The association between attachment and mental health symptoms among school-going adolescents in northern Uganda: the moderating role of war-related trauma

The relationship between attachment and posttraumatic stress in children and adolescents: A meta-analytic review

The relationship between attachment and posttraumatic stress symptoms (PTSS) has been researched extensively within adult samples, with findings consistently demonstrating a relationship between insecure attachment and increased PTSS, and between secure attachment and decreased PTSS. To a lesser extent, such relationships have also been explored within child and adolescent samples. The evidence to date is equivocal and there have been no attempts to synthesize studies. This meta-analysis aimed to provide a quantitative synthesis of studies reporting a relationship between attachment orientation (on both developmental and social psychological measures) and PTSS within children and adolescents. A random effects model was used to pool 30 studies (N = 10,431) reporting exposure to a range of traumatic events including maltreatment and war trauma. Results demonstrate a negative correlation between secure attachment and PTSS (r = -.16) and a positive correlation between insecure attachment (r = .20), avoidant attachment (r = .20), anxious attachment (r = .32), and disorganized attachment (r = .17) and PTSS. These findings indicate a small but significant relationship between attachment and PTSS in children and adolescents. Exposure to maltreatment did not moderate the relationship between secure attachment and PTSS, though strengthened the relationship between insecure attachment and PTSS.

Educational crisis of Rohingya refugee children in Bangladesh: Access, obstacles, and prospects to formal and non-formal education

Purpose

The article discusses the contemporary educational crisis of Rohingya children in Bangladesh. It aims to identify the challenges of formal and non-formal education faced by Rohingya children and their prospects. In this scholarship, the author attempts to answer the questions-what are the current formal and non-formal educational services in the Rohingya refugee camps and how and to what extent do the existing educational services intensify the other crisis in their lives, and what are the prospects for them going forwards.

Method

ology: This study is primarily based on secondary sources of data. It focuses on the available educational services and key obstacles that affect Rohingya children's formal and non-formal educational opportunities in Bangladesh and their prospects in Myanmar.

Findings

The study found the absence of formal and non-formal education for Rohingya children in refugee camps has a significant impact on their ability to become an active member of society. Although refugee children and their parents express a willingness to formal education under the Myanmar curriculum, limited educational services and various structural and legal barriers hinder their progress. Finally, the study explores the prospects of formal and non-formal education for Rohingya children in Bangladesh and concludes with recommendations to improve their educational opportunities.

Limitation

The study results can differ in other contexts and countries hosting refugees.

Practical implications

Findings of the study may be helpful for policymakers and practitioners.

Contextualizing Potential Factors Impacting on Behaviors of Primary School Adolescents in Northern Uganda

Our study contextualized empirical factors influencing adolescent behaviors. An assessment using focus group discussion (FGD) was done with randomly selected adolescents in primary schools in Northern Uganda to explore the influence of child poverty and parenting among other factors on adolescents' behaviors. A semi-structured interview guide and in-depth interviews were also conducted for parents/guardians and teachers, respectively. Adolescents expressed desirable developmental outcomes contrary to teachers' concerns regarding achieving them. Parenting and places of residence had a significant positive impact on adolescent behaviors, with the village residence having a much earlier influence compared to parenting. Our findings revealed a scanty understanding of child poverty, parenting, and adolescent development among parents/guardians. Any action-oriented toward awareness would promote adolescent behavioral development.

Parental neglect, anxious attachment, perceived social support, and mental health among Chinese college students with left-behind experience: A longitudinal study

The harm of childhood parental neglect to emerging adults' maladjustment has garnered empirical support. For college students who have left-behind experience (LBE), this relationship is rarely discussed and the psychological process underlying this relationship is not well understood. Using a longitudinal study and guided by the Risky Families model, this study aimed to explore the mediating roles of anxious attachment and perceived social support in the link between parental neglect and maladjustment of LBE college students. We used two-wave longitudinal data, with a time lag of 3 months, collected among Chinese college students with LBE in Chongqing (N = 391). The results revealed that parental neglect in wave one was positively associated with maladjustment (depression, anxiety, and stress) in wave two. Anxious attachment and perceived social support in wave two separately mediated the relationship between parental neglect in wave one and maladjustment in wave two. Anxious attachment and perceived social support in wave two only sequentially mediated the pathway from parental neglect to later depression. These findings emphasize the importance of anxious attachment and social support in resilience and have significant implications for LBE college students' social work practice in China.

