The relationship between organized violence, family violence and mental health: findings from a community-based survey in Muhanga, Southern Rwanda

Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019 : a prospective cohort study

BACKGROUND

To assess the burden and change in incidence, death, and disability-adjusted life years (DALYs) for all-cause-specific injuries among children and adolescents in 204 countries and territories between 1990 and 2019.

MATERIALS AND METHODS

Data were extracted from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019). Global, regional, and country-level age-standardized rate (per 100,000) of incidence (ASRI), mortality (ASRM), and DALYs (ASRD) with 95% uncertainty interval (95% UI) of injuries were estimated by age, sex, socio-demographic index (SDI), and all-cause specific injuries from 1990 to 2019.

RESULTS

Overall, the ASRI, ASRM, and ASRD of injury were 9006.18 (95%UI: 7459.74 to 10918.04), 23.04 (20.00 to 26.50), and 2020.19 (1759.47 to 2318.64) among children and adolescents worldwide in 2019, respectively. All the above indicators showed a downward trend from 1990 to 2019. In level 2 cause of injury, both the global transport injury and unintentional injury declined during the study years, while self-harm and interpersonal violence-related injury showed an increasing trend. High SDI regions had higher ASRI of injuries, but low SDI regions had higher ASRM and ASRD of injuries globally in 2019. Males had a higher burden of injuries than those in females. The ASRI of injuries is higher in adolescents aged 15-19 years, whereas the mortality and DALYs rate are higher among children under 5 years old. Moreover, adolescents aged 15-19 years and individuals living in Central Asia, Middle East, and Africa had higher ASRI, ASRM, and ASRD of injuries owing to self-harm and interpersonal violence. Generally, falls and road traffic injuries are the leading cause of injury among the population aged 0-19 years worldwide, but self-harm, interpersonal violence, and conflict and terrorism are also leading types of injuries in some regions, particularly in Low- and Middle-Income Countries.

CONCLUSIONS

Injury remains a major global public health problem among children and adolescents, although its burden at the worldwide level showed a decreasing trend from 1990 to 2019. Of concern, the burden of injuries caused by transport injuries, and unintentional injuries has shown a downward trend in most countries, while the burden caused by self-harm and interpersonal violence has shown an upward trend in most countries. These findings suggest that more targeted and specific strategies to prevent the burden of injuries should be reoriented, and our study provides important findings for decision-makers and healthcare providers to reduce injury burden among children and adolescents.

Clinical characteristics of psychotic disorders in patients with childhood trauma

Childhood trauma is an important predictor of psychotic disorders, with special emphasis on physical and sexual abuse. It influences the clinical picture and course of psychotic disorders. This study was conducted in the Department of Psychiatry of the University Clinical Hospital Mostar. The sample consisted of 135 participants, aged 18 to 65 years. The screening instrument to examine cognitive status was the short version of MMSE-2. Patients' background information was collected using a sociodemographic questionnaire constructed for this study. To determine childhood trauma, the Child Abuse Experience Inventory was used to examine physical, sexual, and emotional abuse, neglect and domestic violence. The positive and negative syndrome scale scale was used to evaluate the clinical profile of psychoticism, the SSI questionnaire was used to evaluate the severity of suicidality, and the functionality of the participants was evaluated using the WHODAS 2.0. Results indicate that a significant number of participants with psychotic disorders experienced childhood trauma, an important determinant of their illness. Participants who had witnessed abuse had more severe clinical presentations (earlier onset and longer duration of illness) and more pronounced psychotic symptomatology and a lower degree of functionality. Decreased functionality is associated with witnessing abuse and physical abuse. During the civil war, a significant percentage of the participants were in childhood and adolescent development (26.7%) and exposed to frequent emotional abuse and domestic violence. As 1 traumatic event in childhood makes a person more susceptible to more traumatic experiences during life. Childhood trauma is a serious and pervasive problem that has a significant impact on the development, course, and severity of the clinical presentation of psychotic disorders. Accordingly, it is necessary to provide continuous education to mental health workers, primarily psychiatrists, regarding childhood trauma so that treatment may be approached more systematically and a plan of therapeutic interventions may be more adequately designed, which would necessarily include psychosocial support in addition to pharmacotherapy.

