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Schneider J, Rukundo-Zeller AC, Bambonyé M, Lust S, Mugisha H, Muhoza JA, Ndayikengurukiye T, Nitanga L, Rushoza AA, Crombach A. The impact of parental acceptance and childhood maltreatment on mental health and physical pain in Burundian survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2024; 154:106906. [PMID: 38917765 DOI: 10.1016/j.chiabu.2024.106906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/13/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Parental support has been suggested to mitigate mental and physical consequences following childhood sexual abuse (CSA). However, many CSA survivors experience parental rejection post-CSA. OBJECTIVE We aimed to understand the impact of abuse-specific parental acceptance on post-traumatic stress disorder (PTSD) and physical pain in Burundian CSA-survivors. We further assessed the significance of parental acceptance among known risk factors for predicting PTSD. METHODS, PARTICIPANTS, AND SETTINGS Participants (N = 131, 80.9 % female, mean age 16.21 years) were recruited via primary health care centers for survivors of sexual violence which survivors approached post-CSA. Survivors reported on PTSD symptoms, daytime/nighttime pain, and adverse childhood experiences in semi-structured interviews. Parental acceptance levels were categorized (acceptance, no acceptance, no contact) for mothers and fathers separately. Kruskal-Wallis tests assessed group differences. Conditional random forests (CRF) evaluated the significance of parental acceptance in predicting PTSD symptom severity. RESULTS No significant differences regarding PTSD symptoms and physical pain between levels of maternal acceptance were obtained. Pairwise comparisons revealed significant differences in PTSD symptom severity between paternal acceptance and no acceptance (d = 1.04) and paternal acceptance and no contact (d = 0.81). The CRF identified paternal acceptance as important variable for the prediction of PTSD symptom severity. Even though results were less conclusive, medium effect sizes hint at less pain perception within the paternal acceptance group. CONCLUSIONS The results highlight paternal acceptance as a potential risk or protective factor regarding psychological and possibly physical well-being in the aftermath of CSA, even in the context of other known risk factors.
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Affiliation(s)
- Julia Schneider
- Saarland University, Psychology, Clinical Psychology and Psychotherapy for Children and Adolescents, Saarbrücken, Germany.
| | - Anja C Rukundo-Zeller
- University of Konstanz, Psychology, Clinical Psychology and Clinical Neuropsychology, Konstanz, Germany; Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi; Non-Governmental Organization vivo international e.V., Konstanz, Germany
| | - Manassé Bambonyé
- Université Lumière de Bujumbura, Clinical Psychology, Bujumbura, Burundi; Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Sarah Lust
- University of Konstanz, Psychology, Clinical Psychology and Clinical Neuropsychology, Konstanz, Germany
| | - Hervé Mugisha
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Jean-Arnaud Muhoza
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | | | - Lydia Nitanga
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Amini Ahmed Rushoza
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Anselm Crombach
- Saarland University, Psychology, Clinical Psychology and Psychotherapy for Children and Adolescents, Saarbrücken, Germany; Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi; Non-Governmental Organization vivo international e.V., Konstanz, Germany
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Midhat-Najami N, Goldner L, Lev-Wiesel R, Saint-Arnault D. "Being My Own Pillar of Support": How Palestinian-Arab Women Citizens of Israel Cope With IPV. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241265436. [PMID: 39066576 DOI: 10.1177/08862605241265436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Studies on the ways in which women implement coping strategies to recover from intimate partner violence have primarily focused on Western, non-collectivistic societies. To contribute to the scant literature on coping strategies among women in traditional-collectivistic societies, the current study applied the principles of Clinical Ethnographic Narrative Interview to analyze the experiences of 15 Palestinian-Arab citizens of Israel as these women confronted violence within marriage. This exploration is situated within the backdrop of entrenched collectivistic traditional norms and the broader context of the enduring Israeli-Arab conflict. An Interpretative Phenomenological Analysis revealed three themes that translated into a transformative three-phase coping model. The first theme covers navigating violent relationships through avoidance, emotional encapsulation, and cognitive reframing. The second theme describes strategies to mitigate violence and its consequences, including escapist and immediate departure, sustained fulfillment of duties, and maintaining hope amid adversity. The third theme characterizes strategies aimed at achieving self-care and self-empowerment. The findings highlight the importance of acknowledging women's definition of coping and recovery within their cultural constraints as they chart their coping trajectories.
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Yosep I, Suryani S, Mediani HS, Mardhiyah A, Hernawaty T. A scoping review of nursing interventions to reduce PTSD in adolescents who have been sexually abused. BMC Nurs 2024; 23:470. [PMID: 38982487 PMCID: PMC11232336 DOI: 10.1186/s12912-024-02130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
Incidences of sexual violence have increased over the past few years. The negative impacts of sexual violence on adolescents are social isolation, low self-esteem, and disrupting the developmental stages of adolescents, and can even cause the risk of suicide. Nurses as providers of comprehensive nursing care have a role in reviewing various aspects to reduce the impact of sexual violence on adolescents. The purpose of this study is to explore methods of nursing intervention for reducing the symptoms of post-traumatic stress disorder among adolescents who are victims of sexual violence. The design used in this study is scoping review. Article were searched from CINAHL, PubMed, and Scopus databases. The inclusion criteria for articles in this study were full text, randomized control trial or quasi-experimental research design, English language, samples is adolescents (10-19 years based on WHO) who are victims of sexual violence, and the publication period of the last 10 years (2013-2022). We found 12 articles which discussed about nursing interventions in reducing PTSD symptoms in adolescents who are victims of sexual violence. Range of the samples is 40-405 adolescents. Several articles from developed countries. There are three nursing intervention methods that can be carried out, namely improve skill interventions, relaxation interventions, and cognitive behavior therapy. Nurses act as educators, facilitators and counselors so that victims can recover from their traumatic experiences. Providing nursing interventions to adolescents who are victims of sexual violence needs to pay attention to all aspects that affect the physical and psychological condition of the victim.
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Affiliation(s)
- Iyus Yosep
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia.
| | - Suryani Suryani
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Henny Suzana Mediani
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Ai Mardhiyah
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Taty Hernawaty
- Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
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Lortye SA, Will JP, Rameckers SA, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Types of childhood maltreatment as predictors of posttraumatic stress disorder severity and complex posttraumatic stress disorder in patients with substance use disorders. Eur J Psychotraumatol 2024; 15:2367179. [PMID: 38934350 PMCID: PMC11212561 DOI: 10.1080/20008066.2024.2367179] [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: 08/28/2023] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.
