitical conflicts have significantly impacted pupils' mental health. This opinion article presents evidence-based recommendations to bolster mental health support within educational systems, aiming to alleviate the psychological burden faced by students during these challenging times. This article argues that a proactive, holistic approach to mental health is essential for building a resilient educational infrastructure. More than ever, we support the call for the integration of mental health education into the core curriculum, equipping students with vital coping skills and fostering emotional intelligence. Additionally, we emphasize the importance of training educators and staff to identify and address mental health issues. Furthermore, this article highlights the need for interdisciplinary collaboration involving general practitioners, mental health professionals, community organizations, and policymakers in crafting and implementing support strategies. Educational institutions can effectively leverage the expertise of diverse stakeholders to create targeted interventions by cultivating partnerships. Finally, the significance of continuously evaluating and refining mental health support policies to ensure their efficacy and adaptability in the face of evolving crises is emphasized. Through these comprehensive recommendations, this opinion article seeks to catalyze a transformation in educational policies, prioritize mental health support, and empower pupils to thrive during tumultuous times.
Collapse
Affiliation(s)
- Christian J Wiedermann
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
- Department of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology, 6060 Hall, Tyrol, Austria
| | - Verena Barbieri
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
| | - Barbara Plagg
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
- Faculty of Education, Free University of Bolzano, 39100 Bolzano, Italy
| | - Pasqualina Marino
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
| | - Adolf Engl
- Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy
| |
Collapse
|
23
|
El-Khani A, Calam R, Maalouf W. The role of faith in parenting; considerations when implementing family skills interventions with families affected by armed conflict or displacement. Front Psychiatry 2023; 14:1118662. [PMID: 36911116 PMCID: PMC9995944 DOI: 10.3389/fpsyt.2023.1118662] [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: 12/07/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Religious beliefs and practices are fundamental to shaping family functioning in many countries and cultures around the world. They are often associated with a strong influence on parenting, and a potential resource for parents. While nurturing caregiving can act as a protective shield, buffering against the negative effects on children's well-being, armed conflict and displacement often compromises parental well-being and positive parenting practices. Making interventions available to families affected by conflict and displacement that help to develop the quality of parenting is now seen as an important component in the care of war-affected children, causing a rise in family skills interventions for humanitarian contexts. Accordingly, there are certain considerations that need to be taken to achieve cultural sensitivity and acceptability, that account for the influence of religion. Here we share our United Nations Office on Drugs and Crime (UNODC) experience in the case of implementing "Strong Families," a UNODC family skills programme implemented in over 30 countries, providing key recommendations. (1) Appreciate and account for common religious beliefs and practices in your target populations; (2) ensure programme material acceptability and sensitivity; (3) avoid initiation of direct discussions, on religious beliefs or practices; and (4) facilitator need to be trained and prepared to respond to questions about faith. Though these considerations are presented considering the implementation of family skills programmes, they are also relevant to a range of other programming in which direct social (or other) contact is made with families in challenged contexts, aiming to reduce any perceived gaps between trainers and the families they are working with, and give families a sense that their religious beliefs, values, and priorities are understood.
Collapse
Affiliation(s)
- Aala El-Khani
- United Nations Office on Drugs and Crime, Vienna, Austria
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Wadih Maalouf
- United Nations Office on Drugs and Crime, Vienna, Austria
| |
Collapse
|
24
|
Carter S, Sadiq S, Calear AL, Housen T, Joshy G, Fredj N, Lokuge K. The feasibility and acceptability of implementing and evaluating a caregiver group intervention to address child mental health: A pilot study in Iraq. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
|
25
|
Karnaze MM, Kious BM, Feuerman LZ, Classen S, Robinson JO, Bloss CS, McGuire AL. Public mental health during and after the SARS-CoV-2 pandemic: Opportunities for intervention via emotional self-efficacy and resilience. Front Psychol 2023; 14:1016337. [PMID: 36755671 PMCID: PMC9899813 DOI: 10.3389/fpsyg.2023.1016337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
Importance During the pandemic, the number of United States adults reporting clinically significant symptoms of anxiety and depression sky-rocketed, up from 11% in 2020 to more than 40% in 2021. Our current mental healthcare system cannot adequately accommodate the current crisis; it is therefore important to identify opportunities for public mental health interventions. Objective Assess whether modifiable emotional factors may offer a point of intervention for the mental health crisis. Design setting and participants From January 13 to 15, 2022, adults living in the United States were recruited via Amazon Mechanical Turk to complete an anonymous survey. Main outcomes and measures Linear regressions tested whether the primary outcomes during the SARS-CoV-2 pandemic (depressive and anxiety symptoms, burnout) were associated with hypothesized modifiable risk factors (loneliness and need for closure) and hypothesized modifiable protective factors (the ability to perceive emotions and connect with others emotionally; emotion-regulation efficacy; and resilience, or the ability to "bounce back" after negative events). Results The sample included 1,323 adults (mean [SD] age 41.42 [12.52] years; 636 women [48%]), almost half of whom reported clinically significant depressive (29%) and/or anxiety (15%) symptoms. Approximately 90% of participants indicated feeling burned out at least once a year and nearly half of participants (45%) felt burned out once a week or more. In separate analyses, depressive symptoms (Model A), anxiety symptoms (Model B), and burnout (Model C) were statistically significantly associated with loneliness (βModel A, 0.38; 95% CI, 0.33-0.43; βModel B, 0.30; 95% CI, 0.26-0.36; βModel C, 0.34; 95% CI, 0.28-0.41), need for closure (βModel A, 0.09; 95% CI, 1.03-1.06; βModel B, 0.13; 95% CI, 0.97-0.17; βModel C, 0.11; 95% CI, 0.07-0.16), recent stressful life events (βModel A, 0.14; 95% CI, 0.10-0.17; βModel B, 0.14; 95% CI, 0.11-0.18; βModel C, 0.10; 95% CI, 0.06-0.15), and resilience (βModel A, -0.10; 95% CI, -0.15 to -0.05; βModel B, -0.18; 95% CI, -0.23 to -0.13; βModel C, -0.11; 95% CI, -0.17 to -0.05). In addition, depressive and anxiety symptoms were associated with emotional self-efficacy (βModel A, -0.17; 95% CI, -0.22 to -0.12; βModel B, -0.11; 95% CI, -0.17 to -0.06), and beliefs about the malleability of emotions (βModel A, -0.08; 95% CI, -0.12 to -0.03; βModel B, -0.09; 95% CI, -0.13 to -0.04). Associations between loneliness and symptoms were weaker among those with more emotional self-efficacy, more endorsement of emotion malleability beliefs, and greater resilience, in separate models. Analyses controlled for recent stressful life events, optimism, and social desirability. Conclusion and relevance Public mental health interventions that teach resilience in response to negative events, emotional self-efficacy, and emotion-regulation efficacy may protect against the development of depressive symptoms, anxiety, and burnout, particularly in the context of a collective trauma. Emotional self-efficacy and regulation efficacy may mitigate the association between loneliness and mental health, but loneliness prevention research is also needed to address the current mental health crisis.