"What Did You Do in the War, Daddy?": Paternal Military Conscription During WWII, Economic Hardship and Family Violence in Childhood, and Health in Late Life in Japan

Childhood adversity is a risk factor for poor health in late life and includes economic hardship and family violence, whose prevalence is high among offspring of military conscripted father. We assessed the association between paternal military conscription (PMC) and paternal war death (PWD) during Second World War and self-rated health (SRH) among older adults in Japan. Data were obtained from a population-based cohort of functionally independent people aged 65 years or older from 39 municipalities across Japan in 2016. Information on PMC and SRH was obtained through a self-report questionnaire. A total of 20,286 participants were analyzed with multivariate logistic regression to investigate the association between PMC, PWD, and poor health. Causal mediation analysis was performed to see whether childhood economic hardship and family violence mediated the association. Among participants, 19.7% reported PMC (including 3.3% PWD). In the age- and sex-adjusted model, older people with PMC showed higher risk of poor health (odds ratio [OR]: 1.16, 95% confidence interval [CI] [1.06, 1.28]), while those with PWD were not associated (OR: 0.96, 95% CI [0.77, 1.20]). Causal mediation showed a mediation effect of childhood family violence exposure on the association between PMC and poor health (proportion mediated: 6.9%). Economic hardship did not mediate the association. PMC, but not PWD, increased the risk of poor health in older age, which was partially explained by the exposure to family violence in childhood. There appears to be a transgenerational health impact of war which continues to affect the health of offspring as they age.

"A calf cannot fail to pick a colour from its mother": intergenerational transmission of trauma and its effect on reconciliation among post-genocide Rwandan youth

BACKGROUND

More than one million Rwandans were killed over a span of one hundred days during the 1994 genocide against the Tutsis. Many adult survivors were severely traumatized by the events, and young people, including those who were born after the genocide, have experienced similar genocide-related trauma. Building on a growing body of research on the generational transmission of trauma, our study addressed the following questions: (1) what are the possible mechanisms of trauma transmission from older generation to post-genocide Rwandan youth, and (2) what are the effects of intergenerational trauma on reconciliation processes in Rwanda.

METHODS

A qualitative study was conducted in Rwanda among youth born after the genocide, with parents who survived the 1994 genocide against the Tutsis and among mental health and peace-building professionals. Individual interviews (IDIs) included 19 post-genocide descendants of survivors and six focus group discussions (FGDs) were conducted with 36 genocide survivor parents residing in Rwanda's Eastern Province. Ten IDIs were also conducted with mental health and peace-building professionals in the capital city of Kigali. Respondents were recruited through five local organisations that work closely with survivors and their descendants. An inductive thematic analysis approach was used to analyse the data.

RESULTS

Findings from this study suggest that the trauma experienced by genocide survivor parents is perceived by Rwandan youth, mental health and peace-building professionals, and survivor parents themselves to be transmitted from parent to child through human biology mechanisms, social patterns of silence and disclosure of genocide experiences, and children's and youth's everyday contact with a traumatized parent. Genocide-related trauma among survivor parents is seen as often being triggered by both life at home and the annual genocide commemoration events. Additionally, when transmitted to genocide survivor descendants, such trauma is understood to negatively affect their psychological and social well-being. Intergenerational trauma among youth with genocide survivor parents limits their involvement in post-genocide reconciliation processes. Findings specifically show that some youth avoid reconciliation with a perpetrator's family due to mistrust as well as fear of re-traumatizing their own parents.

Putative juvenile terrorists: the relationship between multiple traumatization, mental health, and expectations for reintegration among Islamic State recruited adolescent and young adult fighters

Background

In several conflicts worldwide children are recruited as fighters in irregular forces. These children need to be reintegrated into the society after the conflict. However, concurrent to various reservations in the communities, the reintegration of former child soldiers is challenged by the fact that many of the affected children were indoctrinated by the armed group and traumatized through war events. Even several years after the defeat of the terrorist organization ISIS in Iraq, systematic efforts towards the reintegration of children who had been recruited by ISIS are notably absent.

Methods

we conducted clinical interviews with a sample of N = 59 adolescents and young adults who were incarcerated for terrorism in the prisons of the Kurdistan Region of Iraq to assess levels and types of trauma exposure, PTSD, depression, readiness to reintegrate and ongoing identification with ISIS.

Results

We found high levels of PTSD and depression that were associated with trauma exposure. The subjective readiness to reintegrate into the communities was associated with trauma exposure and was mediated by depression, even after controlling for the influence of ongoing identification with the armed group.

Conclusion

The study indicates that trauma-related mental ill-health should be considered in efforts to reintegrate young former terrorists.