Attachment and social support mediate associations between polyvictimization and psychological distress in early Uganda and Kenya adolescents

BACKGROUND

There is strong evidence that the experience of several potentially traumatic events (polyvictimization) is a risk factor for posttraumatic stress disorder (PTSD) and psychological distress among adolescents. The identification of the variables that influence the link between polyvictimization and PTSD and other psychiatric symptoms is warranted.

OBJECTIVE

We analyzed the associations between polyvictimization, PTSD symptoms (PTSS) and psychiatric symptoms in Kenya and Uganda adolescents, and explored the mediating roles of attachment orientations and perceived social support in the associations between polyvictimization, PTSS and psychiatric symptoms among adolescents from lower-middle-income countries (LALMIC).

PARTICIPANTS AND SETTING

A sample of 481 Kenyan adolescents (M = 16.28; SD = 1.878) and a sample of 408 Uganda adolescents (M = 15.95; SD = 1.377) completed validated self-report questionnaires.

METHODS

Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008).

RESULTS

Polyvictimization was related to higher PTSS and psychiatric symptoms. Importantly, polyvictimization was significantly linked to high attachment anxiety, which was linked with low perceived social support, which in turn was linked with high PTSS levels and psychiatric symptoms.

CONCLUSIONS

High levels of attachment anxiety might be connected with lack of perceived social support, which might be seen as a possible psychological distress mechanism subsequent to exposure to polyvictimization in adolescence from LALMIC.

The content and meaning of war experiences: A qualitative study of trauma and resilience among Liberian young refugees in Ghana

Abundant research has shown that traumatic war experiences can interfere with the mental health and wellbeing of children and adolescents, but less is known about the subjective experiences and views of war survivors. The present study identified and described the different types of war experiences of young refugees in an African context and analyzed how they perceived the meanings and impact of war on their lives. The participants were 13 Liberian 25-35-year-old male and female refugees living in Ghana who agreed to take part in semi-structured interviews based on the life history approach. The transcripts were analyzed using a phenomenological method to detect themes incorporating multiple subthemes. The results revealed five main themes about war experiences, all negative in nature: pain and humiliation, loss of close relationships, horrific scenes, threats to life, and fleeing for one's life. Concerning the perceived meanings and impact of war, the results identified six main themes. Three of them were positive in nature: increased awareness of life, compassion for life, and identification with those suffering. The negative main themes incorporated vivid horrific memories, deprivation of age-appropriate opportunities, and self-harm and destructive behavior. Our findings suggest that young war survivors may be highly motivated to participate in nation- and peace-building and should be provided opportunities to contribute to broader political and civic life.

The impact of parent and child media use on early parent-infant attachment

With the rise in affordability of digital media and mobile devices, children under age 2 on average spend significantly more time with digital media than is recommended. Although concerns have been expressed about how parent and child media use might negatively impact parent-child attachment, there continues to be a scarcity of research on the topic. The current study assessed both the amount and the way in which children (11-26 months) and their parents engage with digital media and the impact on early attachment after controlling for temperament, parent income, parent age, marital status, and access to support. The study utilizes data from a diverse sample: 248 parents of infants completed an attachment q-sort and surveys assessing the amount of media use, parental absorption in media, types of parental mediation, temperament, and demographics. Results showed that for both parent and child, time using digital media and co-viewing was not predictive of attachment insecurity. Parental absorption in media was found to significantly predict attachment insecurity. Greater child TV media use was associated with poorer attachment security when there was limited to no parental active mediation. Active mediation served as a protective factor for attachment while parental absorption in media serves as a risk factor for attachment.