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Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Sophie A. Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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5
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Boumpa V, Papatoukaki A, Kourti A, Mintzia S, Panagouli E, Bacopoulou F, Psaltopoulou T, Spiliopoulou C, Tsolia M, Sergentanis TN, Tsitsika A. Sexual abuse and post-traumatic stress disorder in childhood, adolescence and young adulthood: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024; 33:1653-1673. [PMID: 35716220 DOI: 10.1007/s00787-022-02015-5] [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] [Received: 08/25/2021] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
Child sexual abuse (CSA) has been associated with mental health disorders throughout life during childhood, adolescence and adulthood; one of the most prevalent mental health conditions after CSA is post-traumatic stress disorder (PTSD). The present systematic review and meta-analysis aims to examine the association between CSA and PTSD in children and adolescents, evaluating also the role of potential effect modifiers, such as gender and geographic region. Participants were sexually abused (vs. CSA-free) children, adolescents and young adults, up to 21 years of age, with or without a PTSD diagnosis. Settings of eligible studies spanned school, college, university, community, hospital and non-hospital mental health facilities. Eligible studies were sought in PUBMED, ΕΜΒΑSE, PSYCINFO and GOOGLE SCHOLAR databases; end-of-search was set at August 31, 2020. Random-effects (DerSimonian-Laird) models were used for the pooling of studies. Results were reported as pooled odds ratios (OR) and 95% confidence intervals (95% CIs). Twenty-eight studies were identified, including a total cohort of 28,693 subjects. CSA was strongly associated with PTSD, at a similar extent in boys (pooled OR = 2.86, 95% CI 2.09-3.91) and girls (pooled OR = 2.38, 95% CI 1.76-3.23); meta-regression with gender confirmed the non-significant effect of gender. The association was present in all examined geographic regions. CSA is strongly associated with PTSD in childhood, adolescence and young adulthood, irrespectively of gender. Future studies should opt for thorough assessment of confounders and examine regions with paucity of studies, such as East Asia and Latin America.
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Affiliation(s)
- Vasiliki Boumpa
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece
| | - Aikaterini Papatoukaki
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece
| | - Anastasia Kourti
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece
| | - Sofia Mintzia
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece
| | - Eleni Panagouli
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair On Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Clinical Therapeutics, "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Maria Tsolia
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece
| | - Theodoros N Sergentanis
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece
- Department of Clinical Therapeutics, "Alexandra" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemis Tsitsika
- MSc Program "Strategies of Developmental and Adolescent Health", Medical School of Athens, National and Kapodistrian University of Athens, 15 Mesogeion Ave, 11527, Athens, Greece.
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6
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Lee AH, Kitagawa Y, Mirhashem R, Rodriguez M, Hilerio R, Bernard K. Do dimensions of childhood adversity differ in their direct associations with youth psychopathology? A meta-analysis. Dev Psychopathol 2024:1-31. [PMID: 38584264 DOI: 10.1017/s0954579424000737] [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: 04/09/2024]
Abstract
Growing evidence supports the unique pathways by which threat and deprivation, two core dimensions of adversity, confer risk for youth psychopathology. However, the extent to which these dimensions differ in their direct associations with youth psychopathology remains unclear. The primary aim of this preregistered meta-analysis was to synthesize the associations between threat, deprivation, internalizing, externalizing, and trauma-specific psychopathology. Because threat is proposed to be directly linked with socioemotional development, we hypothesized that the magnitude of associations between threat and psychopathology would be larger than those with deprivation. We conducted a search for peer-reviewed articles in English using PubMed and PsycINFO databases through August 2022. Studies that assessed both threat and deprivation and used previously validated measures of youth psychopathology were included. One hundred and twenty-seven articles were included in the synthesis (N = 163,767). Results of our three-level meta-analyses indicated that adversity dimension significantly moderated the associations between adversity and psychopathology, such that the magnitude of effects for threat (r's = .21-26) were consistently larger than those for deprivation (r's = .16-.19). These differences were more pronounced when accounting for the threat-deprivation correlation. Additional significant moderators included emotional abuse and youth self-report of adversity. Findings are consistent with the Dimensional Model of Adversity and Psychopathology, with clinical, research, and policy implications.
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Affiliation(s)
- Amy Hyoeun Lee
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | | | - Rebecca Mirhashem
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Micaela Rodriguez
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Romola Hilerio
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - Kristin Bernard
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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7
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Darnell BC, Lee SR, Despotes AM, Jones DA, Valentiner DP. Metacognition as a Mediator for Posttraumatic Stress Symptoms Following Childhood Stressful Life Events: An Examination of the Construct Validity of the Metacognitions Questionnaire-Posttraumatic Stress Disorder. Psychol Rep 2024:332941231217467. [PMID: 38197222 DOI: 10.1177/00332941231217467] [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: 01/11/2024]
Abstract
Both cognitive and metacognitive theories implicate posttraumatic metacognition as an important factor in the maintenance of posttraumatic stress symptoms (PTSS) following stressful life events (SLEs). The Metacognitions Questionnaire-posttraumatic stress disorder (MCQ-PTSD; Wells, 2009) was previously developed to assess for metacognitions specific to SLEs and resulting PTSS. This study aimed to examine the construct validity of this measure in the context of childhood SLEs specifically. First, we confirmed the factor structure underlying the MCQ-PTSD in our sample. We then assessed whether the MCQ-PTSD would function as expected based on a theoretical model in which, controlling for posttraumatic cognitions, posttraumatic metacognitions were expected to mediate the relationship between childhood SLEs and PTSS. Using data from a racially diverse sample of undergraduate psychology students (N = 402; Agemean = 19.38 ± 1.81) at a large Midwestern university, the two-factor structure of the MCQ-PTSD was confirmed. Among participants who endorsed clinically significant experience of childhood SLEs (n = 203; Agemean = 19.49 ± 1.94), negative metacognitions mediated the relationships of emotional and sexual abuse with PTSS, when controlling for other posttraumatic cognitions. These relationships were not observed for positive metacognitions. These results are consistent with a metacognitive model for PTSD and suggest that the MCQ-PTSD may be a valid measure of posttraumatic metacognitions following childhood SLEs.
