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Möllerherm J, Saile R, Wieling E, Neuner F, Catani C. Parenting in a post-conflict region: Associations between observed maternal parenting practices and maternal, child, and contextual factors in northern Uganda. Dev Psychopathol 2024:1-12. [PMID: 38414340 DOI: 10.1017/s0954579424000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Studies show that war leads to an increase in harsh parenting and a decrease in parental warmth, which in turn has a devastating impact on children's development. However, there is insufficient research on the factors that affect parenting in post-conflict regions. In addition, most previous studies on the role of parenting in the context of war rely on self-reports, which are subject to a number of limitations. To complement existing research, the present cross-sectional study used behavioral observations of 101 mothers and their 6-12 year old children to assess parenting in post-conflict northern Uganda. The aim of the current study was to explore associations between observed maternal warmth and coercion and self-reported socioeconomic status (e.g., mother's educational level) as well as maternal (e.g., posttraumatic stress disorder), child (e.g., externalizing problems), and social contextual factors (e.g., family violence). Results show a link between observed parenting, child characteristics, and family violence. Higher levels of children's externalizing problems were associated with more severe maternal coercion. In addition, a negative association was found between family violence and maternal warmth. Findings are discussed in terms of their implications for prevention and intervention programs and the use of behavioral observations in post-conflict environments.
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Affiliation(s)
- Julia Möllerherm
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Regina Saile
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Elizabeth Wieling
- University of Georgia, College of Family and Consumer Sciences, Department of Human Development and Family Science, Athens, GA, USA
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Claudia Catani
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Dumke L, Schmidt T, Wittmann J, Neldner S, Weitkämper A, Catani C, Neuner F, Wilker S. Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany-A prospective follow-up study over 12 months and a nationwide cross-sectional study. Appl Psychol Health Well Being 2024. [PMID: 38193582 DOI: 10.1111/aphw.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12-month follow-up study of newly arrived refugees (N = 166, Mage = 32.38 years, 30.7% female) and a nationwide cross-sectional study (N = 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health-care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Telja Schmidt
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jasmin Wittmann
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Claudia Catani
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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de Haan A, Meiser-Stedman R, Landolt MA, Kuhn I, Black MJ, Klaus K, Patel SD, Fisher DJ, Haag C, Ukoumunne OC, Jones BG, Flaiyah AM, Catani C, Dawson K, Bryant RA, de Roos C, Ertl V, Foa EB, Ford JD, Gilboa-Schechtman E, Tutus D, Hermenau K, Hecker T, Hultmann O, Axberg U, Jaberghaderi N, Jensen TK, Ormhaug SM, Kenardy J, Lindauer RJL, Diehle J, Murray LK, Kane JC, Peltonen K, Kangaslampi S, Robjant K, Koebach A, Rosner R, Rossouw J, Smith P, Tonge BJ, Hitchcock C, Dalgleish T. Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials. Lancet Child Adolesc Health 2024; 8:28-39. [PMID: 37980918 DOI: 10.1016/s2352-4642(23)00253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. METHODS This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. FINDINGS We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. INTERPRETATION This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. FUNDING Swiss National Science Foundation.
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Affiliation(s)
- Anke de Haan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Markus A Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Melissa J Black
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Kristel Klaus
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Shivam D Patel
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - David J Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Obioha C Ukoumunne
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK
| | - Benjamin G Jones
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK; Exploristics, Belfast, UK
| | | | - Claudia Catani
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Carlijn de Roos
- Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands
| | - Verena Ertl
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania Medical School, Philadelphia, PA, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Eva Gilboa-Schechtman
- Emotional Processing Laboratory, Department of Psychology and the Gonda Brain Science Center, Bar-Ilan University, Ramat Gan, Israel
| | - Dunja Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Katharin Hermenau
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University Medical Centre EWL, Bielefeld University, Bielefeld, Germany
| | - Tobias Hecker
- Division of Clinical Developmental Psychopathology, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Ole Hultmann
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Axberg
- Faculty of Social Studies, VID Specialized University, Oslo, Norway
| | - Nasrin Jaberghaderi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tine K Jensen
- Department of Psychology, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Silje M Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Justin Kenardy
- School of Psychology, University of Queensland, Brisbane, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ramon J L Lindauer
- Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands; Department of Child and Adolescent Psychiatry, Public Mental Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Diehle
- WODC-Research and Documentation Centre, Ministry of Justice and Security, The Hague, Netherlands
| | - Laura K Murray
- Department of Mental Health and International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy C Kane
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | - Kirsi Peltonen
- INVEST Research Flagship Centre, University of Turku, Turku, Finland
| | - Samuli Kangaslampi
- Faculty of Social Sciences, Psychology, Tampere University, Tampere, Finland
| | - Katy Robjant
- Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany
| | - Anke Koebach
- Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Development Research Group, Department of Politics and Administration, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa; Centre for Cognitive-Behavioural Therapy, Cape Town, South Africa
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bruce J Tonge
- Centre for Developmental Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
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Agostinelli V, Ballatore Z, Ricci G, Lucarelli A, Burattini M, Mariotti L, Catani C, Tarantino V, Berardi R. Impact of coronavirus disease 2019 pandemic on good clinical practice trials in oncology. Explor Target Antitumor Ther 2023; 4:1095-1103. [PMID: 38023994 PMCID: PMC10651351 DOI: 10.37349/etat.2023.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/10/2023] [Indexed: 12/01/2023] Open
Abstract
Aim Coronavirus disease 2019 (COVID-19) became pandemic on 11th March 2020 and it deeply stressed the healthcare system. Cancer patients represent a vulnerable population, so many recommendations have been approved to ensure optimal management. Clinical research was notably impacted by COVID too. This review aims to analyze the challenges occurred during a pandemic for the management of enrolled patients (enrollment, use of telemedicine visits, study procedures) and for the clinical trials system (from feasibility to selection visit, site initiation visit, monitorings, use of e-signature, deviations and discontinuations). Methods The studies included in the present review were selected from PubMed/Google Scholar/ScienceDirect databases. Results During the first phase of pandemic many clinical trials were suspended in accrual and, as the pandemic progressed, recommendations were established to guarantee the safety and the continuity of care of enrolled patients. In addition, lot of new strategies was found during the pandemic to reduce the negative consequences on clinical trial performance and to guarantee new opportunities of care in the respect of good clinical practice (GCP) in a bad scenario. Conclusions Among all modifiers, investigators would prefer to maintain the positive ones such as pragmatic and simplified trial designs and protocols, reducing in-person visits when not necessary and to minimizing sponsor and contract research organizations (CROs) visits.