Domestic and family violence knowledge and skills: A private mental health service survey of nurses, allied health, and medical clinicians

Mental healthcare services have an important role to play in recognizing and responding to domestic and family violence (DFV). This study aimed to evaluate staff knowledge, confidence, and clinical skills in family violence in an Australian private mental healthcare service. The methodology utilized was a cross-sectional, online survey of clinical staff. In total, 93 clinical staff participated (51 nursing, 37 allied health, and 5 medical), with a 29% response rate. Most clinicians reported working with patients who had disclosed experiencing family violence, but the majority of clinicians (63%) had received no training in the area, with nurses reporting the lowest training levels. Less than 20% reported definitive knowledge of important clinical skills including key family violence indicators, asking about family violence, and responding to disclosures. However, qualitative text response data indicated that many clinicians would provide responses that encompassed best-practice recommendations. Overall, the results indicated suboptimal clinician family violence knowledge, with further training needed, particularly in nursing staff. Stronger knowledge and skills in social workers and psychologists, relative to nurses, paralleled existing research in a medical hospital sample. The data from the study will be utilized to inform the implementation of a hospital-wide quality and service improvement project in the area of DFV clinical response.

Which Factors Are Associated With Adolescent Reports of Experiencing Various Forms of Abuse at the Family Level in Post-Conflict Northern Uganda?

Research assessing familial violence against adolescents, using caregiver-adolescent dyads, is limited in post-conflict settings. This study aimed to determine the prevalence and factors associated with adolescent-reported familial abuse in post-conflict northern Uganda. It also assessed the relationship between abuse subtypes and (a) beliefs supporting aggression and (b) adolescent well-being and life satisfaction. A randomly selected community-based sample of 10- to 17-year-old adolescents (54% girls) and their caregivers (N = 427 dyads) in two northern Uganda districts was used. Abuse outcomes were adolescent reported. All measures used standardized tools that have been adapted for research in resource-limited settings. Analyses used multivariable linear regressions in Stata 14/IC. Overall, physical, emotional, and sexual abuse rates were 70% (confidence interval [CI] = [65.7, 74.4]), 72% (CI = [67.4, 76.0]), and 18.0% (CI = [14.0, 21.2]), respectively. Polyvictimization was 61% (CI = [55.4, 64.7]). There were no gender differences regarding adolescent reports of physical and emotional abuse, but adolescent girls were more likely to report sexual abuse and polyvictimization than adolescent boys. All forms of adolescent-reported abuse (except sexual abuse) were associated with caregiver reports of harsh disciplinary practices. In addition, emotional abuse was associated with physical and sexual abuse. Physical abuse was associated with being an orphan and emotional abuse. Sexual abuse was associated with being a girl, older adolescent age, living in a larger household, and emotional abuse. Polyvictimization was positively associated with being an orphan, younger caregiver age, caregiver-reported poor monitoring and supervision, and higher household socioeconomic status, but negatively associated with lower parental role satisfaction. Physical and emotional (but not sexual) abuse and polyvictimization were associated with beliefs supporting aggression among adolescents. All abuse subtypes were associated with lower levels of perceived well-being and life satisfaction among adolescents in this study. Child abuse prevention programs have the potential to improve adolescent-caregiver interaction and interrupt the violence transmission cycle in this setting.

Transgenerational Trauma and Mental Health Needs among Armenian Genocide Descendants

The trauma of a genocide can be transmitted to subsequent generations though familial mental health, sociopolitical trauma, and cultural narratives, thereby impacting mental health and well-being. Understanding specific mechanisms that are unique to each ethnic group impacted by genocide illuminates cultural, sociopolitical, and individual factors related to the transmission. For the Armenian community, the unresolved historical loss of the Armenian Genocide of 1915, with the threat of acculturation for such a large diasporic population, a continued denial by the perpetrators, as well as subsequent generations’ refugee experiences, may further exasperate the impact of transgenerational trauma from the genocide. This literature review explores the mental health needs of Armenian youth in the current sociopolitical context and provides implications for how schools and communities may use this knowledge to inform supports that center Armenian community healing. Future directions for research are also discussed.

Impact of Parental Exposure on Offspring Health in Humans

The possibility that parental life experiences and environmental exposures influence mental and physical health across generations is an important concept in biology and medicine. Evidence from animal models has established the existence of a non-genetic mode of inheritance. This form of heredity involves transmission of the effects of parental exposure to the offspring through epigenetic changes in the germline. Studying the mechanisms of epigenetic inheritance in humans is challenging because it is difficult to obtain multigeneration cohorts, to collect reproductive cells in exposed parents, and to exclude psychosocial and cultural confounders. Nonetheless, epidemiological studies in humans exposed to famine, stress/trauma, or toxicants have provided evidence that parental exposure can impact the health of descendants, in some cases, across several generations. A few studies have also started to reveal epigenetic changes in the periphery and sperm after certain exposures. This article reviews these studies and evaluates the current evidence for the potential contribution of epigenetic factors to heredity in humans. The challenges and limitations of this fundamental biological process, its implications, and its societal relevance are also discussed.

Maternal mental health symptoms are positively associated with child dietary diversity and meal frequency but not nutritional status in Eastern Democratic Republic of Congo

OBJECTIVE

The objective was to examine the association between symptoms of maternal mental health problems and child diet and nutritional status in South Kivu, Democratic Republic of Congo.

