Shame, dissociative seizures and their correlation among traumatised female Yazidi with experience of sexual violence

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

Increasing Sexual Violence Reporting and Disclosure in Higher Education Institutions: A Proposed Approach to Critically Analyze the Internal Organizational Context

AIMS

This article explores the underreporting of sexual violence (SV) in higher education, highlighting serious implications for survivors who may silently cope with its aftermath instead of accessing crucial resources.

METHODS

We utilize Bolman and Deal's four-frame model for organizational change to assess how internal factors within organizations may influence reporting of SV. The four frames-symbolic, structural, human resources, and political-offer a systematic analysis of the internal organizational context in higher education institutions concerning SV reporting.

RESULTS

Our suggested approach offers concrete dimensions and probing questions for examination. Derived from a qualitative study, our recommendations align with Bolman and Deal's four-frame model, aiding in assessing the organizational environment. This approach assists stakeholders in identifying barriers/facilitators in the internal organizational context of higher education institutions, enabling effective planning for improved SV reporting/disclosure.

CONCLUSIONS

A thorough analysis is essential for understanding factors influencing campus SV reporting. Our proposed critical analysis and recommendations serve as a starting point to identify organizational barriers/facilitators, informing the revision of SV policies and processes, including reporting.

POTENTIAL IMPACT OF IMPROVED SEXUAL ASSAULT REPORTING IN HIGHER EDUCATION INSTITUTIONS ON FORENSIC NURSING AND SURVIVORS/VICTIMS ALLIES

Enhanced reporting of sexual assault in higher education benefits forensic nurses and allies, like student affairs, advocacy groups, unions, SV coordinators, health centers, equity departments, human rights officers, and administration. Improved analysis of institutional and cultural contexts allows for tailored services to better meet survivors' needs. Increased reporting should lead institutions to higher service utilization, requiring careful planning for resource allocation.

Mental health in genocide: Balancing between posttraumatic distress and growth among displaced Yazidi mothers

BACKGROUND

The Islamic State of Iraq and Syria (ISIS) committed genocide of the Yazidis in Sinjar 2014, resulting in dispersion and enslavement. Research shows severe mental health problems, such as posttraumatic stress disorder (PTSD) among survivors, but less is known about their resources and strengths, conceptualized as posttraumatic growth (PTG).

AIMS

are to examine the balance between symptoms and strengths among Yazidi women caring for their infants by identifying groups differing in PTSD and PTG, and analyze how demographic, obstetric, and infant-related factors associate with the groups.

METHOD

Participants were 283 Yazidi mothers with their 1-18-month-old infants displaced in Kurdish Region of North Iraq. PTSD symptoms were measured by Harvard Trauma Questionnaire and PTG by the Posttraumatic Growth Inventory.

RESULTS

identified four groups: "Severe symptoms and low growth" (39%), "Low symptoms and moderate growth" (38%), "Moderate symptoms and very high growth" (13%), and "Moderate symptoms and low growth" (10%). Low education, economic difficulties and obstetric problems related to the "Severe symptoms and low growth" group, whereas newborn and infant health problems did not have an impact.

CONCLUSION

Effective help for genocide survivors should both alleviate suffering and encourage resources through tools of recreating a sense of cultural security and pride.

Anger regulation in patients with functional neurological disorder: A systematic review

BACKGROUND

Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND.

METHODS

MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340).

RESULTS

A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality.

CONCLUSIONS

This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.

Neurological Care of Refugees and Other Forcibly Displaced Persons

There are more than 100 million forcibly displaced persons (FDPs) in the world today, including a high number of people who experience neurologic symptoms and presentations. This review summarizes the conceptual frameworks for understanding neurological health risks and conditions across the migration journey (premigration, migration journey, and postmigration) and life span, including special attention to pediatric FDPs. The interaction with psychiatric illness is discussed, as well as the available published data on neurologic presentations in FDPs in the medical literature. A social determinant of health lens is used to provide ways in which forcible displacement can influence brain health and neurological outcomes. Priorities and future needs for the neurological care of refugees and other FDPs are suggested.