Collapse
Affiliation(s)
- Melissa M. Karnaze
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
| | - Brent M. Kious
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Lindsay Z. Feuerman
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Sarah Classen
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Jill O. Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Cinnamon S. Bloss
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
| | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States,*Correspondence: Amy L. McGuire,
| |
Collapse
|
26
|
Bravo-Sanzana M, Miranda R, Oriol X. Adolescent Victimization during COVID-19 Lockdowns and Its Influence on Mental Health Problems in Seven Countries: The Mediation Effect of Resilience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1958. [PMID: 36767323 PMCID: PMC9915164 DOI: 10.3390/ijerph20031958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The objective of this study was to test the differences between the mean scores of victimization, an indicator of depression, stress, and anxiety (DASS), across seven countries (Australia, Chile, India, Indonesia, Mexico, Poland, and the Russian Federation) during the COVID-19 lockdowns. In addition, this study sought to analyze the mediator role of resilience in these relationships in the different countries. To this end, a structural equation model (SEM) was tested and differences across countries were considered through a multigroup analysis. Data for adolescent students from seven countries (n = 7241) collected by the Global Research Alliance showed that levels of anxiety, depression, and stress among adolescents were different in the countries assessed; all of them presented values above the mean of the indicator, with Chile and Russia having the highest values. Regarding the prevalence of exposure to violence, the mean across all countries studied was 34%, with the highest prevalence in Russia and India. At the global level, an adequate adjustment was observed in the SEM mediation model considering all countries. However, a mediator effect of resilience was only observed in the relationship between victimization and the indicator of DASS in Chile, Indonesia, and Russia. The results are discussed, analyzing the relevance of resilience as a protective factor for mental health during COVID-19 lockdowns.
Collapse
Affiliation(s)
- Mónica Bravo-Sanzana
- Núcleo Científico-Tecnológico en Ciencias Sociales y Humanidades, Universidad de La Frontera, Temuco 4811230, Chile
| | - Rafael Miranda
- Department of Psychology, Universidad Continental, Huancayo 12000, Peru
| | - Xavier Oriol
- Department of Psychology, Universidad de Girona, 17004 Girona, Spain
| |
Collapse
|
27
|
Hocking DC, Sundram S. Age and environmental factors predict psychological symptoms in adolescent refugees during the initial post-resettlement phase. Child Adolesc Psychiatry Ment Health 2022; 16:105. [PMID: 36539785 PMCID: PMC9768994 DOI: 10.1186/s13034-022-00538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adolescent refugees are at high risk of developing mental disorders but are often not recognised early. This pilot study aimed to identify early putative risk factors associated with psychological symptoms in newly resettled refugee youth at potential risk of subsequently developing mental disorders. METHODS Newly resettled adolescent refugees were recruited through English language schools in Melbourne, Australia. Participants were assessed with the MINI-Kid, Achenbach Youth Self-Report and Reaction of Adolescents to Traumatic Stress scale. Parents completed a mental health screening separately. Linear regression models were used to identify predictive factors associated with symptom ratings. RESULTS Seventy-eight, ostensibly well, refugee adolescents (mean age = 15.0 ± 1.6 years) resettled in Australia for 6.1 ± 4.2 months were assessed. Levels of anxiety, depression and post-traumatic stress symptoms were considerably lower than in mainstream population data. Prior displacement was a key determinant of symptomatology. Transitory displacement, irrespective of duration, was associated with elevated scores for depression (t (47) = -4.05, p < 0.0001), avoidance/numbing (U = 466, p < .05) and total trauma (U = 506, p < .05) symptoms. Older age was a unique predictor of depression (F (1,74) = 8.98, p < .01), internalising (F(1,74) = 6.28, p < .05) and total (F(1,74) = 4.10, p < .05) symptoms, whilst parental depression symptoms (t = 2.01, p < 0.05), displacement (t = 3.35, p < 0.01) and, expectedly, trauma exposure (t = 3.94, p < 0.001) were unique predictors of post-traumatic stress symptoms. CONCLUSIONS Displaced status, older age, and parental symptoms predicted psychological symptoms in adolescent refugees in an initial relatively asymptomatic post-resettlement phase. The early recognition of at-risk refugee youth may provide an opportunity for preventative mental health interventions.
Collapse
Affiliation(s)
- Debbie C. Hocking
- Cabrini Outreach, 183 Wattletree Road, Malvern, VIC 3144 Australia ,grid.1002.30000 0004 1936 7857Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC 3800 Australia
| | - Suresh Sundram
- Cabrini Outreach, 183 Wattletree Road, Malvern, VIC 3144 Australia ,grid.1002.30000 0004 1936 7857Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC 3800 Australia ,grid.419789.a0000 0000 9295 3933Mental Health Program, Monash Health, 246 Clayton Road, Clayton, VIC 3168 Australia
| |
Collapse
|
28
|
Rizzi D, Ciuffo G, Sandoli G, Mangiagalli M, de Angelis P, Scavuzzo G, Nych M, Landoni M, Ionio C. Running Away from the War in Ukraine: The Impact on Mental Health of Internally Displaced Persons (IDPs) and Refugees in Transit in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16439. [PMID: 36554321 PMCID: PMC9778520 DOI: 10.3390/ijerph192416439] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
A growing body of research highlights how communities traumatized by conflict and displacement suffer from long-term mental and psychosocial illnesses. The Russian army's attack on Ukraine has resulted in an estimated 10 million people being internally or externally displaced from Ukraine, of whom more than 3.8 million have left Ukraine to seek refuge elsewhere in Europe. Soleterre has decided to launch an intervention to provide psychological support to Ukrainian refugees and IDPs, aimed at containing war trauma, assessing the severity of symptoms, and enabling those affected to receive psychological support. The intervention model envisioned the administration of an intake form to provide a rapid collection of qualitative and quantitative information for those arriving in Poland or Lviv from Ukraine. Our results showed how most of the samples reported high or very high levels of anxiety, depression, and sleep disturbances. Moreover, results highlighted how being close to families or being able to keep in touch with them work as a protective factor in enhancing resilience, as well as a support network. These findings underscored the importance of re-thinking our perception of "family" in a broader sense, considering the new facets it can take on in post-conflict situations.