DESIGN

Maternal depression and anxiety symptoms were measured by the Hopkins Symptom Checklist-25 (HSCL-25), and post-traumatic stress was measured by the Harvard Trauma Questionnaire (HTQ). Participants were classified as having high psychological distress if their mean item score was in the upper quartile of both measures. Dependent variables included child dietary diversity, meal frequency, height-for-age z score (HAZ), weight-for-age z score (WAZ), weight-for-height z score (WHZ), stunting and underweight. Bivariate and multivariate regression analyses were conducted.

SETTING

The study was nested in a larger quasi-experimental study evaluating Jenga Jamaa II, a food and nutrition assistance project in Uvira and Fizi territories.

PARTICIPANTS

In total, 812 mother-child pairs participated. Children ranged from 2·6 to 5·6 years of age.

RESULTS

HSCL-25 (ß: 0·18, P < 0·05) and HTQ (ß: 0·19, P < 0·05) were statistically significantly associated with higher dietary diversity scores, and all maternal mental health measures were associated with higher meal frequency (HSCL-25: ß: 0·13, P = 0·001; HTQ: ß: 0·12, P = 0·001; high distress: ß: 0·15, P < 0·05) and consumption of at least three meals/snacks per day (HSCL-25: OR: 2·06, HTQ: OR: 1·93, high distress: OR: 2·68, P < 0·001 for all). No significant associations were found with HAZ, WAZ, WHZ, stunting or underweight indicators.

CONCLUSIONS

More severe symptoms of maternal mental health problems were positively associated with child diet, but not anthropometry indicators. More research is needed to understand the role of maternal mental health in child feeding practices in food insecure and resource-poor settings.

Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire

BACKGROUND

Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.

OBJECTIVE

We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.

PARTICIPANTS AND SETTING

192 unique samples consisting of 68,830 individuals.

METHODS

We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.

RESULTS

We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.

CONCLUSIONS

These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.

Mental health symptoms and their relations with dietary diversity and nutritional status among mothers of young children in eastern Democratic Republic of the Congo

Background

In developing countries, maternal mental health problems have been linked to sub-optimal child feeding practices and child underweight and stunting, but little is known about how maternal mental health is associated with mothers’ own diets and nutritional status. The objective of the study was to investigate the association between mental health symptoms and diet and nutritional status of mothers of young children in South Kivu, DR Congo.

Methods

Participants were 828 mothers of young children enrolled in a larger, quasi-experimental study evaluating a multi-year food security and nutrition project. The present analysis was conducted with cross-sectional data collected from 2015 to 2016. We assessed symptoms of anxiety and depression using the Hopkins Symptom Checklist-25 (HSCL-25) and post-traumatic stress disorder (PTSD) with the Harvard Trauma Questionnaire (HTQ), using a four-point Likert scale. Mean scale scores were calculated ranging from one to four. A variable was created for high distress (participants scoring in the upper quartile of both measures). Dietary diversity scores were calculated from the number of food groups (range zero to ten) consumed the previous day, identified from an open recall. Nutritional status was measured by body mass index (BMI) and underweight (BMI < 18.5 kg/m², or mid-upper arm circumference < 23 cm for pregnant women). Bivariate and multivariate (adjusting for parent study intervention group, education, age, health, parity, livelihoods zone, and territory of origin) regression analyses were conducted.

Results

Maternal mental health measures were positively and statistically significantly associated with higher dietary diversity scores in adjusted analyses (HSCL-25: ß= 0.18, p = 0.002, HTQ: ß= 0.12, p = 0.029, High Distress: ß= 0.47, p < 0.001). Mental health symptoms were not significantly associated with BMI (HSCL-25: ß = − 0.04, p = 0.824; HTQ: ß = 0.02, p = 0.913; High distress: ß= − 0.02, p = 0.938) or underweight (HSCL 25: OR = 0.91, p = 0.640; HTQ: OR = 1.03, p = 0.866; High distress: OR = 0.78, p = 0.489).

Conclusions

More severe maternal mental health symptoms were associated with higher dietary diversity but not nutritional status, and the reasons for these findings are not clear from available data. More research is needed to identify underlying factors that could influence mental health symptomatology and diet quality among food insecure and extremely resource-limited populations.