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Affiliation(s)
| | - Sarah R Lee
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Andrea M Despotes
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Dominoe A Jones
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
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8
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Yang X, Zhen R, Liu Z, Wu X, Xu Y, Ma R, Zhou X. Bullying Victimization and Comorbid Patterns of PTSD and Depressive Symptoms in Adolescents: Random Intercept Latent Transition Analysis. J Youth Adolesc 2023; 52:2314-2327. [PMID: 37468821 DOI: 10.1007/s10964-023-01826-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
Many studies have examined post-traumatic stress disorder (PTSD) or depressive symptoms in adolescents under the background of school bullying, but not their comorbidities and changes over time. This study used random intercept latent transition analysis (RI-LTA) to examine the transitions in comorbid patterns of PTSD and depressive symptoms among 815 adolescents (45.0% boys; Mage-baseline = 13.69, SD = 1.60), who reported their symptoms in a 3-year longitudinal study. Three comorbid patterns were found: low symptoms, predominantly PTSD symptoms, and symptoms of comorbidity. Among these patterns, five trends were found through 3 years: stable low symptoms, stable PTSD symptoms, improving symptoms, worsening symptoms, and an inverted-U pattern. Age, time that parents spend with their child, being an only child, family income and experiencing relational bullying were predictors of these transitions. These suggest that patterns of PTSD and depressive symptoms are heterogeneous and may change over time since trauma events. Developing targeted interventions based on underlying factors through distinct patterns and transitions may help us better optimize and utilize intervention resources to alleviate symptoms from bullying victims.
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Affiliation(s)
- Xima Yang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Rui Zhen
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, 311121, China
| | - Zhengyi Liu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Xinyue Wu
- Faculty of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Yongyong Xu
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Rong Ma
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310058, China.
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9
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Walsh C, Cunningham T. THE PAINS OF PARAMILITARISM: The Latent Criminogenic Effects of Exposure to Paramilitary Violence Among Young Men in a Post-Conflict Society. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:547-558. [PMID: 37593052 PMCID: PMC10427590 DOI: 10.1007/s40653-023-00516-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 08/19/2023]
Abstract
Purpose: Whilst most people who experience adversity recover, there is a cumulative body of evidence that illustrates that the effects can be long lasting, and can even become debilitating over time. Links have been made between traumatic distress, mental health disorders and disturbances in behavioural and emotional regulatory systems that may in context elevate the risk of offending. Despite the burgeoning evidence around the criminogenic effects of adversity, few studies have examined the traumatic effects of paramilitary related adversity in the context of post-conflict Northern Ireland. Methods: With reference to DSM-V PTSD diagnostic clusters, the aim of this study was to explore the latent impact of adversity and latent trauma among justice involved young men and identify potential criminogenic effects of exposure to paramilitary related adversity. Results and conclusions: This study found that across the sample, young men had self-reported to have experienced significant adversity, including violent victimisation. Exposure to paramilitary adversity often began during early adolescence. The participants described symptoms that were consistent with clinically diagnosable disorders such as Post-Traumatic Stress Disorder. Despite this, there appears to be a paucity of trauma screening and assessment, and few supports that victim could benefit from. In the absence of appropriate and evidence-based supports, many young men appear to find other (and more maladaptive) ways to cope. This exacerbates the risk of interfacing with the justice system and may even contribute towards a deterioration in wider psycho-social outcomes. Implications for practice are discussed.
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Affiliation(s)
- Colm Walsh
- Queen’s University Belfast, Belfast, United Kingdom
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10
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Schiff M, Auslander WF, Gerke DR. Child Maltreatment, Mental Health, and Self-Reported Health Among Adolescent Girls in Child Welfare: Mediating Pathways. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:759-771. [PMID: 37593056 PMCID: PMC10427600 DOI: 10.1007/s40653-023-00545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 08/19/2023]
Abstract
Child maltreatment is common in the US and has been shown to be associated with physical and psychological health problems in adolescence and adulthood. Based on the allostatic load theory, this study examined the association between different types of child maltreatment (emotional, physical, and sexual abuse, and physical neglect) and self-rated health, and the mediating roles of post-traumatic stress and depression in these relationships. Participants were 249 girls involved in the child welfare system, ages 12-19 years, the majority of whom were African American. A one item self-reported general health measure, the Child Trauma Questionnaire-Short Form (CTQ-SF), Child PTSD Symptom Scale (CPSS) and the Child Depression Inventory (CDI) measured self-reported health, child maltreatment, and posttraumatic and depression symptoms, respectively. Higher levels of emotional, physical, and sexual abuse, and physical neglect were significantly associated with poorer ratings of health. PTSD and depression were significant mediators between histories of childhood emotional, physical, and sexual abuse and physical health. In conclusion, results indicate that the pathways from child abuse to physical health problems in adolescents are through psychological distress. Trauma focused interventions to reduce symptoms of PTSD and depression among this vulnerable group of adolescents are essential to improve health.
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Affiliation(s)
- Miriam Schiff
- The Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Haws JK, Laifer LM, Acosta LM, Ralston AL, Ruggiero KJ, Davidson TM, Andrews AR. A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents. Res Child Adolesc Psychopathol 2023; 51:1021-1035. [PMID: 36881210 DOI: 10.1007/s10802-023-01042-3] [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] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.
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Affiliation(s)
- James Kyle Haws
- Department of Family Medicine, and the Adult and Child Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 300, Aurora, CO, 80045, USA.
| | - Lauren M Laifer
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Laura M Acosta
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Allura L Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arthur R Andrews
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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12
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Walsh C. Disrupting the cycle of youth violence: The role of social support for youth in a Northern Irish Youth Work Programme. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023:1-9. [PMID: 37359468 PMCID: PMC10043538 DOI: 10.1007/s40653-023-00529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 06/28/2023]
Abstract
Youth violence is a significant concern and previous research has found that violence is both trauma inducing and violence inducing. Meta-analyses have demonstrated that peri-trauma contextual factors such as the presence or absence of social supports following the onset of trauma may be predictive of the onset and duration of psychological stress. The aim of this study is to build upon the existing research evidence to clarify the links between social support, psychological stress and physical violence among a cross-section of youth living in high-violence areas of Northern Ireland. Participants were a sample of 10-25-year-olds (N = 635) who participated in a targeted youth work programme in Northern Ireland. This study conducted a mediation analysis, entering social support as the independent variable, psychological distress as the mediator and self-reported violence as the outcome variable. Violent victimisation was entered as a covariate in the analysis. After controlling for violent victimisation, social support operates through psychological stress to influence the risk of physical violence. Social support may contribute to reductions in psychological stress and thus buffer against the risks of living in areas of elevated community violence. Specialist youth work approaches may provide an opportunity to reduce psychological stress and thus help to mitigate the risk of further violence. Combined, these insights provide opportunities for harm reduction and prevention. At the same time, these findings advance our understanding of the distinct mechanisms of change involved in youth work-led violence prevention efforts.