Collapse
Affiliation(s)
- Damiano Rizzi
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
- Unità di Medicina d’Urgenza, Dipartimento di Medicina Interna, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Ciuffo
- CRIdee, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
| | - Giulia Sandoli
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
| | - Matteo Mangiagalli
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Unità di Terapia Intensiva, Università degli Studi di Pavia, 27100 Pavia, Italy
| | | | - Gioele Scavuzzo
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
| | | | - Marta Landoni
- CRIdee, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
| | - Chiara Ionio
- CRIdee, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
| |
Collapse
|
29
|
Maftei A, Dănilă O, Măirean C. The war next-door-A pilot study on Romanian adolescents' psychological reactions to potentially traumatic experiences generated by the Russian invasion of Ukraine. Front Psychol 2022; 13:1051152. [PMID: 36544444 PMCID: PMC9762354 DOI: 10.3389/fpsyg.2022.1051152] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Romania shares the longest UE border with Ukraine, and since the Russian invasion of Ukraine began, many have been involved in helping the refugees. Consequently, children and adolescents might be directly and indirectly exposed to war-related trauma. In the present exploratory research, we investigated Romanian adolescents' potential risk and protective factors related to the psychological outcomes of war exposure. Our cross-sectional study was conducted shortly after February 24th (i.e., the first invasion day). Methods The sample included 90 Romanian adolescents aged 11 to 15 (M = 12.90, SD = 1.17), residents in Iași, Romania (i.e., 205,7 km from the Ukrainian border). Participants completed self-reported measures of peritraumatic dissociative experiences, knowledge about the conflict in Ukraine, personal, school, and family implications in volunteering/helping behavior, discussions about the conflict, threat perception (self and perceived parental threat), anxiety, social media engagement, resilience, and moral elevation. Results The main findings suggested that participants involved in helping behaviors toward Ukrainian refugees present higher peritraumatic dissociative experiences, anxiety symptoms, and higher moral elevation than boys and participants not involved in these behaviors. Moreover, anxiety symptoms were positively associated with threat perception, peritraumatic dissociation, and social media engagement and negatively related to resilience. Discussions Finally, we discuss the implications of our findings concerning their practical utility in managing peritraumatic exposure to war by using interventions designed to increase adolescents' resilience during difficult times.
Collapse
|
30
|
Rojas Perez OF, Sanchez SE, Cruz V, Sánchez E, Levey E, Gelaye B. Comparative Performance of the Resilience Inventory (IRES) and Resilience Scale-14 (RS-14) Spanish Versions Among Postpartum Adolescent Mothers. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1069-1080. [PMID: 36439676 PMCID: PMC9684388 DOI: 10.1007/s40653-022-00458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 06/16/2023]
Abstract
We sought to evaluate the psychometric properties of two resilience scales; the Resilience Inventory (IRES) and the 14-item Resilience Scale (RS-14) among Peruvian postpartum adolescent mothers. This cross-sectional study included 785 adolescent mothers who delivered at a maternity hospital in Lima, Peru. The Spanish versions of IRES and RS-14 were used to evaluate the properties of the measures. We examined reliability using Cronbach's alpha. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity and factor structures of the two scales. Both scales had good internal consistency (Cronbach's alpha > 0.7). Correlation between IRES and RS-14 scores was fair (r = 0.53). The EFA results of both scales yielded a three-factor structure. EFA including all items from IRES and RS-14 yielded a six-factor structure. CFA results corroborated the original seven-factor structure for IRES and yielded measures indicating a good level of goodness of fit (comparative fit index of 0.93) and accuracy (root mean square error of approximation of 0.07). Overall, Spanish language versions of both the IRES and the RS-14 are reliable and valid scales for assessing resilience among Peruvian postpartum adolescent mothers. Additional research is needed to integrate culturally-specific traits into resilience measures.
Collapse
Affiliation(s)
| | - Sixto E. Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Asociación Civil PROESA, Lima, Peru
| | - Victor Cruz
- Peruvian National Institute of Mental Health, Honorio Delgado – Hideyo Noguchi, Lima, Peru
| | | | - Elizabeth Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Bizu Gelaye
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
| |
Collapse
|
31
|
Johnson SL, Kim ET, Rieder AD, Green EP, Finnegan A, Chase RM, Zayzay J, Puffer ES. Pathways from parent mental health to child outcomes in Liberia: Testing cross-sectional and longitudinal serial mediation models. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
32
|
Hanewald B, Knipper M, Daub J, Ebert S, Bogdanski C, Hinder L, Hall M, Berthold D, Stingl M. Addressing the Mental Health Challenges of Refugees-A Regional Network-Based Approach in Middle Hesse Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13436. [PMID: 36294018 PMCID: PMC9602567 DOI: 10.3390/ijerph192013436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Refugees constitute a vulnerable group with an increased risk of developing trauma-related disorders. From a clinician's integrative perspective, navigating the detrimental impact of the social, economic, structural, and political factors on the mental health of refugees is a daily experience. Therefore, a collective effort must be made to reduce health inequities. The authors developed a treatment concept which provides broader care structures within a scientific practitioner's approach. The resulting "Trauma Network" addresses the structural challenges for refugees in Middle Hesse. Accompanying research provided a sound basis for further discussions with policy-makers to improve the situation for refugees in the short- and long-term.