Complex PTSD and intergenerational transmission of distress and resilience among Tutsi genocide survivors and their offspring: A preliminary report

The research on survivors of genocide has focused on PTSD, but complex PTSD (CPTSD) and its potential effect on intergenerational transmission are understudied. This study assessed complex PTSD and resilience among Tutsi genocide survivors (n = 60, mean age = 52.27 [SD = 6.27]) and their offspring (n = 60, mean age = 21.21 [SD = 1.78]). Offspring of parents suffering from PTSD or CPTSD reported more secondary traumatization symptoms relative to offspring of parents without PTSD (p < 0.0001). Moreover, parental CPTSD was related to lower resilience among both survivors and offspring (p < 0.0001). The current findings suggest that parental CPTSD may have broader influences manifested in offspring lower resilience.

Transmitting trauma: a systematic review of the risk of child abuse perpetrated by parents exposed to traumatic events

OBJECTIVES

To review the empirical evidence of a potential association between parental trauma and parental child abuse.

METHODS

Following PRISMA guidelines, 4645 publications were identified through a systematic search in PubMed, PsycINFO and Cochrane. The final number of publications included was 15.

RESULTS

The prevalence of child abuse was found to be consistently higher in populations exposed to traumatic events (prevalence range 36.0-97.5%) compared with non-exposed groups. Parents exposed to trauma were more likely to abuse their children in all studies, and trauma severity, including a PTSD diagnosis in parents, was associated with perpetration of child abuse in most studies. Such associations appeared to be independent of the type of traumatic event. The findings underscore that trauma does not only affect the individual, but also the family.

CONCLUSIONS

Parental trauma seems to be associated with perpetration of child abuse within the family. Abusive behavior against children could be a potential trauma reaction, which should be considered in preventive strategies aimed at reducing harm in traumatized families.

Childhood malnutrition and maltreatment are linked with personality disorder symptoms in adulthood: Results from a Barbados lifespan cohort

Both childhood malnutrition and maltreatment are associated with mental health problems that can persist into adulthood. Previously we reported that in Barbados, those with a history of infant malnutrition were more likely to report having experienced childhood maltreatment. Few studies, however, address the long-term outcomes of those who have been exposed to both. We assessed the unique and combined associations of a history of early malnutrition and childhood maltreatment with personality pathology in mid-adulthood in participants of the 47-year longitudinal Barbados Nutrition Study. We used the Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders Personality Questionnaire (SCID-II-PQ) and NEO Personality Inventory-Revised derived Five-Factor Model (NEO PI-R FFM) personality disorder (PD) scores to assess personality pathology, the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to assess childhood maltreatment, and clinical documentation of malnutrition in infancy. We tested the associations of malnutrition and maltreatment with PD scores using linear regression models, unadjusted and adjusted for other childhood adversities. We found increased scores for paranoid, schizoid, avoidant, and dependent PDs among those who had been malnourished and increased scores for paranoid, schizoid, schizotypal, and avoidant PDs among those with higher childhood maltreatment scores. Overall, those exposed to both adversities had even greater PD scores.

Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies

BACKGROUND

Epidemiological surveys on depression and posttraumatic stress disorder (PTSD) among civilian war survivors in war-afflicted regions have produced heterogeneous prevalence estimates of these conditions.

METHODS

To determine the prevalence of both depression and PTSD in civilian war survivors in the area of conflict, we conducted a systematic search of Medline, PsycInfo, and Pilots databases. We included epidemiological studies that had used structured clinical interviews. We conducted random effects meta-analyses on prevalence proportions as well as univariate mixed model meta-regressions.

RESULTS

We included 33 studies that assessed prevalences of depression (k = 18) and/or PTSD (k = 30). Across all studies, pooled point prevalences of 0.27 and 0.26 were found for depression and PTSD, respectively. Ten percent of participants fulfilled criteria for both disorders. Surveys with a higher mean age of participants reported higher prevalence of depression. Furthermore, samples with higher rates of unemployment and higher percentages of women reported higher prevalence of PTSD, whereas samples with a higher number of participants living with a partner reported lower prevalence of PTSD.

LIMITATIONS

The findings are limited by poor psychometric reporting practices.

CONCLUSIONS

Our findings suggest that both depression and PTSD are highly prevalent in war survivors who stayed in the area of conflict. Yet, future research on this topic need to focus on psychometric properties of instruments used to assess psychopathology among war survivors. Notwithstanding this limitation, there is an urgent need for large-scale mental health programs that are appropriate for war-affected countries with limited resources and address depression as much as PTSD.

Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide

BACKGROUND

In August 2014, the Islamic State of Iraq and Syria (ISIS), a terrorist organization, attacked the Yazidi's ancestral homeland in northwestern Iraq. Among other atrocities, they abducted thousands of women and girls and traded many of them into sexual slavery. The aim of this study is to determine the mental health of women and girl survivors of these events in relation to enslavement and experiences with genocide-related events, as well as perceived social rejection in their community.