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Affiliation(s)
- Colm Walsh
- Queen’s University Belfast, Belfast, Northern Ireland
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13
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Neuner F. Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging. Clin Psychol Rev 2023; 99:102219. [PMID: 36395560 DOI: 10.1016/j.cpr.2022.102219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
Current theories of psychological trauma assume that posttraumatic symptoms originate from stress reactions caused by extremely adverse life experiences. Since the diagnosis of PTSD is restricted to events that involve threats to the physical or sexual integrity of a person, such as accidents and physical and sexual violence, these theories are not well suited to explain the psychopathological consequences of severe violations of one's social integrity, such as emotional abuse and bullying. However, it is evident that social threats contribute to a broad range of mental disorders and increase symptom severity in patients with posttraumatic stress disorder. The aim of the Physical and Social Trauma (PAST) framework is to extend current memory theories of psychological trauma to incorporate threats to a person's social integrity. Within this perspective, the harmful effects of events that involve social threats result from violations of core social motives such as the need for status and belonging that bring about intense affective reactions, including despair and defeat. Within associative threat structures, these emotions are tied to the stimulus characteristics of the experiences and can be re-activated in social situations. The resulting psychopathology transcends PTSD criteria and other current classifications and suggests a transdiagnostic perspective of psychological trauma. Implications for treatment and further directions for research are discussed.
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Affiliation(s)
- Frank Neuner
- Bielefeld University, Department of Psychology, Postbox 100131, 33501 Bielefeld, Germany.
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Redican E, Hyland P, Cloitre M, McBride O, Karatzias T, Murphy J, Bunting L, Shevlin M. Prevalence and predictors of ICD-11 posttraumatic stress disorder and complex PTSD in young people. Acta Psychiatr Scand 2022; 146:110-125. [PMID: 35503737 PMCID: PMC9540630 DOI: 10.1111/acps.13442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The prevalence, construct validity, risk factors and psychopathological correlates associated with ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as measured by the International Trauma Questionnaire for Children and Adolescents (ITQ-CA) were assessed in a sample of young people from Northern Ireland. METHOD Participants were trauma-exposed 11-19-year-olds (N = 507) who participated in the Northern Ireland Youth Wellbeing Prevalence Survey (YWS-NI, 2020). Factor mixture modelling (FMM) was used to test the latent structure of the ITQ-CA. Risk-factors and psychopathological correlates associated with latent class membership, and ICD-11diagnostic status, were also investigated. RESULTS More participants met the ITQ-CA criteria for CPTSD (3.4%, n = 44) than PTSD (1.5%, n = 19). A second-order FMM comprising a 'partial-PTSD class', a 'CPTSD class', a 'DSO class' and a 'low symptom endorsement class' was the best-fitting model. Younger age and cumulative trauma were risk factors for all trauma classes. Female gender and two or more violent traumas were significant predictors of the 'PTSD' and 'CPTSD' classes, while single sexual trauma was a significant predictor of the 'DSO' and 'CPTSD' classes. Two or more sexual traumas was a unique predictor of 'CPTSD class', while two or more vicarious traumas was a unique predictor of 'DSO class'. The 'CPTSD' class displayed the most notable comorbidity. CONCLUSIONS Findings indicate that CPTSD may be more prevalent than PTSD in children and young people. Support for the ICD-11 conceptualisation of CPTSD as representing a unique diagnostic construct was supported using FMM, with findings indicating trauma symptom class-specific risk profiles.
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Affiliation(s)
- Enya Redican
- School of PsychologyUlster UniversityColeraineUK
| | - Philip Hyland
- Department of PsychologyMaynooth UniversityMaynoothIreland
| | - Marylene Cloitre
- National Center for PTSDVerterans Affairs Palo Alto Health Care SystemPalo AltoCaliforniaUSA
| | - Orla McBride
- School of PsychologyUlster UniversityColeraineUK
| | - Thanos Karatzias
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Jamie Murphy
- School of PsychologyUlster UniversityColeraineUK
| | - Lisa Bunting
- School of Social Sciences, Education and Social WorkQueen's UniversityBelfastUK
| | - Mark Shevlin
- School of PsychologyUlster UniversityColeraineUK
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Sevenoaks T, Fouche JP, Phillips N, Heany S, Myer L, Zar HJ, Stein DJ, Hoare J. Childhood Trauma and Mental Health in the Cape Town Adolescent Antiretroviral Cohort. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:353-363. [PMID: 35600517 PMCID: PMC9120333 DOI: 10.1007/s40653-021-00362-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 06/03/2023]
Abstract
This study aimed to assess the association of childhood trauma, stressful life events and HIV stigma with mental health in South African adolescents from the Cape Town Adolescent Antiretroviral Cohort (CTAAC). The Childhood Trauma Questionnaire, Life Events Questionnaire and the HIV Stigma Scale for South African Adolescents Living with HIV was used to assess childhood trauma, stressful life events and stigma in adolescents living with perinatally acquired HIV and healthy controls enrolled in the CTAAC. These measures were associated with mental health outcomes including the Beck-Youth Inventories, Child Behaviour Checklist, Columbian Impairment Scale, Childrens Motivation Scale, Conners Scale for Attention Deficit Hyperactivity Disorder using Pearson correlations and self-reported alcohol use, using Spearman-rank correlation. 63.7% of adolescents reported at least one childhood trauma on the CTQ. Significant associations were reported between CTQ measures and Beck-Youth Inventories. Emotional abuse was associated with anxiety, anger, depression and disruptive behaviour. Emotional neglect was associated with poor self-concept and disruptive behaviour. LEQ total score was significantly associated with Beck-Youth Inventories including anxiety, depression, anger and disruptive behaviour scales. HIV stigma was significantly associated with Beck-Youth Inventories including depression, anger and disruptive behaviour. Childhood trauma, stressful life events and HIV stigma in South African adolescents are associated with anxiety, depression, anger, disruptive-behaviour and poor self-concept. This study highlights the importance of enquiring about exposure to a variety of traumas, particularly those commonly experienced by South African adolescents. In addition, it is important to understand the impact of trauma exposure on each individuals mental health and functioning.
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Affiliation(s)
- Tatum Sevenoaks
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nicole Phillips
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sarah Heany
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- SA MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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16
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Miliauskas CR, Faus DP, da Cruz VL, do Nascimento Vallaperde JGR, Junger W, Lopes CS. Community violence and internalizing mental health symptoms in adolescents: A systematic review. BMC Psychiatry 2022; 22:253. [PMID: 35397541 PMCID: PMC8994919 DOI: 10.1186/s12888-022-03873-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 03/16/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSES Mental disorders are responsible for 16% of the global burden of disease in adolescents. This review focuses on one contextual factor called community violence that can contribute to the development of mental disorders OBJECTIVE: To evaluate the impact of community violence on internalizing mental health symptoms in adolescents, to investigate whether different proximity to community violence (witness or victim) is associated with different risks and to identify whether gender, age, and race moderate this association. METHODS systematic review of observational studies. The population includes adolescents (10-24 years), exposition involves individuals exposed to community violence and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers. RESULTS A total of 2987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witnessing is less harmful for mental health than being a victim. Age and race did not appear in the results as modifiers, but male gender and family support appear to be protective factors in some studies. CONCLUSION This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.