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Affiliation(s)
- Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Zelmira Ballatore
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Giulia Ricci
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Alessandra Lucarelli
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Michela Burattini
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Lorenzo Mariotti
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Claudia Catani
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Valentina Tarantino
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, 60126 Ancona, Italy
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
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Schmidt TL, Catani C, Dumke L, Groß M, Neldner S, Scharpf F, Weitkämper A, Wilker S, Wittmann J, Stammnitz A, van den Heuvel R, Neuner F. Welcome, how are you doing? - towards a systematic mental health screening and crisis management for newly arriving refugees. Eur J Psychotraumatol 2023; 14:2202053. [PMID: 37097725 PMCID: PMC10132251 DOI: 10.1080/20008066.2023.2202053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Background: Compared to the general German population, refugees in Germany are a high-risk group for trauma spectrum disorders. Currently, many barriers exist for the implementation of a screen-and-treat approach for mental disorders as part of the routine health care provision during the early stage of the immigration process.Objective: The aim of the present study was to develop and test a systematic screening approach to identify individual refugees in need of mental health care during the initial immigration phase.Method: 167 newly arrived refugees underwent a screening interview with the Refugee Health Screener (RHS) carried out by Intercultural Therapy Assistants (ITAs). The ITAs were super-vised by psychologists at a reception centre in Bielefeld, Germany. A subsample of 48 persons partici-pated in clinical validation interviews.Results: Findings demonstrated the need for and feasibility of a systematic screening during the initial immigration phase. However, established cut-off values of the RHS had to be adapted and the screening procedure had to be adjusted due to the needs of a significant number of refugees in severe psychological crises.Conclusion: A systematic screening that is applied shortly after arrival facilitates the early identification of refugees at risk of developing mental disorders and may be helpful to prevent chronic symptom development and an aggravation of psychological crises.
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Affiliation(s)
| | - Claudia Catani
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Melissa Groß
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Florian Scharpf
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, Bielefeld, Germany
| | | | - Sarah Wilker
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jasmin Wittmann
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | | | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Catani C, Wittmann J, Schmidt TL, Wilker S, Neldner S, Neuner F. School-based mental health screenings with Ukrainian adolescent refugees in Germany: Results from a pilot study. Front Psychol 2023; 14:1146282. [PMID: 37143592 PMCID: PMC10151552 DOI: 10.3389/fpsyg.2023.1146282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Abstract
Since the Russian invasion of Ukraine in February 2022, high numbers of Ukrainians, mostly women and children, have left the country. As of today, Germany has accepted more than one million refugees fleeing from Ukraine including ~200,000 children and adolescents registered in German schools. Since refugee minors are typically affected by high rates of mental health issues, the identification of potential psychological problems at an early stage after arrival is essential in order to make timely referrals for vulnerable youth to diagnostic or treatment services possible. The aim of the present study was to test the feasibility of a classroom-based mental health screening procedure and to assess symptoms of PTSD, depression, and anxiety in a small sample of adolescents who had fled to Germany. Forty-two adolescents (n = 20 girls) took part in the study. Screening results showed that more than half of the sample had elevated ratings in the Refugee Health Screener (RHS) and about 45% reported clinically significant levels of PTSD. Overall, the amount of both mental health problems and current worries related to the war was significantly higher in girls compared to boys. In general, screenings were well received by the adolescents. The findings of this pilot study point to a considerable level of mental health problems and distress in adolescent refugees affected by the recent war in Ukraine. Brief psychological screenings within the school setting might represent a promising approach to identifying potential mental health disorders as early as possible in newly arriving refugee youth.
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Wittmann J, Groß M, Catani C, Schmidt T, Neldner S, Wilker S, May T, Ertl V, Rosner R, Zindler A, Odenwald M, Neuner F. The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: update to the study protocol for the multi-center randomized controlled trial YOURTREAT. Trials 2022; 23:360. [PMID: 35477413 PMCID: PMC9044372 DOI: 10.1186/s13063-022-06288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The trial YOURTREAT aims to compare the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) with treatment as usual (TAU) for the treatment of young refugees in Germany. This update outlines changes made to the study protocol in response to the current COVID-19 pandemic with the aim of allowing the continuation of the clinical trial while ensuring the safety of the staff and the participants, maintaining methodological quality, and ensuring compliance with legal regulations. Methods The major amendments to the original study protocol include (1) the possibility of using telehealth technology for the conduction of diagnostic and therapy sessions, (2) a reduction of the diagnostic set, and (3) an increased flexibility in the time frame of the study protocol. Discussion The adaptations to the study protocol made it feasible to continue with the trial YOURTREAT during the COVID-19 pandemic. Although the diagnostic set had to be shortened, the primary outcomes and the main secondary outcomes remain unimpaired by the amendment. Therefore, we expect the trial to provide evidence regarding effective treatment options for young refugees in Germany, a population that has received little scientific attention so far and has only very limited access to mental health care in the German health care system. In light of the current pandemic, which globally increases the risk of mental problems, the situation for young refugees is likely to aggravate further. Thus, the clinical and social relevance of the present trial YOURTREAT is even more important in these particular times. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS) DRKS00017222. Registered on May 15, 2019
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Affiliation(s)
- Jasmin Wittmann
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany.