Collapse
Affiliation(s)
- Bernd Hanewald
- Center for Psychiatry and Psychotherapy, University of Giessen, 35392 Giessen, Germany
| | - Michael Knipper
- Institute for the History of Medicine, University of Giessen, 35392 Giessen, Germany
| | - Janneke Daub
- Refugee Law Clinic Giessen, Public and European Law at the University of Giessen Law School, 35394 Giessen, Germany
| | - Saskia Ebert
- Refugee Law Clinic Giessen, Public and European Law at the University of Giessen Law School, 35394 Giessen, Germany
| | | | - Laura Hinder
- Research Network on Migration and Human Rights, Public and European Law at the University of Giessen Law School, 35394 Giessen, Germany
| | - Mila Hall
- Center for Psychiatry and Psychotherapy, University of Giessen, 35392 Giessen, Germany
| | - Daniel Berthold
- Department for Medical Oncology and Palliative Care, University of Giessen, 35392 Giessen, Germany
| | - Markus Stingl
- Center for Psychiatry and Psychotherapy, University of Giessen, 35392 Giessen, Germany
| |
Collapse
|
33
|
Gartland D, Riggs E, Giallo R, Glover K, Stowe M, Mongta S, Weetra D, Brown SJ. Development of a multidimensional culturally and socially inclusive measure of factors that support resilience: Child Resilience Questionnaire-Child report (CRQ-C)-a community-based participatory research and psychometric testing study in Australia. BMJ Open 2022; 12:e060229. [PMID: 36113941 PMCID: PMC9486312 DOI: 10.1136/bmjopen-2021-060229] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/03/2022] Open
Abstract
OBJECTIVE Development and testing of a comprehensive and social and culturally inclusive child-report measure of resilience factors supporting positive outcomes in the face of adversity. DESIGN The measure is based on a socioecological model of resilience and was developed and revised using community-based participatory research methods with Aboriginal and refugee background communities. Pilot testing and validation of the child-report version (Child Resilience Questionnaire-Child report (CRQ- C)) is described in this paper. SETTING Australia. PARTICIPANTS Children aged 7-12 years from culturally and socially diverse backgrounds completed the CRQ- C in the pilot (n=387) and validation study (n=775). Families recruited via hospital clinics, Aboriginal and refugee background communities and nested follow-up of participants in an existing cohort study. ANALYSIS The factor structure and construct validity of CRQ-C scales were assessed using exploratory and confirmatory factor analyses. Preliminary assessment of criterion validity was conducted usinghe Strengths and Difficulties Questionnaire (SDQ). Internal consistency of final scales was assessed using Cronbach's alpha. RESULTS Conceptually developed CRQ-C was over inclusive of resilience factors and items. Exploratory factor analyses and confirmatory factor analyses supported 10 subscales reflecting personal resilience factors (positive self/future, managing emotions) and connectedness to family, school and culture. Excellent scale reliability (α=0.7-0.9) for all but one scale (Friends, α=0.6). Significant negative correlation between CRQ-C and SDQ total difficulty score supporting criterion validity (rs=-0.317, p<0.001). CONCLUSION The CRQ-C is a new culturally and socially inclusive self-report measure of resilience factors in childhood, with demonstrated content, construct and scale reliability. Further testing of criterion validity required. Availability of child and parent report CRQ supports broad applications in clinical, research and intervention work. Socially inclusive and culturally appropriate tools are fundamental to create the evidence needed to assess and guide intervention efforts.
Collapse
Affiliation(s)
- Deirdre Gartland
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
- Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
| | - Karen Glover
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Mardi Stowe
- Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia
| | - Sharon Mongta
- Wadja Aboriginal Family Place, The Royal Children's Hospital Melbourne, Parkville, Melbourne, Australia
| | - Donna Weetra
- Women and Kids Theme, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Stephanie Janne Brown
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia
- Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| |
Collapse
|
34
|
Bat Or M, Ishai R, Barkay N, Shalev O. Visual Expressions of Children's Strengths, Difficulties and Wishes in Person Picking an Apple from a Tree Drawings among Preschoolers Living in Areas of Persistent Political Violence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1387. [PMID: 36138696 PMCID: PMC9498054 DOI: 10.3390/children9091387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
The present study sought to inquire into the subjective experience of 156 preschoolers (age 4-6.9 years) living in an area of political violence in Israel (on the border with the Gaza Strip) during a period of massive bombing. Children were invited to draw a Person Picking an Apple from a Tree (PPAT), and were interviewed on their sense of self-potency using the CAMP, a measure of potency. Teachers were asked to report problems in executive functions using a few BRIEF scales; and mothers filled out a questionnaire for maternal distress (BSI), a measure of their child strengths and difficulties (SDQ), and were asked to provide their assessment regarding the extent to which their child was exposed to political violence. Findings reveal associations between mothers' distress, the degree of exposure of their child to trauma, and the child's emotional symptoms. PPAT analysis identified four main factors: Tree Generosity, Person Agency, Vividness, and As-Real-R. Positive associations were found between self-potency and the main factors of the drawings; negative associations were found between the child's difficulties in executive functions and the drawing's four main factors; and two small negative associations were found between the child's emotional symptoms and Tree Generosity and As-Real-R factors. The following associations were found within each gender group: mothers' depression degree was associated with boy's Tree Generosity, and mother's perceptions of their girl's exposure to trauma was related to Person Agency, Tree Generosity, and As-Real-R factors; furthermore, a significant difference was found between the narrative focus of drawings in this sample and the narrative focus of drawings of a sample of the same age group from a non-war zone. In addition, narrative focus was found to be related to children's self-potency. The discussion deals with the study's findings through the prism of developmental psychology, self-agency, object-relations, and art-therapy theories.
Collapse
Affiliation(s)
- Michal Bat Or
- School of Creative Arts Therapies, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Rafi Ishai
- Department of Psychology, The Program of Psychoanalytic Psychotherapy, Haifa 3498838, Israel
| | - Nirit Barkay
- Junior-High and High School Meshutaf Hof Hacarmel Yahad, Maagan Michael 3780500, Israel
| | - Or Shalev
- School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel
| |
Collapse
|
35
|
Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [DOI: https:/doi.org/10.1007/s10597-021-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 06/22/2023]
|
36
|
Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [PMID: 35013831 DOI: 10.1007/s10597-021-00928-0] [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: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.
Collapse
Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA, 23284, USA.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St., Madison, WI, 53726, USA
| |
Collapse
|
37
|
Cao H, Zhang R, Li L, Yang L. Coping Style and Resilience Mediate the Effect of Childhood Maltreatment on Mental Health Symptomology. CHILDREN 2022; 9:children9081118. [PMID: 36010009 PMCID: PMC9406941 DOI: 10.3390/children9081118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
Background: A well-known distal risk factor for mental health symptomology is childhood maltreatment. Previous research revealed that several mediators, such as coping style and resilience, might be connected to the psychological mechanism of childhood maltreatment on mental health symptomology. Objective: The purpose of this study was to assess how coping style and resilience affect the relationship between childhood maltreatment and mental health symptomology of college students. Methods: With the method of cross-sectional survey, 740 college students from China (Gansu Province) completed the Childhood Trauma Questionnaire (CTQ), the Simplified Coping Style Questionnaire (SCSQ), the Connor–Davidson Resilience Scale (CD-RISC), and the Symptom Checklist 90 (SCL-90). Structural equation modeling (SEM) was used to reveal the link between childhood maltreatment, coping style, resilience, and mental health symptomology. Results: The results showe that childhood maltreatment was significantly positively correlated with mental health symptomology and significantly negatively correlated with coping style and resilience. Coping style was significantly negatively correlated with mental health symptomology and significantly positively correlated with resilience. Resilience was significantly negatively correlated with mental health symptomology. Coping style and resilience played a partially mediating role in the relationship between childhood maltreatment and college students’ mental health symptomology. Through a chain of intermediary effects on coping style and resilience, childhood maltreatment not only had a direct impact on mental health symptomology but also had an indirect impact. Conclusion: Childhood maltreatment could affect college students’ mental health symptomology through the chain mediating effect of coping style and resilience. Therefore, it is an effective way to reduce the influence of childhood maltreatment on mental health symptomology through some intervention measures to cultivate positive coping style and improve resilience.