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Affiliation(s)
- Claudia Reis Miliauskas
- Medical Sciences College/Department of Medical Specialties, State University of Rio de Janeiro, Vinte e Oito de Setembro Avenue, 77, 4° floor, 432. Vila Isabel, Rio de Janeiro, 20.551-030, Brazil. .,Institute of Social Medicine/State University of Rio de Janeiro, São Francisco Xavier Street, 524, Maracanã, 7 floor, Rio de Janeiro, 20.550-013, Brazil.
| | - Daniela Porto Faus
- grid.8536.80000 0001 2294 473XInstitute of Social Medicine/State University of Rio de Janeiro, São Francisco Xavier Street, 524, Maracanã, 7 floor, Rio de Janeiro, 20.550-013 Brazil ,grid.8536.80000 0001 2294 473XUniversidade Federal do Rio de Janeiro, Maternidade Escola, Laranjeiras Street, 180. Laranjeiras, Rio de Janeiro, 22.240-000 Brazil
| | - Valéria Lima da Cruz
- grid.8536.80000 0001 2294 473XInstitute of Social Medicine/State University of Rio de Janeiro, São Francisco Xavier Street, 524, Maracanã, 7 floor, Rio de Janeiro, 20.550-013 Brazil
| | - João Gabriel Rega do Nascimento Vallaperde
- grid.8536.80000 0001 2294 473XInstitute of Social Medicine/State University of Rio de Janeiro, São Francisco Xavier Street, 524, Maracanã, 7 floor, Rio de Janeiro, 20.550-013 Brazil
| | - Washington Junger
- grid.8536.80000 0001 2294 473XInstitute of Social Medicine/State University of Rio de Janeiro, São Francisco Xavier Street, 524, Maracanã, 7 floor, Rio de Janeiro, 20.550-013 Brazil
| | - Claudia Souza Lopes
- grid.8536.80000 0001 2294 473XInstitute of Social Medicine/State University of Rio de Janeiro, São Francisco Xavier Street, 524, Maracanã, 7 floor, Rio de Janeiro, 20.550-013 Brazil
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Muradwij N, Allwood M. Making meaning of community violence among adolescents: Associations between exposure, pro-violence attitudes and psychological symptoms. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1315-1330. [PMID: 34599845 DOI: 10.1002/jcop.22717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
This study examined one type of adolescent meaning making (i.e., the development of beliefs about violence) and its association with reported mental health symptoms in a sample of youth exposed to community violence. Eighty-seven adolescents (age 11-18; 64.4% female) from a metropolitan city in the Northeast were recruited through Craigslist and recreation center postings and data collection occurred from 2009 to 2013. Participants completed self-reported measures of community violence exposure, attitudes toward violence, and psychological symptoms of depression and posttraumatic stress disorder [PTSD]. Bivariate correlations, hierarchical linear regressions, and mediation analyses examined the associations between exposure, beliefs about violence, and mental health symptoms. Self-reported pro-violence attitudes were positively correlated with depression symptoms (r = 0.32, p < 0.01) and PTSD (r = 0.45, p < 0.01). Pro-violence attitudes significantly mediated the relationship between community violence exposure and depression symptoms (95% confidence interval [CI] = 0.003-0.061) and PTSD symptoms (95% CI = 0.046-0.260). Preliminary findings suggest that meaning making through the development of pro-violence attitudes may not protect against symptoms of PTSD and depression among youth. Findings can inform the integration of meaning making processes into community mental health interventions for youth.
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Affiliation(s)
- Nawal Muradwij
- Department of Psychology, John Jay College of Criminal Justice and The Graduate Center, City University of New York, 524 W 59th St, New York, United States, 10019, USA
| | - Maureen Allwood
- Department of Psychology, John Jay College of Criminal Justice and The Graduate Center, City University of New York, 524 W 59th St, New York, United States, 10019, USA
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18
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Massazza A, de Almeida JF, Quinlan-Davidson M, da Silva RT, Devakumar D, Peres MFT, Lewis G, Kiss L. Local understandings of PTSD and complex PTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city, Brazil. BMC Psychiatry 2022; 22:196. [PMID: 35303808 PMCID: PMC8932201 DOI: 10.1186/s12888-022-03821-6] [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] [Received: 09/16/2021] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Adolescents in low-resource urban settings in Brazil are often exposed to high levels of trauma that can result in post-traumatic stress disorder (PTSD). However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Additionally, little is known about the perceived applicability among clinicians of the new ICD-11 diagnosis of complex PTSD (CPTSD), despite its potential relevance for contexts of chronic trauma. The current study investigated local understandings of PTSD and CPTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city. METHODS Semi-structured interviews were conducted with 58 health professionals working at both the primary care and specialized mental health levels in two areas of São Paulo city with high levels of community violence. RESULTS Most participants knew about PTSD, but most did not know about CPTSD. There were mixed views concerning the commonality of PTSD among adolescents exposed to community violence. Many participants reported having no experience working with patients with the PTSD diagnosis. According to some, community violence was normalized by adolescents and health professionals, and did not result in PTSD. Others highlighted how they did not use psychiatric diagnoses in their practice, had critical perspectives towards psychiatric diagnoses and/or PTSD, or simply knew little about PTSD. Furthermore, many highlighted how the chronic nature of multiple traumas experienced by adolescents often resulted in complex clinical presentations characterised by many symptoms beyond PTSD. The diagnosis of CPTSD was considered appropriate to the context by many participants as it captured the complex traumatic histories and symptom presentations of adolescents exposed to community violence in Brazil. CONCLUSIONS These findings have important implications for the assessment and treatment of mental health among adolescents exposed to community violence in Brazil.
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Affiliation(s)
- Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.
| | | | | | - Renata Teixeira da Silva
- São Paulo Municipal Health Department- Medical Residency Program in Psychiatry, São Paulo, Brazil
| | | | | | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK
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Falconer NS, Casale M, Kuo C, Nyberg BJ, Hillis SD, Cluver LD. Factors That Protect Children From Community Violence: Applying the INSPIRE Model to a Sample of South African Children. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:11602-11629. [PMID: 31948335 DOI: 10.1177/0886260519898425] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009-2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies-positive parenting, basic necessities, formal social support, and school structural support-and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct p < .001; adjusted odds ratio [AOR] = .57; indirect p < .01; AOR = .62), formal support (direct p < .05; AOR = .83; indirect p < .05; AOR = .73), and school support (direct p < .001; AOR = .53; indirect p < .001; AOR = .49). Combined interventions in direct and indirect community violence analyses demonstrated that children reporting a higher number of strategies were less likely to have experienced community violence. This outcome extends the results of longitudinal studies in South Africa highlighting social protection with care as a means to overcome structural deprivation strains, thereby reducing the likelihood of children's exposure to community violence. Moreover, these findings uphold the INSPIRE model as an effective cross-sectoral approach to prevent and reduce the community violence that children experience.