| | - Melissa Groß
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Telja Schmidt
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Sina Neldner
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
| | - Theodor May
- Independent Biostatistician, Johann-Strauß-Str. 11a, D 33647, Bielefeld, Germany
| | - Verena Ertl
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, D 85071, Eichstätt, Germany
| | - Rita Rosner
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, D 85071, Eichstätt, Germany
| | - Areej Zindler
- Outpatient Clinic for Refugee Children and Adolescents, Medical Center Hamburg-Eppendorf, Martinistraße 52, D 20246, Hamburg, Germany
| | - Michael Odenwald
- Department of Psychology, Konstanz University, Universitätsstraße 10, D 78464, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, D 33615, Bielefeld, Germany
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Ibrahim H, Catani C, Neuner F. The posttraumatic stress interview for children (KID-PIN): development and validation of a semi-structured interview of PTSD symptoms among displaced children in the Middle East. PeerJ 2022; 9:e12403. [PMID: 35003912 PMCID: PMC8684325 DOI: 10.7717/peerj.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 10/07/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In populations affected by mass disaster such as armed conflict and displacement, children are at risk of developing mental ill-health, in particular post-traumatic stress disorder (PTSD). Valid and reliable screening instruments are needed to assess the severity of PTSD symptoms among children and to identify individuals in need of treatment. METHOD In the context of an ongoing war in the Middle East, we developed the KID-PIN as a semi-structured interview for PTSD symptoms that can be administered by trained paraprofessionals. To achieve a culturally and contextually appropriate instrument, the development was based on open-ended interviews with affected children and involved both local and international experts. Using the KID-PIN and instruments for constructs associated with PTSD, 332 Iraqi and Syrian displaced children were interviewed. A subset of the sample (n = 86) participated in validation interviews based on experts applying the Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version (CAPS-CA-5). RESULTS The KID-PIN demonstrated excellent internal consistency (Cronbach's alpha = 0.94) with good convergent validity. Confirmatory factor analyses of the KID-PIN showed an acceptable fit with the DSM-5 and other common models; the best fit was reached with the Hybrid model. Receiver operating characteristic analyses indicated that the cut-off score of 28 or higher on the KID-PIN is the optimum cut-off for a probable PTSD diagnosis. CONCLUSION The utility of the newly developed KID-PIN as a screening instrument for PTSD in children is supported by the measure's high internal consistency and good convergent and structural validity, as well as its diagnostic accuracy.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.,vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.,vivo International, Konstanz, Germany
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.,vivo International, Konstanz, Germany
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Wilker S, Kolassa S, Ibrahim H, Rajan V, Pfeiffer A, Catani C, Kolassa IT. Sex differences in PTSD risk: evidence from post-conflict populations challenges the general assumption of increased vulnerability in females. Eur J Psychotraumatol 2021; 12:1930702. [PMID: 34531962 PMCID: PMC8439243 DOI: 10.1080/20008198.2021.1930702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Next to the dose-dependent effect of trauma load, female sex represents a well-established risk factor for PTSD. Exposure to particularly toxic traumatic event types, different coping styles, and biological risk factors are frequently listed as potential causes for the increased PTSD vulnerability in females. Nevertheless, sex differences have not been consistently observed in all study populations. Objective: To investigate sex differences in PTSD risk in post-conflict populations from different countries while considering trauma load. Method: In civilian post-conflict samples from Northern Uganda (N = 1665), Rwanda (N = 433), Syria (N = 974) and Sri Lanka (N = 165), we investigated sex differences in PTSD risk while taking trauma load into account. PTSD and trauma load were assessed using standardized diagnostic interviews. Potential sex differences in PTSD risk were analysed by logistic regression analyses considering trauma load. Results: Across all samples, males reported more traumatic events than females. Both sexes predominantly reported war-related traumatic events. Without considering trauma load, sex effects in PTSD risk were only detected in the Syrian sample. When taking trauma load into account, evidence for an increased PTSD vulnerability in females was found in the Syrian sample, and, to a much lesser extent, in the Northern Ugandan sample. Conclusion: In contrast to the literature, we did not find evidence for a general increased PTSD vulnerability in females. The dose-response effect of trauma load was a much stronger predictor of PTSD risk than sex across all samples.
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Affiliation(s)
- Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
| | - Stephan Kolassa
- SAP S/4HANA CIC & Q2C, SAP Switzerland AG, Tägerwilen, Switzerland
| | - Hawkar Ibrahim
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq
| | - Vathsalan Rajan
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | | | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
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10
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Ballatore Z, Bastianelli L, Merloni F, Ranallo N, Cantini L, Mariotti L, Catani C, Burattini M, Lucarelli A, Berardi R. Abstract S07-03: Scientia potentia est: How the Italian world of oncology changes in the COVID19 pandemic. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-s07-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: After COVID-19 was declared a pandemic by the World Health Organization, a response from the Italian Health System to react to an unprecedented condition became necessary and sudden. COVID- 19 pandemic required oncologists to redefine clinical organization and management of cancer patients. The aim of our study was to take a picture of the situation of Italian oncologies and to evaluate the difficulties in patients’ management.
Methods: Between 18th March and 9th April 2020 we conducted an online survey (Google Forms). It consisted of 45 questions ranging from individual perception of pandemic management by oncologic centers to physicians’ and nurses’ psychological distress and patient care. The survey was anonymous and broadcast to oncology health workers by mailing contacts, word of mouth, and social networks.