METHODS

Between February and July 2017, trained local assessors interviewed a sample of 416 Yazidi women and girls (65 of whom had survived sexual enslavement), aged between 17 and 75 years, and living in internally displaced person camps in the Kurdistan Region of Iraq. Post-traumatic stress disorder (PTSD) and depression symptoms were assessed using validated Kurdish versions of standard instruments. Scales for trauma exposure and perceived rejection were developed for the purpose of this study.

RESULTS

Participants reported a high number of traumatic events. More than 80% of girls and women, and almost all participants who were formerly enslaved, met criteria for a probable DSM-5 PTSD diagnosis. Trauma exposure and enslavement predicted poor mental health. In addition, among formerly enslaved girls and women, perceived social rejection in their community mediated the relationship between traumatic enslavement events and depression symptoms.

CONCLUSIONS

In a context of maximum adversity, enslavement and war-related events contribute to high levels of PTSD and depression. Perceived social rejection seems to play a role in the relationship between trauma exposure and mental health among abducted genocide survivors. Providing psychosocial support and treatment for Yazidi people is essential and urgently required.

Transgenerational Epigenetics of Traumatic Stress

Traumatic stress is a type of environmental experience that can modify behavior, cognition and physiological functions such as metabolism, in mammals. Many of the effects of traumatic stress can be transmitted to subsequent generations even when individuals from these generations are not exposed to any traumatic stressor. This book chapter discusses the concept of epigenetic/non-genomic inheritance of such traits involving the germline in mammals. It includes a comprehensive review of animal and human studies on inter- and transgenerational inheritance of the effects of traumatic stress, some of the epigenetic changes in the germline currently known to be associated with traumatic stress, and possible mechanisms for their induction and maintenance during development and adulthood. We also describe some experimental interventions that attempted to prevent the transmission of these effects, and consider the evolutionary importance of transgenerational inheritance and future outlook of the field.

Trauma exposure and the mediating role of posttraumatic stress on somatic symptoms in civilian war victims

BACKGROUND

It has been well documented that the exposure to war has a negative effect on the psychological health of civilian. However, little is known on the impact of war exposure on the physical health of the civilian population. In addition, the link between trauma exposure and somatic symptoms remain poorly understood. This cross-sectional study examined levels of somatic symptoms in the aftermath of war, and the mediating role of posttraumatic stress symptoms in the relationship between trauma exposure and somatic symptoms.

METHODS

Civilian war survivors (N = 142) from Kosovo were assessed for potentially traumatic events, posttraumatic stress symptoms, and somatic symptoms. Data were analyzed using mediation analyses. Posttraumatic stress disorder (PTSD) symptoms were categorized based on King's four factor model (Psychol Assessment. 10: 90-96, 1998).

RESULTS

Participants reported on average more than 5 types of traumatic exposure. The cut-off indicative for PTSD was exceeded by 26.1% of participants. Symptom levels of PTSD were associated with somatic symptoms. The relationship between trauma exposure and somatic symptoms was partly mediated by the active avoidance and hyperarousal symptom clusters of PTSD.

CONCLUSION

Active avoidance and hyperarousal symptoms seem to play a key role in traumatized people suffering from somatic symptoms.

Intergenerational transmission of violence and resilience in conflict-affected Burundi: a qualitative study of why some children thrive despite duress

BACKGROUND

Research suggests that in environments where community conflict and violence are chronic or cyclical, caregiving can impact how children may begin to reproduce violence throughout the various stages of their lives. The aim of this study is to understand how caregiving affects processes of reproducing violence and resilience among children in conflict-affected Burundi.

METHODS

We combined a socio-ecological model of child development with a child-actor perspective. We operationalized the core concepts 'vulnerable household', 'resilience', and 'caregiving' iteratively in culturally relevant ways, and put children's experiences at the center of the inquiry. We carried out a comparative case study among 74 purposively sampled vulnerable households in six collines in three communes in three provinces in the interior of Burundi. Burundian field researchers conducted three consecutive interviews; with the head of the household, the main caregiver, and a child.

RESULTS

Our findings reveal a strong congruence between positive caregiving and resilience among children. Negative caregiving was related to negative social behavior among children. Other resources for resilience appeared to be limited. The overall level of household conditions and embedment in communities attested to a generalized fragile ecological environment.

CONCLUSIONS

In conflict-affected socio-ecological environments, caregiving can impact children's functioning and their role in reproducing violence. Interventions that support caregivers in positive caregiving are promising for breaking cyclical violence.