Collapse
|
38
|
Gartland D, Riggs E, Giallo R, Glover K, Stowe M, Mongta S, Weetra D, Brown SJ. Development and validation of a multidimensional, culturally and socially inclusive Child Resilience Questionnaire (parent/caregiver report) to measure factors that support resilience: a community-based participatory research and psychometric testing study in Australia. BMJ Open 2022; 12:e061129. [PMID: 35725263 PMCID: PMC9214413 DOI: 10.1136/bmjopen-2022-061129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Develop a comprehensive socially inclusive measure to assess child resilience factors. DESIGN A socioecological model of resilience, community-based participatory research methods and two rounds of psychometric testing created the Child Resilience Questionnaire (parent/caregiver report, child report, school report). The parent/caregiver report (CRQ-P/C) is the focus of this paper. SETTING Australia. PARTICIPANTS Culturally and socially diverse parents/caregivers of children aged 5-12 years completed the CRQ-P/C in the pilot (n=489) and validation study (n=1114). Recruitment via a large tertiary hospital's outpatient clinics, Aboriginal and refugee background communities (Aboriginal and bicultural researchers networks) and nested follow-up of mothers in a pregnancy cohort and a cohort of Aboriginal families. ANALYSIS Exploratory and confirmatory factor analyses conducted to assess the structure and construct validity of CRQ-P/C subscales. Cronbach's alpha used to assess internal consistency of subscales. Criterion validity assessed with the Strengths and Difficulties Questionnaire (SDQ) parent report. RESULTS Conceptually developed CRQ comprised 169 items in 19 subscales across five socioecological domains (self, family, friends, school and community). Two rounds of psychometric revision and community consultations created a CRQ-P/C with 43 items in 11 scales: self (positive self, positive future, managing emotions), family (connectedness, guidance, basic needs), school (teacher support, engagement, friends) and culture (connectedness, language). Excellent scale reliability (α=0.7-0.9), except basic needs scale (α=0.61) (where a highly endorsed item was retained for conceptual integrity). Criterion validity was supported: scales had low to moderate negative correlations with SDQ total difficulty score (Rs= -0.2/-0.5. p<0.001); children with emotion/behavioural difficulties had lower CRQ-P/C scores (β=-14.5, 95% CI -17.5 to -11.6, adjusted for gender). CONCLUSION The CRQ-P/C is a new multidomain measure of factors supporting resilience in children. It has good psychometric properties and will have broad applications in clinical, educational and research settings. The tool also adds to the few culturally competent measures relevant to Aboriginal and refugee background communities.
Collapse
Affiliation(s)
- Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Pediatrics Department, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Karen Glover
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Women and Families, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Mardi Stowe
- Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia
| | - Sharon Mongta
- Family Violence, Djirra, Melbourne, Victoria, Australia
| | - Donna Weetra
- Women and Families, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie Janne Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Women and Families, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| |
Collapse
|
39
|
Agentic and Receptive Hope: Understanding Hope in the Context of Religiousness and Spirituality through the Narratives of Salvadoran Youth. RELIGIONS 2022. [DOI: 10.3390/rel13040376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hope contributes to positive development in adolescents, and religious and spiritual contexts may be particularly important for developing and supporting hope. However, extant literature on hope, religion, and spirituality neglects their synergistic relation, leaving questions about how they work together to support development. In this study, we explore how religiousness and spirituality (R/S) inform hope by identifying unique synergies that might be particularly useful in difficult contexts. Multilevel qualitative content analyses of interviews conducted with 18 thriving Salvadoran adolescents (50% female, Mage = 16.39 years, SD = 1.83) involved in a faith-based program provided evidence that the ideological and relational resources associated with R/S informed these adolescents’ agentic and receptive hopes. Agentic hopes, identified through expressed hopeful future expectations, revealed that adolescents held beyond-the-self hopes focused on benefiting three distinct targets: God, community, and family. Youth also described “sanctified hopes”, which were hopes focused on fulfilling God’s purposes directly and indirectly. Analyses of receptive hopes, which consider how hope is shaped and empowered by context, revealed that for these youth, hope was experienced in seven key contexts: self, caring adult relationships, family, God, youth development sponsor, social activities, and peers. Implications for fostering hope in R/S contexts within low-to-middle-income countries are discussed.
Collapse
|
40
|
Miller-Graff LE. The Multidimensional Taxonomy of Individual Resilience. TRAUMA, VIOLENCE & ABUSE 2022; 23:660-675. [PMID: 33143570 PMCID: PMC8905118 DOI: 10.1177/1524838020967329] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Theoretical work in resilience has continuously evolved to inform and respond to advances in empirical work. In order to further scientific inquiry, it must continue to do so. This narrative overview of the field of resilience science focuses on contemporary challenges confronted by theoretical models of individual resilience and proposes a taxonomic structure for resilience-the multidimensional taxonomy of individual resilience (MTIR). The goal of the MTIR is to articulate a systematic framework within which extant theoretical and empirical work can be nested. Consistent with existing work, the MTIR organizes resilience into two primary branches-manifested resilience and generative resilience. These two components are then organized into subdomains that demonstrate evidence of conceptual distinctiveness. The specification of the subdomains in the MTIR draws support from a diverse body of work on resilience across disciplines and in multiple global contexts. The MTIR makes several critical advances, including expanding and refining the definitions and components of resilience in psychology, providing a clearer framework for conceptualizing mixed profiles of resilience, and tempering assumptions regarding the relational dependencies across domains of resilience. Finally, the utility of the MTIR in organizing research in resilience and advancing theory-testing and development is discussed.