The Differential Effects of Insecure Attachment on Post-Traumatic Stress: A Systematic Review of Extant Findings and Explanatory Mechanisms

It is well-documented that insecure attachment poses substantial risks to post-trauma recovery. Although attachment anxiety reliably predicts and is associated with elevated post-traumatic stress symptoms (PTSS), the attachment avoidance-PTSS link has been far less consistent. This suggests both attenuating and enhancing connections between attachment difficulties and post-trauma outcomes. The goal of this study is 2-fold: (a) to review and summarize extant evidence concerning the relation between insecure attachment and PTSS and (b) to review mechanism(s) underlying attachment anxiety and attachment avoidance that may explain the development of PTSS. Following a systematic review of the empirical literature investigating attachment, trauma, and post-trauma reactions, a total of 138 studies were identified and summarized. The review further identifies explanatory mechanisms underlying the association between insecure attachment and PTSS, including stress appraisals, cognitive factors, self-esteem, emotion regulation strategies, social factors, and trauma-specific factors (i.e., type of trauma, extreme stress). Implications for practice, policy, and research are discussed.

The mental, reproductive, and physical health impacts of female children's association with armed forces and groups

BACKGROUND

Globally, over 300,000 children are being used in armed groups, including young girls some as young as eight years old. These young girls often called female children associated with armed groups and armed forces (CAAFAG), are exposed to high levels of violence and experience extensive abuse.

OBJECTIVE

This review aimed to understand the unique health consequences of association on female CAAFAG and the factors associated with their increased health vulnerability.

METHODS

The research utilized a review protocol, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search yielded 449 unique articles, 53 (12 %) of which were included for final analysis to identify health concerns for female CAAFAG. Qualitative literature was also analyzed using thematic analysis to identify factors and experiences associated with female CAAFAG's increased risk of experiencing adverse health outcomes.

RESULTS

Internalizing and functional impairment presented unique challenges for females, largely due to their distinct experiences with stigma upon return to communities and returning with children.

CONCLUSIONS

Based on the findings of this review, female CAAFAG are at a unique risk for internalizing, functional impairment, and reduced adaptive behaviors. This review also highlights girls' post-conflict experiences of stigma, internal tensions, and returning with a child as modifiable risk factors for poor mental health.

Trauma exposure, mental health and tobacco use among vulnerable Syrian refugee youth in Jordan

BACKGROUND

Little is known about tobacco use among youth exposed to armed conflicts, or the influence of trauma on tobacco use in this context. This study examined patterns of smoking by tobacco product and gender among Syrian refugee youth living in host communities in Jordan and assessed the associations of post-traumatic stress disorder (PTSD) and depression symptoms, trauma exposure and social support with current smoking status in boys and girls.

METHODS

Syrian refugee students (mean [standard deviation] age = 14.9 [1.33] years) were identified through the public school system. Data were collected using an online Arabic questionnaire that included questions about demographics, trauma exposure, current smoking (cigarette and waterpipe), PTSD, depression and perceived social support. Logistic regression was used to assess the adjusted effects of independent variables on current smoking status.

RESULTS

One in 7 boys and one in 14 girls were current smokers, with boys reporting greater tobacco use than girls. Among boys, current smokers reported significantly higher family member loss and lower perceived family social support than nonsmokers; among girls, current smokers also reported significantly higher family member loss as well as greater PTSD symptoms and lower perceived significant other/special person social support.

CONCLUSIONS

Tobacco use is established among this vulnerable group. The findings highlight the potential role of psychosocial support for tobacco prevention and cessation strategies.

Are parenting practices associated with the same child outcomes in sub-Saharan African countries as in high-income countries? A review and synthesis

Introduction

There is increasing interest in the transferability of parenting interventions from high-income countries (HICs) to low-income countries (LICs) in order to improve child development and health outcomes. This is based on the premise that associations between parenting practices and child outcomes are similar in both settings. Many parenting interventions in HICs are evidence-based, but less evidence exists on associations of parenting practices with child outcomes in LICs, in particular, sub-Saharan African (SSA) countries. This review synthesises evidence on the association of parenting practices with child outcomes in SSA in order to compare findings with those from HICs.

Methods

We searched electronic databases—Web of Science, ASSIA, Embase, IBSS and PsycINFO—to identify studies from SSA that reported quantitative associations between parenting practices and child health or psychosocial outcomes (eg, sexual and reproductive health (SRH), mental health, conduct disorders). Due to inconsistent conceptual framing of parenting across studies, we used a modified version of the international WHO classification of parenting dimensions to guide synthesis of the results.