The prevalence of psychiatric disorders among Yazidi people results from ISIS invasion and consecutive trauma: A systematic review

BACKGROUND

The Yazidi community is a Kurdish minority of the population that lives mainly in Iraq. In history, they suffered from many problems and disasters, including the most recent brutal invasion by ISIS, which significantly impacted their mental health.

AIMS

Our objective is to examine the prevalence of psychiatric disorders among Yazidi people resulting from the invasion of ISIS in 2014.

METHODS

A systematic review was performed using the PRISMA protocol. 252 publications were initially identified in PubMed, EMBASE, Scopus, and Google Scholar using relevant keywords. Finally, 23 full articles were included for data extraction. The inclusion criteria were English papers that investigated Yazidi's psychiatric problems, regardless of gender, or age. However, letters to editors, systematic reviews, and studies that examine general physical health were excluded.

RESULTS

A total of 252 publications were identified; 217 were assessed for eligibility, of which 23 studies met eligibility criteria and were included in the present systematic review. According to the findings, the Yazidi people were severely affected by persecution, forced migration, massacres, and ISIS violence in the recent period and suffered from a variety of mental and psychiatric problems. The most prevalent mental disorders among Yazidi people of all ages and sexes are PTSD, depression, and anxiety disorders.

CONCLUSION

This study indicates that the Yazidi minority is a traumatized population. According to the results of the current systematic review, the Yazidi have suffered from a variety of mental and psychological disorders, most commonly PTSD, depression, and anxiety. Eventually, addressing these challenges should be prioritized to improve the quality of life of Yazidis through implications for intervention.

Ethical and Forensic Issues in the Medico-Legal and Psychological Assessment of Women Asylum Seekers

Asylum-seeking migrants represent a vulnerable segment of the population, and among them, women constitute an even more vulnerable group. Most of these women and girls have been exposed to threats, coercion, and violence of many kinds, including rape, forced prostitution, harassment, sexual slavery, forced marriage and pregnancy, female genital mutilation/excision, and/or other violations of their rights (e.g., deprivation of education, prohibition to work, etc.). The perpetrators of the violence from which they flee are often their own families, partners, and even institutional figures who should be in charge of their protection (such as police officers). In the process for the acceptance/rejection of an asylum application, the forensic and psychological certification can make the difference between successful and unsuccessful applications, as it can support the credibility of the asylum seeker through an assessment of the degree of compatibility between the story told and the diagnostic and forensic evidence. This is why constant and renewed reflection on the ethical, forensic, and methodological issues surrounding medico-legal and psychological certification is essential. This article aims to propose some reflections on these issues, starting from the experience of the inward healthcare service dedicated to Migrant Victims of Maltreatment, Torture, and Female Genital Mutilation operating since 2018 at the Institute of Forensic Medicine of the University Hospital of Palermo.

Health and social consequences for survivors of genocidal rape: A systematic scoping review

The unique forms of trauma experienced by survivors of genocidal rape are not well understood. Hence, we conducted a systematic scoping review regarding the consequences for survivors of rape during genocide. Searches conducted in PubMed, Global Health, Scopus, PyscInfo, and Embase produced a total of 783 articles. After completing the screening process, 34 articles were eligible for inclusion in the review. The included articles focus on survivors from six different genocides, with most focusing on either the genocide of the Tutsis in Rwanda or the Yazidis in Iraq. The study findings consistently show that survivors deal with stigmatization as well as a lack of both financial and psychological social support. This lack of support is partly due to social ostracization and shame but is also attributed to the fact that many survivors' families and other providers of social support were murdered during the violence. Many survivors, particularly young girls, reported dealing with intense forms of trauma both as a direct result of sexual violence and due to witnessing the death of their community members during the period of genocide. A notable proportion of survivors became pregnant from genocidal rape and contracted HIV. Group therapy was shown to improve mental health outcomes across numerous studies. These findings have important implications and can inform recovery process efforts. Psychosocial supports, stigma reduction campaigns, community reestablishment, and financial assistance are integral in facilitating recovery. These findings can also play an important role in shaping refugee support programs.