Collapse
Affiliation(s)
- Laura E. Miller-Graff
- Department of Psychology, Kroc Institute for International Peace Studies, Notre Dame, IN, USA
| |
Collapse
|
41
|
Christodoulou J, Rotheram-Borus MJ, Hayati Rezvan P, Comulada WS, Stewart J, Almirol E, Tomlinson M. Where you live matters: Township neighborhood factors important to resilience among south African children from birth to 5 years of age. Prev Med 2022; 157:106966. [PMID: 35065975 DOI: 10.1016/j.ypmed.2022.106966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/20/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This is a secondary analysis examining neighborhood factors predicting high rates of child resilience in South African Township neighborhoods. METHODS A population cohort of South African pregnant women (98%; n = 1238), were recruited and assessed across five years with high follow-up rates (83-96%). Resilient children were identified based on consistently meeting global standards for growth, cognitive functioning, and behavior. Community infrastructure, maternal risks, and caretaking behaviors were examined based on neighborhood as predictors of childhood resilience. RESULTS The rate of resilient children varied significantly by neighborhood (9.5% to 27%). Mothers living in high prevalence neighborhoods (HPN) compared to low prevalence neighborhoods (LPN) were older and more likely be living with three or more people in formal housing with access to water and electricity. In the HPN, resilient children had more food security and were less likely to have mothers with depressed mood. Migration to rural areas occurred more frequently among resilient compared to non-resilient children in the HPN. CONCLUSION This study applies a novel measure of resilience that is multidimensional and longitudinally defined. Living in formal housing with consistent access to food was associated with resilience. Migration to rural areas among families living in HPN suggests that rural areas could be protective. TRIAL REGISTRATION ClinicalTrials.gov registration #NCT00996528.
Collapse
Affiliation(s)
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Panteha Hayati Rezvan
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - W Scott Comulada
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Jackie Stewart
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ellen Almirol
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Mark Tomlinson
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
42
|
Walsh Family Resilience Questionnaire-Polish Adaptation (WFRQ-PL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074197. [PMID: 35409879 PMCID: PMC8998248 DOI: 10.3390/ijerph19074197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 12/02/2022]
Abstract
Family resilience is a construct based on interactive processes occurring in the family, enabling the family to effectively overcome everyday stressors, as well as developmental and unpredictable crises. By observing how the family deals with difficulties using family resilience processes, we are able to support both parents and protect children against the harmful effects of unfavourable conditions. The aim of our research was to carry out the procedure of adaptation to the Polish language and culture of the Walsh Family Resilience Questionnaire. In this study, 930 Poles participated (72.5% women), aged from 18 to 63 (M = 26.94, SD = 9.8). They filled in the questionnaire online. Confirmatory factor analysis confirmed the model with three factors: belief system, organisational processes, and communication processes. The model indicators were found to be well suited to the data: χ2/df = 1.12, RMSEA = 0.01, CFI = 0.99, TLI = 0.99, SRMR = 0.04. The reliability (Cronbach’s alpha) of the scales was also satisfactory (0.94 for the belief systems, 0.86 for the organisational processes, and 0.94 for the communication processes). Tool validation with FRAS-PL scales showed convergence. We named the Polish version of the WFRQ Questionnaire Kwestionariusz Prężności Rodzinnej Walsh (WFRQ-PL) and found it to be a good tool for assessing the processes of family resilience in our country.
Collapse
|
43
|
Bryant RA, Bawaneh A, Awwad M, Al-Hayek H, Giardinelli L, Whitney C, Jordans MJD, Cuijpers P, Sijbrandij M, Ventevogel P, Dawson K, Akhtar A. Effectiveness of a brief group behavioral intervention for common mental disorders in Syrian refugees in Jordan: A randomized controlled trial. PLoS Med 2022; 19:e1003949. [PMID: 35298469 PMCID: PMC8929659 DOI: 10.1371/journal.pmed.1003949] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 02/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Common mental disorders are frequently experienced by refugees. This study evaluates the impact of a brief, lay provider delivered group-based psychological intervention [Group Problem Management Plus (gPM+)] on the mental health of refugees in a camp, as well as on parenting behavior and children's mental health. METHODS AND FINDINGS In this single-blind, parallel, randomized controlled trial, 410 adult Syrian refugees (300 females, 110 males) in Azraq Refugee Camp (Jordan) were identified through screening of psychological distress (≥16 on the Kessler Psychological Distress Scale) and impaired functioning (≥17 on the WHO Disability Assessment Schedule). Participants were randomly allocated to gPM+ or enhanced usual care (EUC) involving referral information for psychosocial services on a 1:1 ratio. Participants were aware of treatment allocation, but assessors were blinded to treatment condition. Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL; depression and anxiety scales) assessed at baseline, 6 weeks, and 3 months follow-up as the primary outcome time point. It was hypothesized that gPM+ would result in greater reductions of scores on the HSCL than EUC. Secondary outcomes were disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behavior, and children's mental health. Between October 15, 2019 and March 2, 2020, 624 refugees were screened for eligibility, 462 (74.0%) screened positive, of whom 204 were assigned to gPM+ and 206 to EUC. There were 168 (82.4%) participants in gPM+ and 189 (91.7%) in EUC assessed at follow-up. Intent-to-treat analyses indicated that at follow-up, participants in gPM+ showed greater reduction on HSCL depression scale than those receiving EUC (mean difference, 3.69 [95% CI 1.90 to 5.48], p = .001; effect size, 0.40). There was no difference between conditions in anxiety (mean difference -0.56, 95% CI -2.09 to 0.96; p = .47; effect size, -0.03). Relative to EUC, participants in gPM+ had greater reductions in severity of personally identified problems (mean difference 0.88, 95% CI 0.07 to 1.69; p = .03), and inconsistent disciplinary parenting (mean difference 1.54, 95% CI 1.03 to 2.05; p < .001). There were no significant differences between conditions for changes in PTSD, disability, grief, prodromal symptoms, or childhood mental health outcomes. Mediation analysis indicated the change in inconsistent disciplinary parenting was associated with reduced attentional (β = 0.11, SE .07; 95% CI .003 to .274) and internalizing (β = 0.08, SE .05; 95% CI .003 to 0.19) problems in children. No adverse events were attributable to the interventions or the trial. Major limitations included only one-quarter of participants being male, and measures of personally identified problems, grief, prodromal psychotic symptoms, inconsistent parenting behavior, and children's mental health have not been validated with Syrians. CONCLUSIONS In camp-based Syrian refugees, a brief group behavioral intervention led to reduced depressive symptoms, personally identified problems, and disciplinary parenting compared to usual care, and this may have indirect benefits for refugees' children. The limited capacity of the intervention to reduce PTSD, disability, or children's psychological problems points to the need for development of more effective treatments for refugees in camp settings. TRIAL REGISTRATION Prospectively registered at Australian and New Zealand Clinical Trials Registry: ACTRN12619001386123.