Results

Forty-four studies met our inclusion criteria. They were conducted in 13 SSA countries and included cross-sectional and longitudinal studies, and were predominantly descriptive studies rather than intervention research. Synthesis of results showed that associations between patterns of parenting (‘positive’/‘harsh’) and child outcomes (including SRH, mental health and conduct disorders) in studies from SSA were broadly similar to those found in HICs.

Conclusions

These findings suggest that the impacts of parenting practices on child outcomes are similar across contrasting global regions and, therefore, parenting interventions from HICs might be successfully transferred to SSA, subject to appropriate adaptation. However, this review also highlights the paucity of evidence in this area and the urgent need for higher quality studies to confirm these findings to help develop effective parenting interventions in SSA.

Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda

BACKGROUND

Despite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma.

METHODS

A non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention.

RESULTS

Caregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10-0.62] and 6 months (RR 0.33, 95% CI 0.11-0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers.

CONCLUSION

IPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

Early life stress, air pollution, inflammation, and disease: An integrative review and immunologic model of social-environmental adversity and lifespan health

Socially disadvantaged individuals are at greater risk for simultaneously being exposed to adverse social and environmental conditions. Although the mechanisms underlying joint effects remain unclear, one hypothesis is that toxic social and environmental exposures have synergistic effects on inflammatory processes that underlie the development of chronic diseases, including cardiovascular disease, diabetes, depression, and certain types of cancer. In the present review, we examine how exposure to two risk factors that commonly occur with social disadvantage-early life stress and air pollution-affect health. Specifically, we identify neuroimmunologic pathways that could link early life stress, inflammation, air pollution, and poor health, and use this information to propose an integrated, multi-level model that describes how these factors may interact and cause health disparity across individuals based on social disadvantage. This model highlights the importance of interdisciplinary research considering multiple exposures across domains and the potential for synergistic, cross-domain effects on health, and may help identify factors that could potentially be targeted to reduce disease risk and improve lifespan health.

Attachment Security Priming as a Potential Intervention for Depressive Symptoms

Numerous studies have demonstrated that people high on attachment insecurity are more likely to report depressive symptoms as compared to those low on insecurity (secures). These findings suggest that enhancing one's sense of attachment security could help relieve depressive symptoms. One promising technique for increasing attachment security that has received relatively little attention as a therapeutic intervention is attachment security priming. Compared with other interventions, security priming is easier and takes less time to administer. The current studies examined if priming techniques used to increase attachment security could reduce depressive symptoms in an adolescent and emerging adults samples. In Study 1, depressive symptoms were assessed before exposure to either attachment security or neutral primes and then re-assessed one week later. Results revealed that participants who were exposed to the security primes reported a greater decrease in depressive symptoms than the control group. In Study 2, adolescents who were repeatedly exposed over two weeks to security primes showed lower depression symptoms than participants exposed to neutral primes. Overall, our findings provide initial support to the idea that attachment security priming can be a useful method to help decrease depressive symptoms.

The impact of attachment and depression symptoms on multiple risk behaviors in post-war adolescents in northern Uganda

BACKGROUND

We have previously shown that depression symptoms are associated with multiple risk behaviors and that parental attachments are protective against depression symptoms in post-war adolescents. Accumulating literature indicates that low levels of attachment may sensitize individuals to increased multiple risk behaviors when depression symptoms exist. This investigation examined the interactive effects of attachment and depression symptoms on multiple risk behavior.

METHODS

We conducted hierarchical logistic regression analyses to examine the impact of attachment and depression symptoms on multiple risk behavior in our post-war sample of 551 adolescents in Gulu district.

RESULTS

Analyses revealed interactive effects for only maternal attachment-by-depression interaction. Interestingly, high levels of maternal attachment exacerbated the relationship between depression symptoms and multiple risk behaviors while low levels of maternal attachment attenuated this relationship.

LIMITATIONS

It is possible that this analysis could be biased by a common underlying factor that influences self-reporting and therefore is correlated with each of self-reported attachment security, depressive symptoms, and multiple risk behaviors.

CONCLUSIONS

These findings suggest that maternal attachment serves as a protective factor at low levels while serving as an additional risk factor at high levels. Findings support and expand current knowledge about the roles that attachment and depression symptoms play in the development of multiple risk behaviors and suggest a more complex etiology for post-war adolescents.