Results: A total of 383 oncology health workers participated in the survey. The majority was female (72%) and from central Italy (46%). Impressively, a total of 357 (93%) participants declared the Oncologic Department reorganized routine clinical activity, but only 41% were adequately trained about the required procedures. 20% of the survey attendees thought they had not received adequate and timely protective devices with respect to clinical needs, and according to 58% the supply of these devices was only partial. 34% of professionals declared that they did not have or know a defined common guideline to reschedule patients’ treatments. More than 80% of interviewees declared feeling worried about being at greater risk of contagion than the general population, and 92% feared to transmit virus to family members. Deferring treatments has caused fear/anxiety in 228 of the interviewed (60%). Symptoms of stressful situations emerged with a deterioration in sleep quality in 62% of professionals, worsening of mood (69%), and lower concentration ability (49%).
Conclusions: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response quality has been heterogeneous, and several drawbacks emerged from this first analysis. Information, protection, testing, and training of health care professionals are keywords that should be kept in mind to encourage recovery after this tragedy and to be ready to face a similar emergency in the near future.
Citation Format: Zelmira Ballatore, Lucia Bastianelli, Filippo Merloni, Nicoletta Ranallo, Luca Cantini, Lorenzo Mariotti, Claudia Catani, Michela Burattini, Alessandra Lucarelli, Rossana Berardi. Scientia potentia est: How the Italian world of oncology changes in the COVID19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S07-03.
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Affiliation(s)
- Zelmira Ballatore
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Lucia Bastianelli
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Filippo Merloni
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Nicoletta Ranallo
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Cantini
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Lorenzo Mariotti
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Claudia Catani
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Michela Burattini
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandra Lucarelli
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Department of Oncology, AOU Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Mazzilli S, Sebastiani T, Casigliani V, Cocca G, Stemat A, Nicola C, Selva P, Catani C, Tavosci L, Ranieri R. Feasibility of HCV micro-elimination: HCV test and treatment in two harm reduction services in Milan. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Most of Harm Reduction Service (HRS) users represent a crucial high-risk population for blood borne infections, including HCV. With the advent of new direct antiviral agents (DAAs), HCV micro-elimination in this setting has become feasible. We evaluated HCV treatment cascade in two HRSs located in Milan.
Methods
We collected data on demographics, substance abuse history, HIV prevalence, HCV prevalence, testing and treatment on all register HRS users on 1 January 2019. Data collection was closed on 1 January 2020.
Results
A total of 881 HRS users (732M,149F) were included (median age: 45). The majority was addicted to heroin 67.5% (595), 24.1%(212) to cocaine, 5.3%(47) to THC and 3.1%(27) to other substances. The 28.0%(247/881) reported current or prior judiciary problems, 168/881(19.1%) were under psychiatric treatment. HCV serological screening (HCVAb) was performed for 587/881(66.7%), 113/881(12.8%) were in process, 2/881(0.2%) refused, 179/881(20.3%) were not HRS user anymore. 364/587(62%) resulted HCVAb positive, of whom 288(79.1%) were tested for HCV RNA. Among them 123/324(37.9%) were positive, 165/324(50.9%) were negative. Among HCVAb positive, 116/364(31.9%) were tested for HIV and 92(79.3%) resulted HIV positive. Among HCV RNA positive 92/123(74.8%) were initiated on DAAs treatment. Compliance to treatment was high; one treatment failure was registered. Individuals tested for HCV and HCVAb positive people had an average age significantly higher than the individuals not tested and HCVAb negative people (p < 0.001). Heroin user had a higher likelihood of being tested both for HCVAb and for HCV RNA and of being positive to the HCVAb test (p < 0.001).
Conclusions
Our study demonstrate that it is feasible to achieve good efficacy and compliance for HCV treatment among people who use drugs when decentralising treatment to HRS. To achieve the viral hepatitis elimination agenda goals, HRS-based model of treatment provision needs to be implemented at larger scale.
Key messages
Decentralising HCV test and treatment to harm reduction services is an effective strategy to achieve HCV micro-elimination among people who use drugs. Young people and people who are addicted to other substance than heroin resulted more difficult to link to HCV care through the harm reduction services. They require tailored intervention.
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Affiliation(s)
- S Mazzilli
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
- Scuola Normale Superiore, Pisa, Italy
| | - T Sebastiani
- Local Harm Reduction Servece, San Paolo University Hospital, Milan, Italy
| | - V Casigliani
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - G Cocca
- Local Harm Reduction Servece, San Paolo University Hospital, Milan, Italy
| | - A Stemat
- Penitentiary Infectious Diseases Unit, San Paolo University Hospital, Milan, Italy
| | - C Nicola
- Local Harm Reduction Servece, San Paolo University Hospital, Milan, Italy
| | - P Selva
- Local Harm Reduction Servece, San Paolo University Hospital, Milan, Italy
| | - C Catani
- Local Harm Reduction Servece, San Paolo University Hospital, Milan, Italy
| | - L Tavosci
- Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - R Ranieri
- Penitentiary Infectious Diseases Unit, San Paolo University Hospital, Milan, Italy
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Saupe LB, Gößmann K, Catani C, Neuner F. Understanding the link between child maltreatment and adolescent future expectations in Northern Uganda: A serial mediation analysis. Child Abuse Negl 2020; 106:104511. [PMID: 32408023 DOI: 10.1016/j.chiabu.2020.104511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/20/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recent research has identified high levels of child maltreatment and harsh parenting in post-war societies which have had detrimental effects on children's development. Future expectations are an important aspect of adolescents' development particularly in the challenging contexts of post-war societies where social instabilities and violence are prevalent. To date, however, the link between child maltreatment and adolescent future expectations remains understudied. OBJECTIVE By applying a socio-ecological perspective, this study aimed to investigate risk (internalizing symptoms) and protective factors (community integration) linking experiences of harsh parenting with adolescents' future expectations. PARTICIPANTS AND SETTING Data was collected from N = 199 northern Ugandan adolescents (40.2 % females, Mage = 14.56 years) with structured interviews. METHODS Serial mediation analyses were calculated with child maltreatment as the predictor, future expectations as the outcome, and internalizing symptoms as well as community integration as mediating variables. RESULTS Results of the mediation model (R2 = .22, F(5193) = 10.54, p < .001, total effect (b = -0.28, p < .005) revealed a direct effect of child maltreatment on future expectations (effect size: -.20, 95 % bootstrap CI = -0.40, -.01) as well as an indirect effect of child maltreatment via internalizing symptoms and community integration on future expectations (effect size of -.07 (95 % bootstrap CI = -0.14, -0.01). CONCLUSION Child maltreatment was found to be linked to negative future expectations among Northern Ugandan adolescents, and both internalizing symptoms as well as community integration played mediating roles in the associations. Interventions should take psychopathology and community factors into account.