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Affiliation(s)
- N Suzanne Falconer
- GlobalFingerprints, Minneapolis, MN, USA
- Two Sparrows Consulting, Rockford, IL, USA
| | - Marisa Casale
- University of the Western Cape, Bellville, South Africa
- University of Oxford, UK
| | - Caroline Kuo
- Brown University School of Public Health, Providence, RI, USA
- University of Cape Town, South Africa
| | - Beverly J Nyberg
- Clemson University, SC, USA
- Common Root Consulting, Washington, DC, USA
| | - Susan D Hillis
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Roesch PT, Velonis AJ, Sant SM, Habermann LE, Hirschtick JL. Implications of Interpersonal Violence on Population Mental Health Status in a Low-Income Urban Community-Based Sample of Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:8891-8914. [PMID: 31319734 DOI: 10.1177/0886260519862365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research links interpersonal violence (IPV) perpetrated by a close personal contact, such as a family member or partner, to poor mental health; however, few studies assess associations by gender and explore the community-wide impacts of IPV on rates of depression and posttraumatic stress disorder (PTSD). Using Sinai Community Health Survey (2015-2016), a face-to-face probability survey in 10 Chicago neighborhoods, we examined the association of a broad IPV measure, ever being emotionally or physically abused by a partner or someone important to you, with current depressive (DEPsym) or PTSD symptoms (PTSDsym), stratified by gender. After logistic regression model building, we used direct model-based standardization to calculate adjusted relative prevalence and population attributable prevalence fractions. Of 1,535 respondents, 8% of men and 15% of women had DEPsym; 15% and 20% had PTSDsym, respectively; and 12% and 26% ever experienced IPV, respectively. Controlling for confounders, men who experienced IPV had a 3.6 times (95% confidence interval [CI]: [1.5, 6.8]) higher prevalence of DEPsym and a 2.5 times (95% CI: [1.3, 4.9]) higher prevalence of PTSDsym. Women who experienced IPV had a 2.2 times (95% CI: [1.1, 3.9]) higher prevalence of DEPsym. If the association between IPV and mental health is causal, almost one in three cases of DEPsym (males: 31.7%; females: 27.3%) and one in five cases of PTSDsym (19.2%) among males may be attributed to IPV. Our findings underscore the need for a public health response to IPV and mental health, and additional research on evidence-driven practices that address this association among men and women.
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Sekoni O, Mall S, Christofides N. Prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria: a cross-sectional study. BMC Public Health 2021; 21:1546. [PMID: 34384401 PMCID: PMC8359091 DOI: 10.1186/s12889-021-11508-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 07/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of and factors associated with PTSD among adult females in Nigeria, particularly those who live in slums. PTSD is a mental health condition that develops among some individuals who experience or witness a traumatic event. Several other factors could place individuals at heightened risk of PTSD including stress and comorbid mental disorders. Therefore, this study aimed to examine the prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria. METHODS We conducted a cross sectional survey using multistage sampling of 550 women aged 18 and above from selected slums. Interviewer administered questionnaires were used to elicit information on experience of childhood trauma, recent stressors, intimate partner violence, other mental disorders, sociodemographic characteristics and PTSD. PTSD was measured using the Harvard Trauma Questionnaire (HTQ) which is based on DSM IV. A multivariable linear regression model was built to test associations between PTSD and independent variables. RESULTS The prevalence for PTSD was found to be 4.18% and the mean PTSD score was 5.80 ± 7.11. Sexual abuse in childhood, past year intimate partner violence and anxiety were significantly associated with higher PTSD scores. PTSD was not significantly associated with a history of recent stressors. Education, employment and marital status were not associated with PTSD however, age and wealth index showed marginal association with PTSD. CONCLUSION The prevalence of PTSD among women living in Ibadan slums was relatively low. Both child sexual abuse and intimate partner violence can be prevented. We also recommend longitudinal studies to better understand risk and protective factors.
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Affiliation(s)
- Olutoyin Sekoni
- Department of Community Medicine, College of Medicine, University of Ibadan, Queen Elizabeth Road, Ibadan, Nigeria.
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, South Africa.
| | - Sumaya Mall
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193, South Africa
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22
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Swart PC, van den Heuvel LL, Lewis CM, Seedat S, Hemmings SMJ. A Genome-Wide Association Study and Polygenic Risk Score Analysis of Posttraumatic Stress Disorder and Metabolic Syndrome in a South African Population. Front Neurosci 2021; 15:677800. [PMID: 34177453 PMCID: PMC8222611 DOI: 10.3389/fnins.2021.677800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a trauma-related disorder that frequently co-occurs with metabolic syndrome (MetS). MetS is characterized by obesity, dyslipidemia, and insulin resistance. To provide insight into these co-morbidities, we performed a genome-wide association study (GWAS) meta-analysis to identify genetic variants associated with PTSD, and determined if PTSD polygenic risk scores (PRS) could predict PTSD and MetS in a South African mixed-ancestry sample. The GWAS meta-analysis of PTSD participants (n = 260) and controls (n = 343) revealed no SNPs of genome-wide significance. However, several independent loci, as well as five SNPs in the PARK2 gene, were suggestively associated with PTSD (p < 5 × 10-6). PTSD-PRS was associated with PTSD diagnosis (Nagelkerke's pseudo R 2 = 0.0131, p = 0.00786), PTSD symptom severity [as measured by CAPS-5 total score (R 2 = 0.00856, p = 0.0367) and PCL-5 score (R 2 = 0.00737, p = 0.0353)], and MetS (Nagelkerke's pseudo R 2 = 0.00969, p = 0.0217). These findings suggest an association between PTSD and PARK2, corresponding with results from the largest PTSD-GWAS conducted to date. PRS analysis suggests that genetic variants associated with PTSD are also involved in the development of MetS. Overall, the results contribute to a broader goal of increasing diversity in psychiatric genetics.