Relationship between infant malnutrition and childhood maltreatment in a Barbados lifespan cohort

Childhood malnutrition and maltreatment (abuse, neglect) are both prevalent, particularly in resource-limited settings. Despite their known negative impact on child development, there is surprisingly little research documenting their interrelationships. To address this gap, we administered the Childhood Trauma Questionnaire-Short Form (CTQ-SF), a retrospective structured self-report of childhood abuse and neglect, in a Barbadian cohort of 77 adult survivors of infant malnutrition, limited to the first year of life, and 62 healthy controls from the same classrooms and neighborhoods (mean age ± SD = 43.8±2.3 years). This cohort has been followed since birth. Using factor analysis and comparison with archival data addressing similar constructs, we found evidence for reliability and validity of the CTQ-SF in this population. Linear regression analyses, with and without adjusting for childhood household standard of living at three childhood ages, revealed that a history of infant malnutrition was significantly associated with increased levels of self-reported physical neglect in childhood, and, to a somewhat lesser degree, emotional neglect. This study highlights the co-occurrence of infant malnutrition and self-reported maltreatment in childhood in Barbados, with potential public health implications.

Mental health among men who have sex with men in Cambodia: Implications for integration of mental health services within HIV programmes

Background

Poor mental health contributes to poor HIV prevention, treatment and care outcomes. This paper documents factors associated with psychological distress among men who have sex with men (MSM) in Cambodia and discusses potential ways in which routine mental health management could be integrated into HIV services.

Methods

A cross-sectional study was conducted in 2014 among 394 MSM randomly selected from two provinces using a two-stage cluster sampling method. A structured questionnaire was used to assess psychological distress, sexual behaviors, substance use, adverse childhood experiences and family dysfunction. Multivariate logistic regression analysis was performed to explore factors associated with levels of psychological distress.

Results

In total, 10.7 % of the respondents reported having suicidal thoughts and 6.6 % reported having attempted to commit suicide in the past three months, while 38.8 % had a higher level of psychological distress (GHQ-12 > 3), which indicates poor mental health. Higher levels of psychological distress were independently associated with older age (AOR = 1.09, 95 % CI 1.03–1.14), alcohol use (AOR = 3.3, 95 % CI 1.36–7.83), illicit drug use (AOR = 3.53, 95 % CI 1.12–11.18), poor self-reported quality of life (AOR = 7.45, 95 % CI 1.79–3.04), and reduced condom use at last sex (AOR = 0.40, 95 % CI 0.21–0.73). MSM with higher levels of psychological distress were significantly more likely to report that a family member said hurtful things to them (AOR = 1.80, 95 % CI 1.10–2.97), a parent or guardian had been physically abused (AOR = 3.51, 95 % CI 1.86–6.62), and a family member had been mentally ill (AOR = 4.01, 95 % CI 2.06–7.81) when they were growing up.

Conclusions

In order to mitigate psychological distress among MSM in Cambodia, integration of mental health interventions within HIV programmes should be strengthened. To achieve optimal impact, these interventions should also address alcohol and other substance use, and low condom use among distressed MSM. In addition, training of clinical and non-clinical HIV service providers to screen for mental health symptoms, and subsequent provision of peer-based outreach and social support for MSM identified with psychological distress is required.

"A constant struggle to receive mental health care": health care professionals' acquired experience of barriers to mental health care services in Rwanda

BACKGROUND

In Rwanda, many people are still mentally affected by the consequences of the genocide and yet mental health care facilities are scarce. While available literature explains the prevalence and consequences of mental disorders, there is lack of knowledge from low-income countries on health care seeking behavior due to common mental disorders. Therefore, this study sought to explore health care professionals' acquired experiences of barriers and facilitators that people with common mental disorders face when seeking mental health care services in Rwanda.

METHODS

A qualitative approach was applied and data was collected from six focus group discussions (FGDs) conducted in October 2012, including a total of 43 health care professionals, men and women in different health professions. The FGDs were performed at health facilities at different care levels. Data was analyzed using manifest and latent content analysis.

RESULTS

The emerging theme "A constant struggle to receive mental health care for mental disorders" embraced a number of barriers and few facilitators at individual, family, community and structural levels that people faced when seeking mental health care services. Identified barriers people needed to overcome were: Poverty and lack of family support, Fear of stigmatization, Poor community awareness of mental disorders, Societal beliefs in traditional healers and prayers, Scarce resources in mental health care and Gender imbalance in care seeking behavior. The few facilitators to receive mental health care were: Collaboration between authorities and organizations in mental health and having a Family with awareness of mental disorders and health insurance.

CONCLUSION

From a public health perspective, this study revealed important findings of the numerous barriers and the few facilitating factors available to people seeking health for mental disorders. Having a supportive family with awareness of mental disorders who also were equipped with a health insurance was perceived as vital for successful treatment. This study highlights the need of improving availability, accessibility, acceptability and quality of mental health care at all levels in order to improve mental health care among Rwandans affected by mental disorders.