A systematic review on tobacco use among civilian populations affected by armed conflict

OBJECTIVE

To systematically examine evidence on tobacco use among conflict-affected civilian populations.

DATA SOURCES

Primary quantitative and qualitative studies published in English up to April 2014. Bibliographic databases searched were EMBASE, Global Health, MEDLINE, PsycEXTRA, PsycINFO, Web of Science, Cochrane; with the main terms of: (Smoke*, tobacco*, cigarette*, nicotine, beedi, bidi, papirosi, dip, chew, snuff, snus, smokeless tobacco) AND (armed-conflict, conflict-affected, conflict, war, refugee, internally displaced, forcibly displaced, asylum, humanitarian). Grey literature was searched using humanitarian databases, websites and search engines.

STUDY SELECTION

Studies were independently selected by two reviewers, with a study outcome of tobacco use and a population of conflict-affected civilian populations such as internally displaced persons, refugees, residents in conflict-affected areas, residents and returning forcibly displaced populations returning in stabilised and postconflict periods. 2863 studies were initially identified.

DATA EXTRACTION

Data were independently extracted. The Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Programme for qualitative studies were used to assess study quality.

DATA SYNTHESIS

39 studies met inclusion criteria and descriptive analysis was used. Findings were equivocal on the effect of conflict on tobacco use. Evidence was clearer on associations between post-traumatic stress and other mental disorders with nicotine dependence. However, there were too few studies for definitive conclusions. No study examined the effectiveness of tobacco-related interventions. The quantitative studies were moderate (N=13) or weak (N=22) quality, and qualitative studies were moderate (N=3) or strong (N=2).

CONCLUSIONS

Some evidence indicates links between conflict and tobacco use but substantially more research is required.

Mapping Rwanda public health research (1975-2014)

BACKGROUND

Since the genocide occurred in 1994, Rwanda has faced up to the challenge of rebuilding. Public health is a main field to understand this rebuilding.

OBJECTIVES

In this paper, the aim was to map the scientific research on public health in Rwanda after the genocide and to present the links between different financing systems.

METHODS

We used bibliographic analyses with Web of Science of papers published during the period 1975-2014. We performed analyses on journals, most cited articles, authors, publication years, organizations, funding companies, countries, and keywords.

RESULTS

We obtained 86 articles between 1975 and 2014. Most articles were published after 2007. The main countries of research laboratories were the United States of America, Rwanda, England and Belgium and represented the main network collaboration. The relevant keywords were: HIV, woman, child, program, rural and violence.

CONCLUSIONS

Public health research on Rwanda appeared 14 years after the genocide. A main field was emerging: the spread of HIV with mother-child transmission, and the policies to take this subject into account in rural zones. The network of institutions developing these studies was USA-Rwanda.

Differential roles of childhood adversities and stressful war experiences in the development of mental health symptoms in post-war adolescents in northern Uganda

BACKGROUND

Previous studies have shown a relationship between stressful war experiences and mental health symptoms in children and adolescents. To date, no comprehensive studies on the role of childhood adversities have been conducted with war-exposed adolescents living in post-war, low-resource settings in Sub-Saharan Africa.

METHODS

A cross-sectional study of 551 school-going adolescents aged 13-21 years old was undertaken four years post-war in northern Uganda. Participants completed self-administered questionnaires assessing demographics, stressful war experiences, childhood adversities, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms.

RESULTS

Our analyses revealed a main effect of gender on all mental health outcomes except avoidance symptoms, with girls reporting higher scores than boys. Stressful war experiences were associated with all mental health symptoms, after adjusting for potential confounders. Childhood adversity was independently associated with depression symptoms but not PTSD, anxiety, and PTSD cluster symptoms. However, in situations of high childhood adversity, our analyses showed that stressful war experiences were less associated with vulnerability to avoidance symptoms than in situations of low childhood adversity.

CONCLUSIONS

Both stressful war experiences and childhood adversities are risk factors for mental health symptoms among war-affected adolescents. Adolescents with histories of high childhood adversities may be less likely to develop avoidance symptoms in situations of high stressful war experiences. Further exploration of the differential roles of childhood adversities and stressful war experiences is needed.