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Affiliation(s)
- Laura B Saupe
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany.
| | - Katharina Gößmann
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
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13
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Wilker S, Catani C, Wittmann J, Preusse M, Schmidt T, May T, Ertl V, Doering B, Rosner R, Zindler A, Neuner F. The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: study protocol for a multi-center randomized controlled trial (YOURTREAT). Trials 2020; 21:185. [PMID: 32059695 PMCID: PMC7023740 DOI: 10.1186/s13063-020-4127-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Germany hosts a large number of refugees from war-affected countries. The integration of refugees, in particular young refugees from the Middle East, is one of the major current social challenges in Germany. Mental disorders, first of all post-traumatic stress disorder (PTSD) that results from war experiences, are common among young refugees and interfere with quality of life as well as functional integration. Evidence regarding effective treatment options for this population is scarce. In this trial, we aim to evaluate the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) for the treatment of young refugees in Germany. METHODS In a rater-blinded, multi-center, randomized-controlled trial, KIDNET is compared to treatment as usual (TAU) within the general health care system. A total number of 80 young refugees who fulfill the diagnostic criteria of PTSD will be randomized to either KIDNET or TAU. Diagnostic interviews will take place at baseline before treatment as well as 6 and 12 months thereafter. They will assess exposure to traumatic events, PTSD and comorbid symptoms, as well as parameters of integration. DISCUSSION The results of this study should provide evidence regarding effective treatment options for young refugees in Germany, a population that has been understudied and received only limited access to mental health care so far. Next to the effects of treatment on mental health outcomes, integration parameters will be investigated. Therefore, this study should provide broad insights into treatment options for young refugees and their potential implications on successful integration. TRIAL REGISTRATION German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS), ID: DRKS00017222. Registered on 15 May 2019.
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Affiliation(s)
- Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Jasmin Wittmann
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Melissa Preusse
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Telja Schmidt
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Theodor May
- Independent Biostatistician, Johann-Strauß-Str. 11a, 33647, Bielefeld, Germany
| | - Verena Ertl
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, 85071, Eichstätt, Germany
| | - Bettina Doering
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, 85071, Eichstätt, Germany
| | - Rita Rosner
- Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, 85071, Eichstätt, Germany
| | - Areej Zindler
- Medical Center Hamburg-Eppendorf, Outpatient Clinic for Refugee Children and Adolescents, Martinistraße 52, 20246, Hamburg, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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Möllerherm J, Wieling E, Saile R, Forgatch MS, Neuner F, Catani C. Behavioral Observations in Northern UGANDA: Development of a Coding System to Assess Mother-Child Interactions in a Post-war Society. Front Psychol 2019; 10:2519. [PMID: 31787914 PMCID: PMC6853886 DOI: 10.3389/fpsyg.2019.02519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 10/24/2019] [Indexed: 11/13/2022] Open
Abstract
There is growing interest in causes and consequences of disruptions in parent-child relationships in post-war environments. Recent studies mainly relied on self-reports to gain information about family dynamics following war exposure. Considering the limitations of self-report measures, we see the need for an in-depth examination of post-conflict parenting based on observational and quantitative data. The aim of the present study was the development of a coding system for a culturally bound description of parent-child interactions in northern Uganda, where virtually the entire population has been severely affected by 20 years of civil war. Interactions of 101 mothers and their 6- to 12-year-old children were observed during a structured interaction task (problem solving discussion). Foundation for the development of the coding system was the Family and Peer Process Code (FPP code). The cultural adaptation of the FPP code was based on in-depth qualitative analyses of the problem solving task, including a combination of inductive and deductive latent content analyses of textual data and videotapes, member checking and consultations of experts in the field of behavioral observations. The final coding system consists of 35 exhaustive and mutually exclusive content codes including codes for verbal, vocal, and compliance behavior as well as 14 affect codes. Findings indicate that the assessment of behavioral observations in post-conflict settings provides unique insights into culture- and context-specific interaction patterns and may be critical for the development and evaluation of parenting interventions.