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Affiliation(s)
- Patricia C. Swart
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leigh L. van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian M. J. Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Gama CMF, Portugal LCL, Gonçalves RM, de Souza Junior S, Vilete LMP, Mendlowicz MV, Figueira I, Volchan E, David IA, de Oliveira L, Pereira MG. The invisible scars of emotional abuse: a common and highly harmful form of childhood maltreatment. BMC Psychiatry 2021; 21:156. [PMID: 33731084 PMCID: PMC7968325 DOI: 10.1186/s12888-021-03134-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/12/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Childhood maltreatment (CM) is unfortunately widespread globally and has been linked with an increased risk of a variety of psychiatric disorders in adults, including posttraumatic stress disorder (PTSD). These associations are well established in the literature for some maltreatment forms, such as sexual and physical abuse. However, the effects of emotional maltreatment are much less explored, even though this type figures among the most common forms of childhood maltreatment. Thus, the present study aims to investigate the impact of each type of childhood maltreatment, both individually and conjointly, on revictimization and PTSD symptom severity using a nonclinical college student sample. METHODS Five hundred and two graduate and undergraduate students participated in the study by completing questionnaires assessing lifetime traumatic experiences in general, maltreatment during childhood and PTSD symptoms. Bivariate and multivariate negative binomial regressions were applied to examine the associations among childhood maltreatment, revictimization, and PTSD symptom severity. RESULTS Our results showed that using bivariate models, all types of CM were significantly associated with revictimization and PTSD symptom severity. Multivariate models showed that emotional abuse was the type of maltreatment associated with the highest incidence rates of revictimization and PTSD symptom severity. CONCLUSIONS These data provide additional evidence of the harmful effects of childhood maltreatment and its long-term consequences for individuals' mental health. Notably, the findings highlight the importance of studying the impacts of emotional abuse, which seems to be a highly prevalent, understudied, and chronic form of maltreatment that is as toxic as other maltreatment forms.
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Affiliation(s)
- Camila Monteiro Fabricio Gama
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Liana Catarina Lima Portugal
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Raquel Menezes Gonçalves
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Sérgio de Souza Junior
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Liliane Maria Pereira Vilete
- Laboratório Integrado de Pesquisa em Estresse, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Av Venceslau Bras 71, Rio de Janeiro, 22290-140, Brazil
| | - Mauro Vitor Mendlowicz
- Laboratório Integrado de Pesquisa em Estresse, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Av Venceslau Bras 71, Rio de Janeiro, 22290-140, Brazil
- Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense, Niterói, Brazil
| | - Ivan Figueira
- Laboratório Integrado de Pesquisa em Estresse, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Av Venceslau Bras 71, Rio de Janeiro, 22290-140, Brazil
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho 373, Rio de Janeiro, 21941-902, Brazil
| | - Isabel Antunes David
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Leticia de Oliveira
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Mirtes Garcia Pereira
- Laboratório de Neurofisiologia do Comportamento (LABNEC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil.
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Avanci JQ, Serpeloni F, de Oliveira TP, de Assis SG. Posttraumatic stress disorder among adolescents in Brazil: a cross-sectional study. BMC Psychiatry 2021; 21:75. [PMID: 33546640 PMCID: PMC7866458 DOI: 10.1186/s12888-021-03062-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/19/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The frequency of trauma and different types of violence exposure in urban areas and their effects on the mental health of adolescents in developing countries are poorly investigated. Most information about traumatized young people comes from war scenarios or disasters. This study aimed to determine the prevalence of PTSD in trauma-exposed students in a low-resource city of the state of Rio de Janeiro, Brazil. The effects of sociodemographic and individual and family factors in the development of PTSD were also investigated. METHODS Through multi-stage cluster sampling, 862 adolescents (Mage = 15 years old, 65% female) from public and private schools in the city of São Gonçalo were selected for the study. Self-rating structured questionnaires were applied to assess sociodemographic profile, exposure to physical and psychological violence (family, school, community), sexual abuse, social support, social functional impairment, resilience, and posttraumatic stress disorder. The data were grouped in blocks regarding sociodemographic, individual, family, and community variables. For statistical analysis, chi-square, Fisher's exact test, and logistic regression were performed. RESULTS The PTSD prevalence was 7.8% among adolescents. Boys were exposed to significantly higher number of events of community violence, while girls to family violence. The adjusted odds ratio (OR) for PTSD were statistically significant for age (OR, 1.45, [95% CI, 1.043-2.007]), social functional impairment (OR, 4.82, [95% CI, 1.77-13.10]), severe maternal physical violence (OR, 2.79, [95% CI, 0.79-9.93]), psychological violence by significant people (OR, 3.96, [95% CI, 1.89-8.31]) and a high number of episodes of community violence (OR, 3.52, [95% CI, 1.47-8.40). CONCLUSIONS There was a high prevalence of PTSD within this population associated with exposure to violence. Not only physical, but also psychological violence contributed to PTSD. The results also raise awareness to the differences in life trajectories between boys and girls regarding violence. These differences need to be better understood in order to enable the development of effective preventative interventions. Treating and preventing mental health disorders presents a challenge for countries, especially those with a lower degree of social and economic development and high community violence.
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Affiliation(s)
- Joviana Quintes Avanci
- Department of Studies on Violence and Health Jorge Careli, National School of Public Health, Oswaldo Cruz Foundation, Avenida Brasil 4036, 700 Manguinhos, Rio de Janeiro, 21040-361, Brazil.
| | - Fernanda Serpeloni
- Department of Studies on Violence and Health Jorge Careli, National School of Public Health, Oswaldo Cruz Foundation, Avenida Brasil 4036, 700 Manguinhos, Rio de Janeiro, 21040-361, Brazil
| | - Thiago Pires de Oliveira
- Department of Studies on Violence and Health Jorge Careli, National School of Public Health, Oswaldo Cruz Foundation, Avenida Brasil 4036, 700 Manguinhos, Rio de Janeiro, 21040-361, Brazil
- International Business Machines Corporation, Rio de Janeiro, Brazil
| | - Simone Gonçalves de Assis
- Department of Studies on Violence and Health Jorge Careli, National School of Public Health, Oswaldo Cruz Foundation, Avenida Brasil 4036, 700 Manguinhos, Rio de Janeiro, 21040-361, Brazil
- Neurology Post-Graduate Program, Federal University of the State of Rio de Janeiro, Mariz e Barros 775, Rio de Janeiro, 20270-901, Brazil
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Hoeboer C, de Roos C, van Son GE, Spinhoven P, Elzinga B. The effect of parental emotional abuse on the severity and treatment of PTSD symptoms in children and adolescents. CHILD ABUSE & NEGLECT 2021; 111:104775. [PMID: 33158585 DOI: 10.1016/j.chiabu.2020.104775] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/07/2020] [Accepted: 10/08/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Maltreatment by a primary caregiver is an important risk factor for the development of PTSD symptoms. Whereas meta-analyses indicate that parental emotional abuse is one of the most common forms of maltreatment, the impact of emotional abuse on PTSD symptoms and treatment effectiveness is still unclear, especially in children. OBJECTIVE We aimed to investigate the impact of parental emotional abuse on PTSD symptom severity and effectiveness of trauma treatment in children and adolescents. METHOD In an outpatient sample (N = 287, mean age = 15.5 years), emotional abuse, index traumatic event, and PTSD symptoms were assessed at baseline. Thereafter, patients received evidence-based treatment for trauma-related symptoms embedded in a broader (systemic) treatment package. In a subsample (n = 130, mean age = 15.3 years) PTSD symptoms were assessed again 6 and 12 months after baseline. RESULTS Emotional abuse (rather than any other type of maltreatment) was associated with more severe PTSD symptoms in all symptom clusters. This was independent of whether emotional abuse was reported as index traumatic event or not. Moreover, PTSD symptoms were significantly reduced 6 months after the start of trauma-focused treatment, and emotional abuse was associated with more severe PTSD symptoms over the course of treatment. CONCLUSIONS These findings underline the detrimental nature of emotional maltreatment in the context of PTSD symptomatology and treatment effectiveness. This calls for routine assessment of parental emotional abuse in the diagnostic phase, even when this is not the reason of referral.