Collapse
Affiliation(s)
- Richard A. Bryant
- University of New South Wales, Sydney, Australia
- Westmead Institute of Medical Research, Sydney, Australia
| | - Ahmad Bawaneh
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Manar Awwad
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Hadeel Al-Hayek
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | | | - Claire Whitney
- International Medical Corps, Washington DC, United States of America
| | - Mark J. D. Jordans
- War Child, Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Peter Ventevogel
- United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Katie Dawson
- University of New South Wales, Sydney, Australia
| | - Aemal Akhtar
- University of New South Wales, Sydney, Australia
- Vrije Universiteit, Amsterdam, the Netherlands
| | | |
Collapse
|
44
|
Kankaanpää R, Aalto S, Vänskä M, Lepistö R, Punamäki RL, Soye E, Watters C, Andersen A, Hilden PK, Derluyn I, Verelst A, Peltonen K. Effectiveness of psychosocial school interventions in Finnish schools for refugee and immigrant children, "Refugees Well School" in Finland (RWS-FI): a protocol for a cluster randomized controlled trial. Trials 2022; 23:79. [PMID: 35086535 PMCID: PMC8793091 DOI: 10.1186/s13063-021-05715-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools are natural environments in which to enhance young people's social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to. METHODS A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ). DISCUSSION The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group. TRIAL REGISTRATION ISRCTN ISRCTN64245549 . Retrospectively registered on 10 June 2020.
Collapse
Affiliation(s)
- Reeta Kankaanpää
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Sanni Aalto
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Mervi Vänskä
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Riina Lepistö
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | | | - Emma Soye
- School of Education and Social Work, University of Sussex, FIN-33014 Tampere, Finland
| | - Charles Watters
- School of Education and Social Work, University of Sussex, FIN-33014 Tampere, Finland
| | - Arnfinn Andersen
- Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Per Kristian Hilden
- Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Ilse Derluyn
- Department of Social Pedagogy, Ghent University, Ghent, Belgium
| | - An Verelst
- Department of Social Pedagogy, Ghent University, Ghent, Belgium
| | - Kirsi Peltonen
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| |
Collapse
|
45
|
Christodoulou J, Jane Rotheram-Borus M, Hayati Rezvan P, Weiss RE, Tomlinson M. Association of Early Migration with Child Growth, Cognition and Behavior in South Africa. Trop Med Int Health 2022; 27:218-225. [PMID: 34997984 DOI: 10.1111/tmi.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Examine the association of migration with child growth, cognition, and behavior in South Africa. METHODS Secondary analysis assessing effects of migration on child outcomes among a population cohort of women and children (n=1,238) recruited in Cape Town, South African townships and repeatedly assessed from birth to age eight. Logistic regression models analyzed sociodemographic predictors of migration and longitudinal models assessed the association of child migration, with or without their mother, on child growth, cognition, and behavioral outcomes. RESULTS By 8 years post-birth, 41% of children born in the townships in Cape Town had migrated to the rural Eastern Cape. Staying in Cape Town, or not migrating, was associated with having an older mother. Children who migrated with their mother were shorter and weighed less than those who did not migrate. Children who migrated had larger vocabularies and those who migrated with their mothers had fewer behavioral problems than children who stayed in Cape Town. CONCLUSION Migration in South Africa between peri-urban Cape Town and rural Eastern Cape areas during a child's early years is common and is associated with both positive and negative child outcomes.
Collapse
Affiliation(s)
- Joan Christodoulou
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, USA
| | - Panteha Hayati Rezvan
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| |
Collapse
|
46
|
Schwartz L, Nakonechna M, Campbell G, Brunner D, Stadler C, Schmid M, Fegert JM, Bürgin D. Addressing the mental health needs and burdens of children fleeing war: a field update from ongoing mental health and psychosocial support efforts at the Ukrainian border. Eur J Psychotraumatol 2022; 13:2101759. [PMID: 36212118 PMCID: PMC9543048 DOI: 10.1080/20008198.2022.2101759] [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: 12/02/2022] Open
Abstract
UNLABELLED Background: The ongoing horrors of the war in Ukraine have led to enormous consequences: loss of life, severe injuries, and mass movements of civilians. Exposure to war, living in conflict zones, and forced displacement increase the risk of experiencing a broad spectrum of direct and indirect burdens towards physical and mental health, in particular among children. Objective: This letter to the editor aims to provide multiple clinical and 'mental health and psychosocial support' (MHPSS) systems' perspectives by experts working in ongoing aid efforts to bridge and disseminate their current observations towards child and adolescent mental health services involved in the mental health response to the current war in Ukraine. Results and Discussion: The diverse perspectives from three mental health professionals involved in the MHPSS response highlight the different burdens and needs of children being confronted with situations of an existential nature. Children live through transformed social situations, deteriorated life conditions, general uncertainty, and encounter numerous losses. As such, war is the ultimate non-normative and existential stressor. The four perspectives highlight the need to: (1) adjust help toward the needs of the beneficiary, (2) understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters, (3) recognise losses and embrace finding ways to facilitate grief, and (4) continue to address these needs in a coordinated way that follows inter-agency guidelines. Conclusion: Better understanding the needs of refugee children underlines the importance of investing in their future by providing resources for humanitarian aid and psychosocial interventions during sustained emergencies. The perspectives presented in this letter emphasise that psychosocial care is deeply rooted in intersubjective help-encounters and, therefore, a professionalisation of interventions should co-occur with their humanisation and be adapted to subjective needs, varying sociocultural backgrounds, and the individuals themselves with the goal of reducing suffering and fostering well-being. HIGHLIGHTS The three expert humanitarian aid perspectives highlight the need to: adjust help toward the needs of the beneficiary,understand help efforts as intersubjective human encounters and enable parents and caregivers in these encounters,recognise losses and embrace finding ways to facilitate grief, andcontinue to address these needs in a coordinated way that follows inter-agency guidelines.
Collapse
Affiliation(s)
- Lyla Schwartz
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Peace of Mind Afghanistan Global (PoMA Global), Longmeadow, MA, USA
| | - Mariia Nakonechna
- Department of General and Applied Psychology, Nizhyn Gogol State University, Nizhyn, Ukraine.,Unitatem Foundation ("Poland Welcomes"), Jarosław, Poland
| | | | - Donja Brunner
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Christina Stadler
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - David Bürgin
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| |
Collapse
|
47
|
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] [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.