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Affiliation(s)
- Julia Möllerherm
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Elizabeth Wieling
- Marriage and Family Therapy/Department of Human Development and Family Science, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
| | - Regina Saile
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | | | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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15
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Park J, Catani C, Hermenau K, Elbert T. Exposure to family and organized violence and associated mental health in north Korean refugee youth compared to south Korean youth. Confl Health 2019; 13:46. [PMID: 31636698 PMCID: PMC6794884 DOI: 10.1186/s13031-019-0230-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Studies on populations affected by organized violence have shown elevated levels of family violence against children. This form of violence has been found to contribute to children's psychopathology independently of traumatic experiences related to war, persecution or flight. Little is known, so far, about the exposure to family violence and its relation to mental health in North Korean refugee youth affected by political violence. The aim of this study was to examine the amount of organized and family violence and associated psychopathology in a sample of North Korean refugee youth living in South Korea compared to their South Korean peers. Methods Sixty-five North Korean refugee youth and 65 South Korean youth were recruited. Trained researchers conducted the survey in group meetings of five to ten participants. Using questionnaires researchers assessed traumatic experiences, family and organized violence, PTSD symptoms, depressive symptoms and other mental health problems. Results Higher rates of violence and trauma, and higher levels of mental health problems were found in the North Korean sample compared to the South Korean sample. Linear regression analyses including the various types of trauma as potential predictors showed that the severity of PTSD and depressive symptoms in the North Korean sample were associated with the amount of traumatic events and family violence but not with higher levels of organized violence. Conclusions The findings suggest that in a context of organized violence, abusive experiences by family members constitute an important problem that is strongly linked to the psychopathology of adolescents. Our data suggest that psychological treatment and prevention approaches for North Korean refugees should be carefully tailored to fit the specific requirements of this population and address the mental health of the individual as well as potential problems at the family level.
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Affiliation(s)
- Jinme Park
- 1Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Claudia Catani
- 2Department of Psychology, Clinical Psychology and Psychotherapy Unit, University of Bielefeld, Postbox 100131, 33501 Bielefeld, Germany
| | - Katharin Hermenau
- 1Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- 1Department of Psychology, University of Konstanz, Konstanz, Germany
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16
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Saupe LB, Gößmann K, Catani C, Neuner F. Adolescent Life Perspectives After War: Evaluation and Adaptation of the Future Expectation Scale in Uganda. Front Psychol 2019; 10:1527. [PMID: 31338050 PMCID: PMC6626915 DOI: 10.3389/fpsyg.2019.01527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/17/2019] [Indexed: 11/13/2022] Open
Abstract
The formulation of life perspectives is one of the developmental tasks of adolescence. Expectations regarding one's own future are shaped by cultural and contextual factors. However, there is little cross-cultural research that includes countries affected by war and turmoil. A Ugandan version of the Future Expectations Scale for Adolescents (FESA) was developed and evaluated with a sample of 279 Ugandan adolescents with low socioeconomic status living in rural communities affected by the Ugandan civil war (1986-2006). The Ugandan FESA was constructed on the basis of a combined item pool of the original Chilean and an adapted Brazilian FESA. Confirmatory factor analysis revealed that the factor structure of the original FESA did not fit the Ugandan data. Principal component analysis revealed a 3-factor solution, including the domains of children and family, work and education, and general future optimism. The final version consists of 19 items, which were deemed culturally appropriate by local focus groups. Overall, the item pool of the FESA was found useful for further studies in post-conflict societies.
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Affiliation(s)
- Laura B Saupe
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Katharina Gößmann
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
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17
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Ibrahim H, Catani C, Ismail AA, Neuner F. Dimensional Structure and Cultural Invariance of DSM V Post-traumatic Stress Disorder Among Iraqi and Syrian Displaced People. Front Psychol 2019; 10:1505. [PMID: 31354564 PMCID: PMC6629925 DOI: 10.3389/fpsyg.2019.01505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
While the factor structure of post-traumatic stress disorder (PTSD) symptoms has been investigated among various traumatized populations in Western and high-income countries, knowledge regarding the validity of factor structure of PTSD among culturally diverse populations in low-and-middle-income countries is limited. The current study examined the factor structure and cultural invariance of PTSD in 521 Iraqi and 993 Syrian war-affected displaced people who were living in the Kurdistan Region of Iraq. Results from confirmatory factor analyses demonstrated that alternative factor models for PTSD, including a new model derived from this population (anhedonia and affect model) resulted in a better fit than the current DSM V models. Taken together, the results showed that a good fit, as well as the measurement invariance of PTSD factors, could be obtained by applying the anhedonia and hybrid model. This study provides further support for the anhedonia and hybrid model of PTSD and fills an important gap in knowledge about the validity of PTSD symptom clusters among Arab and Kurdish populations.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq.,Vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Vivo International, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Vivo International, Konstanz, Germany
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18
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Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide. BMC Med 2018; 16:154. [PMID: 30208905 PMCID: PMC6136186 DOI: 10.1186/s12916-018-1140-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany. .,Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq. .,vivo International, Konstanz, Germany.
| | - Verena Ertl
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
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Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC Psychiatry 2018; 18:259. [PMID: 30115040 PMCID: PMC6097219 DOI: 10.1186/s12888-018-1839-z] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 08/07/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The Posttraumatic Stress Disorder Checklist (PCL) is a valid and reliable self-report measure for the assessment of Posttraumatic Stress Disorder (PTSD). Recently the PCL was updated according to the DSM-5 criteria for PTSD. So far only a few studies have examined the psychometric properties of the PCL-5, and all of these are restricted to populations living in industrialized countries. The aim of this study was to determine the psychometric properties and diagnostic utility of the PCL-5 as a screening instrument for war-affected displaced Kurdish and Arab populations. The specific goal was to determine a contextually valid cut-off score for a probable diagnosis of PTSD. METHODS The PCL-5 was translated into Arabic and two Kurdish dialects. Trained interviewers administered these translations as assisted self-reports to 206 adults living in camps for displaced people in Iraq, together with depression and war-exposure instruments. Two weeks later, 98 randomly chosen subjects were reassessed by expert clinical psychologists. In the absence of a gold-standard instrument with proven validity in this context, the expert interviewers applied the PCL-5 items in the form of a clinical interview and used a DSM-5-algorithm to determine a diagnosis of PTSD. Receiver operator characteristics (ROC) were performed to determine a valid cutoff-score. RESULTS The internal consistency of the PCL-5 was high (alpha = .85) and the instrument showed an adequate convergent validity. Using the cut-off score of 23, the PCL-5 achieved the optimal balance of sensitivity and specificity (area under the curve = .82, p < .001; sensitivity = .82, specificity = .70). CONCLUSIONS Given that the comparison of the two assessments included both a re-test interval and validation by different interviewers, our results indicate that the PCL-5 can be recommended as an assessment and screening instrument for Kurdish and Arab populations.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany. .,vivo international, Konstanz, Germany. .,Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq, Iraq.