The psychological impact of genocide on the Yazidis

Background

The genocide against the Yazidis by the Islamic State of Iraq and Al-Sham (ISIS) in the Sinjar area of Northern Iraq has costed many lives and has also caused a psychological long-term impact in this minority. This impact can be seen among individual survivors. Additionally, there is a large number of direct and indirect victims and for this reason, the impact can also be observed on the level of the group and society in this region at large.

Methodology

The research examines three different population groups (Yazidis members who had been exposed to violence by terrorist group actions, those not exposed to this experience as they were living in an area not directly exposed to ISIS violence, and a control group of non – Yazidi general population members). In total, 425 participants (age range 15–78) took part in the study and participated in interviews using standard scales to measure general physical and mental health.

Results

The results demonstrate that psychological stress and suicidality are higher among the Yazidis survivors of violence than in the other Yazidi participants.

Conclusion

Psychological disorders after a genocide and war in post-conflict populations should receive more attention in the planning of mental health care and prevention and should be seen as a major problem, especially in camp settings and displaced persons besides the usual increased prevalence of posttraumatic stress and other disorders covered by research so far in this context.

The Molecular Genetics of Dissociative Symptomatology: A Transdiagnostic Literature Review

Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.

The relationship between types of life events and the onset of functional neurological (conversion) disorder in adults: a systematic review and meta-analysis

Adverse life events precede the onset of functional neurological disorder (FND, also known as conversion disorder) more commonly than other neuropsychiatric conditions, but their aetiological role is unclear. We conducted a systematic review and quantitative analysis of the type, timing and number of life events preceding the onset of FND in adults, and a meta-analysis of the proportions of types of events in controlled studies. Fifty-one studies of different designs, covering 4247 patients, were eligible for inclusion. There was no clear majority of any type of preceding event. Family problems were the most common category of events, followed by relationship problems. Females were more likely to experience preceding family/relationship problems than males, who reported more work problems. Family problems were the commonest type of preceding event in studies in developing countries, whereas family and health problems were equally common in developed countries. Abuse was associated with early symptom onset, while patients with later onset were more likely to report family problems. The median number of events was one, and the events occurred closer to onset than in controls. Meta-analysis found that family, relationship and work events were all relatively more common in patients than pathological controls, as were events where symptoms might provide a solution to the stressor. In conclusion, although a range of events precede the onset of FND, they do not appear to do so uniformly. This may support a different aetiological role for stressors than in other disorders, although the support is indirect and the quality generally low.

Resilience and Hope Among Yazidi Women Released From ISIS Enslavement

ABSTRACT

This study aimed to explore the levels of resilience and hope among Yazidi women who survived captivity by Islamic State of Iraq and Syria (ISIS) and to examine its relationship with posttraumatic stress disorder (PTSD), generalized anxiety, and depressive symptoms. In this cross-sectional study, 139 formerly enslaved Yazidi women were assessed. The mean scores of resilience and hope were below the suggested cutoff means (M = 2.47, SD = 0.48, R = 1-5) and (M = 31.6, SD = 11.7, R = 8-64), respectively. Sociodemographic variables were not related to resilience and hope, other than those women who stayed in captivity for more than a 3-year period who reported significantly lower levels of hope (M = 28.36, SD = 11.69). Formerly enslaved Yazidi women who display higher levels of PTSD, generalized anxiety, and depression exhibit significantly lower levels of resilience and hope. Resilience and hope are therefore important concepts to explore in traumatized populations.