Collapse
Affiliation(s)
- David Bürgin
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany ,grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | | | | | - Benedetto Vitiello
- grid.7605.40000 0001 2336 6580Division of Child Neurology and Psychiatry, Department of Public Health and Pediatric Sciences, Regina Margherita Pediatric Hospital, University of Turin, Turin, Italy
| | - Thorsten Sukale
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany
| | - Marc Schmid
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M. Fegert
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany
| |
Collapse
|
48
|
Raz S, Lahad M. Physiological indicators of emotional arousal related to ANS activity in response to associative cards for psychotherapeutic PTSD treatment. Front Psychiatry 2022; 13:933692. [PMID: 36419970 PMCID: PMC9676269 DOI: 10.3389/fpsyt.2022.933692] [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: 05/01/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
SEE FAR CBT is an integrative treatment protocol for PTSD and anxiety disorders which combines CBT, body-mind (somatic experience) and imagery-based (fantastic reality; FR) methods. FR is introduced using associative therapeutic cards (COPE cards) to represent both "a pleasant/safe place" and the re-narrating process of the traumatic story. Although some preliminary evidence exists regarding the impact of COPE cards integration in psychotherapy, further validation is needed as to whether these cards can induce distinct arousal-affective states in the observer. The aim of this study was to examine whether exposure to COPE cards evoke different emotional-psychophysiological states using objective physiological measures reflecting autonomic nervous system responses; hence, to further validate its use as a potentially effective tool within the context of SEE FAR CBT therapeutic process. Ninety-five healthy under-graduate participants were first exposed to high-arousal, negatively-valenced cards and asked to put themselves in a state of emotional/physical arousal. Afterwards, they were exposed to low-arousal, positively-valenced cards and were asked to try to calm and relax to the best of their ability. Heart rate, blood pressure and heart rate variability (HRV) were measured at baseline, at the arousal phase and finally at the relaxation phase. It was found that exposure to arousing negative cards resulted in significant increase in blood pressure and a decrease in HRV, while exposure to relaxing positive cards resulted in significant decrease in blood pressure and an increase in HRV. These findings support the efficacy and utility of associative COPE cards in affecting psychophysiological arousal.
Collapse
Affiliation(s)
- Sivan Raz
- Department of Psychology, Tel-Hai College, Upper Galilee, Israel.,Department of Behavioral Sciences, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Mooli Lahad
- Department of Psychology, Tel-Hai College, Upper Galilee, Israel
| |
Collapse
|
49
|
Bogdanov S, Girnyk A, Chernobrovkina V, Chernobrovkin V, Vinogradov O, Garbar K, Kovalevskaya Y, Basenko O, Ivanyuk I, Hook K, Wessells M. Developing a Culturally Relevant Measure of Resilience for War-Affected Adolescents in Eastern Ukraine. JOURNAL ON EDUCATION IN EMERGENCIES 2021; 7:311-334. [PMID: 35813349 PMCID: PMC9269487 DOI: 10.33682/wxrd-x8fq] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Psychosocial support in education that is provided during emergencies frequently aims to support children's resilience, but strong, contextual measures of resilience are in short supply in Eastern Europe. In this article, our aim is to describe the development and psychometric properties of the first measure of resilience for war-affected adolescents in Eastern Ukraine. We used qualitative methods to identify the main cultural characteristics of resiliency and then used these constructs to develop the measure. We used exploratory structural equation modeling to extract five factors that showed high internal consistency: family support (ω=0.89), optimism (ω=0.87), persistence (ω=0.87), health (ω=0.86), and social networking (ω=0.87). Confirmatory factor analysis suggested that a concise model of resiliency fit the data almost as well as the exploratory structural equation modeling model. The measure demonstrated good test-retest reliability. In this article, we also discuss the importance of development, validation, and the use of culturally relevant measures of resilience for strengthening psychosocial support programs in schools, particularly in Ukraine.
Collapse
Affiliation(s)
- Sergiy Bogdanov
- National University of Kyiv-Mohyla Academy, Center for Mental Health and Psychosocial Support
| | - Andriy Girnyk
- National University of Kyiv-Mohyla Academy, Department of Psychology and Pedagogy
| | - Vira Chernobrovkina
- National University of Kyiv-Mohyla Academy, Department of Psychology and Pedagogy
| | | | | | - Kateryna Garbar
- National University of Kyiv-Mohyla Academy, Center for Mental Health and Psychosocial Support
| | - Yuliya Kovalevskaya
- National University of Kyiv-Mohyla Academy, Center for Mental Health and Psychosocial Support
| | - Oksana Basenko
- National University of Kyiv-Mohyla Academy, Center for Mental Health and Psychosocial Support
| | - Irina Ivanyuk
- National University of Kyiv-Mohyla Academy, Center for Mental Health and Psychosocial Support
| | - Kimberly Hook
- Boston University School of Medicine, Department of Psychiatry
- Boston Medical Center, Department of Psychiatry
- Massachusetts General Hospital, Department of Psychiatry
| | - Mike Wessells
- Columbia University, Program on Forced Migration and Health
| |
Collapse
|
50
|
Campodonico C, Berry K, Haddock G, Varese F. Protective Factors Associated With Post-traumatic Outcomes in Individuals With Experiences of Psychosis. Front Psychiatry 2021; 12:735870. [PMID: 34912247 PMCID: PMC8666594 DOI: 10.3389/fpsyt.2021.735870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/04/2021] [Indexed: 01/28/2023] Open
Abstract
Trauma and trauma-specific mental health difficulties (e.g., post-traumatic stress disorder) are highly prevalent in people with psychosis. However, not everyone develops post-traumatic symptoms, and some people even experience post-traumatic growth (PTG) following trauma. It is important to identify which protective factors are associated with less severe trauma symptoms and/or positive outcomes to inform the development and implementation of interventions fostering these variables. Eighty-five patients with experiences of psychosis took part in a cross-sectional study. They were administered questionnaires measuring exposure to traumatic events, symptoms of PTSD and complex PTSD and potential protective factors assumed to be associated with lower vulnerability for post-traumatic symptoms and higher post-traumatic growth (trait resilience, secure attachment, social support, adaptive coping, optimism, general self-efficacy). Multiple hierarchical regression showed that some of these protective factors, in particular optimism, were associated with lower post-traumatic symptoms, explaining 21% of the variance in complex PTSD symptoms and 16% of the variance in PTSD symptoms. However, the hypothesized protective factors, in particular resilience and adaptive coping, explained a considerably larger proportion of variance in PTG (44%). Our results suggest that whilst these variables provide only moderate protection from the vulnerability to experience post-traumatic stress, they may play an important role in allowing people to find meaning despite multiple traumas and subsequently lead more fulfilling lives. Therapies targeting the emotional and psychological consequences of trauma in people with psychosis might benefit from the integration of intervention strategies to enhance these additional psychological protective factors, which in turn may lead to positive treatment outcomes beyond the mere reduction of post-traumatic stress symptoms.
Collapse
Affiliation(s)
- Carolina Campodonico
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire, United Kingdom
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Katherine Berry
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Filippo Varese
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|