| | - Verena Ertl
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Claudia Catani
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Azad Ali Ismail
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,grid.440835.eDepartment of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq Iraq
| | - Frank Neuner
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,vivo international, Konstanz, Germany
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Affiliation(s)
- Claudia Catani
- Department of PsychologyBielefeld UniversityBielefeldGermany
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Affiliation(s)
- Sefik Tagay
- LVR-Klinikum Essen, University of Duisburg-Essen, Essen 45147, Germany.
| | | | | | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Teufel
- LVR-Klinikum Essen, University of Duisburg-Essen, Essen 45147, Germany
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Wieling E, Mehus C, Yumbul C, Möllerherm J, Ertl V, Laura A, Forgatch M, Neuner F, Catani C. Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda. Fam Process 2017; 56:376-392. [PMID: 26503176 DOI: 10.1111/famp.12189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.
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Affiliation(s)
- Elizabeth Wieling
- Family Social Science, University of Minnesota, St. Paul, MN
- Victims Voice International (vivo.org), Gulu, Uganda
| | | | - Cigdem Yumbul
- Family Social Science, University of Minnesota, St. Paul, MN
| | - Julia Möllerherm
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Verena Ertl
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Achan Laura
- Victims Voice International (vivo.org), Gulu, Uganda
| | - Marion Forgatch
- Oregon Social Learning Center, Implementation Sciences International Incorporated, Eugene, OR
| | - Frank Neuner
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Claudia Catani
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Potthast N, Neuner F, Catani C. Automatic activation of alcohol cues by child maltreatment related words: a replication attempt in a different treatment setting. BMC Res Notes 2017; 10:17. [PMID: 28057039 PMCID: PMC5217616 DOI: 10.1186/s13104-016-2324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
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Abstract
Zusammenfassung. Theoretischer Hintergrund: Studien zum Reviktimisierungsphänomen haben bisher hauptsächlich den Effekt von sexuellen Gewalterfahrungen in der Kindheit auf sexuelle Reviktimisierung überprüft. Dabei zeigte sich, dass sexuelle Gewalterfahrungen in der Kindheit die Wahrscheinlichkeit für das Erleben sexueller Gewalterfahrungen im Erwachsenenalter erhöhen. Ein zusätzlich vorliegender physischer Kindesmissbrauch verstärkt dieses Risiko nochmals. Forschungsbedarf besteht allerdings hinsichtlich physischer Reviktimisierung sowie bezüglich der Frage nach dem spezifischen Einfluss sexueller, körperlicher und emotionaler Missbrauchserfahrungen in der Kindheit. Fragestellung: Ziel dieser empirischen Studie ist es zu untersuchen, inwiefern die verschiedenen Typen von Gewalterfahrungen in der Kindheit mit den verschiedenen Formen von Gewalterfahrungen im Erwachsenenalter zusammenhängen. Methode: Bei 142 Frauen im Alter von 19 – 66 Jahren wurden in einer Onlineerhebung sexuelle, physische und emotionale Gewalterfahrungen, getrennt für Kindheit und Erwachsenenalter, sowie aktuelle Symptome einer Posttraumatischen Belastungsstörung (PTBS) und einer Depression erfasst. Ergebnisse: Lineare Regressionen zeigten, dass sexuelle und physische Gewalterfahrungen in der Kindheit sexuelle Gewalterfahrungen im Erwachsenenalter vorhersagten (stand.Beta-Koeffizienten .49*** und .20*). Physische und emotionale Gewalterfahrungen in der Kindheit zeigten sich hingegen als spezifische Prädiktoren für physische Gewalterfahrungen im Erwachsenenalter (stand.Beta-Koeffizienten .67*** und .20**). Schlussfolgerung: Der Befund, dass unterschiedliche Typen von Missbrauchserleben in der Kindheit mit jeweils verschiedenen Arten der Viktimisierung im Erwachsenenalter zusammenhängen, hat wesentliche Implikationen für die Praxis, insbesondere für die Entwicklung effektiverer Ansätze zur Prävention von wiederholtem Gewalterleben.