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Affiliation(s)
- Chris Hoeboer
- Leiden University, Institute of Psychology, Section Clinical Psychology, Leiden, the Netherlands; Parnassiagroep, PsyQ The Hague, the Netherlands.
| | - Carlijn de Roos
- Amsterdam University Medical Centre, Department of Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
| | | | - Philip Spinhoven
- Leiden University, Institute of Psychology, Section Clinical Psychology, Leiden, the Netherlands; Leiden University Medical Center, Department of Psychiatry, the Netherlands.
| | - Bernet Elzinga
- Leiden University, Institute of Psychology, Section Clinical Psychology, Leiden, the Netherlands.
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Lahti M, Groen G, Mwape L, Korhonen J, Breet E, Chapima F, Coetzee M, Ellilä H, Jansen R, Jonker D, Jörns-Presentati A, Mbanga I, Mukwato P, Mundenda J, Mutagubya J, Janse van Rensburg-Bonthuyzen E, Seedat S, Stein DJ, Suliman S, Sukwa T, Turunen TJ, Valtins K, van den Heuvel L, Wahila R, Grobler G. Design and Development Process of a Youth Depression Screening m-Health Application for Primary Health Care Workers in South Africa and Zambia: An Overview of the MEGA Project. Issues Ment Health Nurs 2020; 41:24-30. [PMID: 31225763 DOI: 10.1080/01612840.2019.1604919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.
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Affiliation(s)
- Mari Lahti
- Turku University of Applied Science, Health and Well-being, Turku, Finland.,Department of Nursing, Turku University, Turku, Finland
| | - Gunter Groen
- Department of Social Science, Hamburg University of Applied Science, Hamburg, Germany
| | - Lonia Mwape
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Joonas Korhonen
- Turku University of Applied Science, Health and Well-being, Turku, Finland
| | - Elsie Breet
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Fabian Chapima
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Marita Coetzee
- Department of Nursing, University of Free State, Bloemfontein, South Africa
| | - Heikki Ellilä
- Turku University of Applied Science, Health and Well-being, Turku, Finland
| | - Ronelle Jansen
- Department of Nursing, University of Free State, Bloemfontein, South Africa
| | - Deporah Jonker
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Ireen Mbanga
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | | | - John Mundenda
- Department of Nursing, Lusaka Apex Medical University, Lusaka, Zambia
| | - Joseph Mutagubya
- Department of Nursing, Lusaka Apex Medical University, Lusaka, Zambia
| | | | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Thomas Sukwa
- Department of Nursing, Lusaka Apex Medical University, Lusaka, Zambia
| | - Timo-J Turunen
- International Cooperation and Foreign Students Department, Riga Technical University, Riga, Latvia
| | - Karlis Valtins
- International Cooperation and Foreign Students Department, Riga Technical University, Riga, Latvia
| | | | - Ruth Wahila
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Gerhard Grobler
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
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Stark L, Seff I, Asghar K, Roth D, Bakamore T, MacRae M, Fanton D’Andon C, Falb KL. Building caregivers' emotional, parental and social support skills to prevent violence against adolescent girls: findings from a cluster randomised controlled trial in Democratic Republic of Congo. BMJ Glob Health 2018; 3:e000824. [PMID: 30398222 PMCID: PMC6203064 DOI: 10.1136/bmjgh-2018-000824] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/12/2018] [Accepted: 06/16/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Parenting programmes are increasingly popular for reducing children's exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls' exposure to violence (sexual and others) and caregivers' gender attitudes and parenting behaviours. METHODS In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10-14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls' self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted. RESULTS At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes. CONCLUSION While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls' violence exposure in humanitarian settings. TRIAL REGISTRATION NUMBER NCT02384642.
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Affiliation(s)
- Lindsay Stark
- George Warren Brown School of Social Work, Washington University in Saint Louis, St. Louis, Missouri, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Ilana Seff
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Khudejha Asghar
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Danielle Roth
- International Rescue Committee, New York City, New York, USA
| | | | - Mairi MacRae
- International Rescue Committee, New York City, New York, USA
| | | | - Kathryn L Falb
- International Rescue Committee, New York City, New York, USA
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Dubé C, Gagné MH, Clément MÈ, Chamberland C. Community Violence and Associated Psychological Problems Among Adolescents in the General Population. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:411-420. [PMID: 30546818 PMCID: PMC6267123 DOI: 10.1007/s40653-018-0218-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Based on a populational survey conducted among 1400 adolescents aged between 12 and 17 years old, the aim of this study is to assess the relationships between their community violence experiences and their psychological health (anger, depressive symptoms, and post-traumatic stress disorder symptoms). One MANOVA confirms that both boys and girls who report at least one incident of physical community violence present more psychological difficulties, especially anger. Subsequent MANOVAs show that anger intensity varies depending on whether the youth was a direct victim or a witness only, as well as on the diversity of the types of violent manifestations and on acquaintance with the perpetrator, whereas the presence of injuries has no significant effect. This study highlights the importance of considering the context of the community violence incident, to clearly understand its relationships with the youth's psychological difficulties.
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Affiliation(s)
- Christine Dubé
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Pavillon Félix-Antoine-Savard 11ème étage, Québec, Québec G1V 0A6 Canada
- Present Address: Centre Hospitalier de l’Université Laval, Québec City, Canada
| | - Marie-Hélène Gagné
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Pavillon Félix-Antoine-Savard 11ème étage, Québec, Québec G1V 0A6 Canada
| | - Marie-Ève Clément
- Psychology and Psychoeducation Department, Université du Québec en Outaouais, Saint-Jérôme, Canada
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