Epilepsy and psychogenic non-epileptic seizures in forcibly displaced people: A scoping review

With a growing number of forcibly displaced people (FDP) globally, the focus on their medical needs has necessarily increased. Studies about the prevalence and incidence of epilepsy and psychogenic non-epileptic seizures (PNES) in this population are, though, sparse. This Review highlights the importance of exploring and managing both conditions in these vulnerable people to promote global health. We performed an exhaustive review of 10 databases, as well as a manual search of relevant websites related to global health and refugee-related organizations. We analyzed data related to the prevalence and incidence of epilepsy and PNES; health visits; costs of medical care and challenges faced by healthcare workers in relation to FDP with these conditions. Fifty six papers met our inclusion criteria. Of these, 53 reported directly or indirectly on the prevalence of epilepsy and its costs in FDP. Two articles reported on the prevalence of PNES in forcibly displaced people. The reported prevalence of epilepsy in FDP varied from 0.2% to 39.13%, being highest in people with pre-existing neurological or psychiatric comorbidities. Only one study reported on the incidence of epilepsy in internally displaced children. Data from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) have identified a tendency to higher incidence of epilepsy in children following wars. While within displaced women without a history of sexual violence the rate of PNES was 16.7%, in FDP women with such a history the rate of PNES was 43.7% (p=0.02). The healthcare costs for epilepsy can be high, with recurrent health visits related to seizures being the most common cause of health encounters in refugee camps. Increasing awareness and further studies of multicultural aspects to improve shared understanding of seizure phenomenon in vulnerable displaced populations would seem crucial.

Positive psychotherapy in the treatment of traumatised Yezidi survivors of sexualised violence and genocide

So far, the psychotherapeutic treatment of patients with trauma spectrum disorders has most commonly been based on a disease model in which the normal reaction to trauma results in negative emotions, cognitions and behaviour which, in turn, cause a pathological state of mind or disorder. Here, trauma is associated with distress. This model focuses on identification, classification and treatment of the pathological and maladaptive modulations of the stress response that lead to psychological and social suffering and disability. In contrast to that, recent models in the Psychotherapy of the sequels of extreme life experiences, such as Positive Psychotherapy, have rather focussed on the building of competence, resilience and posttraumatic growth. In this article we summarise our experience in treating Yazidi women for their complex psychological traumata resulting from their experience of ISIS terror. We will use a short summary of published secondary data and reviews and use case examples from our work as primary data to discuss possible individual and collective resources that can help them to recover and to maintain a positive perspective on their person and the world, in spite of their terrible traumatic experiences. Original models of Positive Psychology already paid considerable attention to strength and resilience. The new approach of 'second wave' Positive Psychology expands on this, suggesting that negative emotions as well cultural factors must also be integrated. This approach appears to be particularly helpful in the treatment of this group of Yazidi women. Likewise, it seems to be promising when treating similar groups of people who survived extreme terror and were continuously exposed to genocidal environments.

The Significance of Justice in the Psychotherapeutic Treatment of Traumatized People After War and Crises

In the aftermath of crimes against humanity, human rights violations, and genocide, the question arises whether and how justice can be restored. A lack of social justice and continuing injustice in post-conflict areas prevent survivors from processing their traumatic experiences. As a consequence, the individuals and often their families, their community, and the whole society are changed in a lasting way. The trauma can even be passed on over generations. Yet, if war has a negative impact on health, then, programs that focus on achieving justice, peace, and stability should be able to offset or reduce this negative impact. For this reason, the importance of psychosocial well-being and mental health for the reconstruction of societies is acknowledged. Various political, legal, and social programs, like transitional justice, are being implemented in post-war regions to develop justice. Developing or restoring justice also requires good psychosocial care, like a treatment that supports individuals when coping with injustice and gaining a new sense of justice. Such a psychological treatment can make an important contribution when it comes to building new trust and improving mental health. Ethical standards in coping with trauma and developing or restoring justice in post-conflict regions are indispensable to enable long-term peace. The course for new social justice can be set, through a just health system. Thereby, only programs and legal processes, which try to do justice to the survivors and take their needs into account, are ethically justifiable. Human rights and health cannot be separated in psychotherapy with survivors of war and terror. Based on ethical principles, new approaches must be generated for psychotherapy in war regions and with survivors of war and terror. The aim will be to make an important contribution to the mental and social reconstruction of countries after mass violence.