Appetitive Aggression and Adverse Childhood Experiences Shape Violent Behavior in Females Formerly Associated with Combat

This study investigated the impact of violent experiences during childhood, posttraumatic stress disorder (PTSD) and appetitive aggression on everyday violent behavior in Burundian females with varying participation in war. Moreover, group differences in trauma-related and aggression variables were expected. Appetitive aggression describes the perception of violence perpetration as fascinating and appealing and is a common phenomenon in former combatants. Semi-structured interviews were conducted with 158 females, either former combatants, supporters of armed forces or civilians during the civil war in Burundi. The PTSD Symptom Scale Interview was used to assess PTSD symptom severity, the Appetitive Aggression Scale to measure appetitive aggression and the Domestic and Community Violence Checklist to assess both childhood maltreatment and recent aggressive behavior. Former combatants had experienced more traumatic events, perpetrated more violence and reported higher levels of appetitive aggression than supporters and civilians. They also suffered more severely from PTSD symptoms than civilians but not than supporters. The groups did not differ regarding childhood maltreatment. Both appetitive aggression and childhood violence predicted ongoing aggressive behavior, whereas the latter outperformed PTSD symptom severity. These findings support current research showing that adverse childhood experiences and a positive attitude toward aggression serve as the basis for aggressive behavior and promote an ongoing cycle of violence in post-conflict regions. Female members of armed groups are in need of demobilization procedures including trauma-related care and interventions addressing appetitive aggression.

Germ Cell Origins of Posttraumatic Stress Disorder Risk: The Transgenerational Impact of Parental Stress Experience

Altered stress reactivity is a predominant feature of posttraumatic stress disorder (PTSD) and may reflect disease vulnerability, increasing the probability that an individual will develop PTSD following trauma exposure. Environmental factors, particularly prior stress history, contribute to the developmental programming of the hypothalamic-pituitary-adrenal stress axis. Critically, the consequences of stress experiences are transgenerational, with parental stress exposure impacting stress reactivity and PTSD risk in subsequent generations. Potential molecular mechanisms underlying this transmission have been explored in rodent models that specifically examine the paternal lineage, identifying epigenetic signatures in male germ cells as possible substrates of transgenerational programming. Here, we review the role of these germ cell epigenetic marks, including posttranslational histone modifications, DNA methylation, and populations of small noncoding RNAs, in the development of offspring stress axis sensitivity and disease risk.

Trauma and Poor Mental Health in Relation to Economic Status: The Case of Cambodia 35 Years Later

Background

Cambodia is one of the poorest countries in south-east Asia and is still emerging from the events of the Khmer Rouge reign. It has been suggested that the atrocities experienced by the Cambodian population can explain why Cambodia continues to lag behind its neighbours in economic outcomes. The purpose of this study is to investigate whether there is an association between exposure to past trauma and/or current poor mental health and current economic status in Cambodia.

Method

A newly conducted survey performed in two regions (north-west and south-east Cambodia) collected information on trauma exposure, psychiatric symptoms, self-rated health outcomes and socio-economic information for 3200 persons aged 18–60. Economic outcomes were measured as household debt and poverty status and whether the respondent was economically inactive. All models were analysed using logistic regression.

Results

No association was found between high exposure to conflict-related or civilian trauma and any economic outcomes save for a negative association between civilian trauma and poverty in the south-east. Current post-traumatic stress was related solely to poverty status. All other measures of current mental health status, however, were found to be strongly negatively associated with all measures of economic status. Thus, mental health interventions could potentially be utilised in poverty reduction strategies, but greater efficacy is likely to be achieved by targeting current mental health status rather than previous trauma exposure.

How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population

BACKGROUND

While studies with survivors of single traumatic experiences highlight individual response variation following trauma, research from conflict regions shows that almost everyone develops posttraumatic stress disorder (PTSD) if trauma exposure reaches extreme levels. Therefore, evaluating the effects of cumulative trauma exposure is of utmost importance in studies investigating risk factors for PTSD. Yet, little research has been devoted to evaluate how this important environmental risk factor can be best quantified.

METHODS

We investigated the retest reliability and predictive validity of different trauma measures in a sample of 227 Ugandan rebel war survivors. Trauma exposure was modeled as the number of traumatic event types experienced or as a score considering traumatic event frequencies. In addition, we investigated whether age at trauma exposure can be reliably measured and improves PTSD risk prediction.

RESULTS

All trauma measures showed good reliability. While prediction of lifetime PTSD was most accurate from the number of different traumatic event types experienced, inclusion of event frequencies slightly improved the prediction of current PTSD.

CONCLUSIONS

As assessing the number of traumatic events experienced is the least stressful and time-consuming assessment and leads to the best prediction of lifetime PTSD, we recommend this measure for research on PTSD etiology.