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Affiliation(s)
- Lioba Langer
- Klinische Psychologie, Fakultät für Psychologie, Universität Bielefeld
| | - Claudia Catani
- Klinische Psychologie, Fakultät für Psychologie, Universität Bielefeld
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Ertl V, Saile R, Neuner F, Catani C. Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and psychopathology in a post-conflict context. BMC Psychiatry 2016; 16:202. [PMID: 27342048 PMCID: PMC4921056 DOI: 10.1186/s12888-016-0905-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It is likely that alcohol use and abuse increase during and after violent conflicts. The most prominent explanation of this phenomenon has been referred to as self-medication hypothesis. It predicts that psychotropic substances are consumed to deal with conflict-related psychic strains and trauma. In northern Uganda, a region that has been affected by a devastating civil war and is characterized by high levels of alcohol abuse we examined the associations between war-trauma, childhood maltreatment and problems related to alcohol use. Deducing from the self-medication hypothesis we assumed alcohol consumption moderates the relationship between trauma-exposure and psychopathology. METHODS A cross-sectional epidemiological survey targeting war-affected families in post-conflict northern Uganda included data of male (n = 304) and female (n = 365) guardians. We used standardized questionnaires in an interview format to collect data on the guardians' socio-demography, trauma-exposure, alcohol consumption and symptoms of alcohol abuse, PTSD and depression. RESULTS Symptoms of current alcohol use disorders were present in 46 % of the male and 1 % of the female respondents. A multiple regression model revealed the unique contributions of emotional abuse in the families of origin and trauma experienced outside the family-context in the prediction of men's alcohol-related symptoms. We found that alcohol consumption moderated the dose-effect relationship between trauma-exposure and symptoms of depression and PTSD. Significant interactions indicated that men who reported more alcohol-related problems experienced less increase in symptoms of PTSD and depression with increasing trauma-exposure. CONCLUSIONS The gradual attenuation of the dose-effect the more alcohol-related problems were reported is consistent with the self-medication hypothesis. Hence, the functionality of alcohol consumption has to be considered when designing and implementing addiction treatment in post-conflict contexts.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany. .,vivo international, Konstanz, Germany. .,Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, P.O. Box 100131, 33501, Bielefeld, Germany.
| | - Regina Saile
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
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26
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Catani C, Sossalla IM. Child abuse predicts adult PTSD symptoms among individuals diagnosed with intellectual disabilities. Front Psychol 2015; 6:1600. [PMID: 26539143 PMCID: PMC4609831 DOI: 10.3389/fpsyg.2015.01600] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/04/2015] [Indexed: 11/13/2022] Open
Abstract
Prior research has shown that people with intellectual disabilities (ID) are more likely to experience child abuse as well as other forms of traumatic or negative events later in life compared to the general population. Little is known however, about the association of these experiences with adult mental health in intellectually disabled individuals. The present study aimed to assess whether child abuse in families and institutions as well as other types of adverse life events, were associated with current posttraumatic stress disorder (PTSD) and depression symptoms in individuals with ID. We conducted clinical interviews which included standardized self-report measures for childhood abuse, PTSD, and depression in an unselected sample of 56 persons with a medical diagnosis of ID who were attending a specialized welfare center. The frequency of traumatic experiences was very high, with physical and emotional child abuse being the most common trauma types. 87% of the persons reported at least one aversive experience on the family violence spectrum, and 50% of the sample reported a violent physical attack later in adulthood. 25% were diagnosed with PTSD and almost 27% had a critical score on the depression scale. Physical and emotional child abuse was positively correlated with the amount of institutional violence and the number of general traumatic events, whereas childhood sexual abuse was related to the experience of intimate partner violence in adult life. A linear regression model revealed child abuse in the family to be the only significant independent predictor of PTSD symptom severity. The current findings underscore the central role of child maltreatment in the increased risk of further victimization and in the development of mental health problems in adulthood in intellectually disabled individuals. Our data have important clinical implications and demonstrate the need for targeted prevention and intervention programs that are tailored to the specific needs of children and adults with intellectual disability.
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Affiliation(s)
- Claudia Catani
- Department of Psychology, Bielefeld University , Bielefeld, Germany
| | - Iris M Sossalla
- Department of Psychology, Bielefeld University , Bielefeld, Germany
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Sriskandarajah V, Neuner F, Catani C. Predictors of violence against children in Tamil families in northern Sri Lanka. Soc Sci Med 2015; 146:257-65. [PMID: 26521032 DOI: 10.1016/j.socscimed.2015.10.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022]
Abstract
Children living in post-conflict settings are not only at high risk of developing war-related psychopathology but also of experiencing maltreatment within their families. However, little is known about the mechanisms of the relationship between war and family violence. In order to investigate the variables associated with the experience and perpetration of child maltreatment, we conducted a two-generational study with Tamil families in the North of Sri Lanka, a region affected by war and Tsunami. We interviewed children and the corresponding family dyads and triads with 359 children, 122 mothers, and 88 fathers on the basis of standardized questionnaires to assess their exposure to adverse life experiences and mental health symptoms. Using multivariate regression analyses, we found that the strongest predictors for children's report of victimization were children's exposure to mass trauma and child psychopathology. Mothers' experiences of mass trauma, family violence and partner violence were each significantly related to mother-reported maternal perpetration as well as child-reported victimization. Likewise, all types of traumatic events reported by fathers were significantly related to child-reported victimization and father-reported perpetration. Fathers' alcohol use was the strongest predictor of father-reported paternal perpetration. These findings provide further support for the transmission of mass trauma into family violence, and emphasize the role of child psychopathology as well as alcohol consumption in this relationship.
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Affiliation(s)
| | - Frank Neuner
- Department of Psychology, Bielefeld University, PO Box 100131, 33501 Bielefeld, Germany.
| | - Claudia Catani
- Department of Psychology, Bielefeld University, PO Box 100131, 33501 Bielefeld, Germany.
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28
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Sriskandarajah V, Neuner F, Catani C. Parental care protects traumatized Sri Lankan children from internalizing behavior problems. BMC Psychiatry 2015; 15:203. [PMID: 26302824 PMCID: PMC4549083 DOI: 10.1186/s12888-015-0583-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in war-torn regions has mainly focused on the impact of traumatic experiences on individual mental health and has found high prevalence rates of psychiatric disorders in affected adults and children. However, little is known about the possible protective factors occurring in children's environments in the aftermath of mass trauma. Therefore, we conducted a cross-sectional study with families in Northern Sri Lanka, a region that had been shattered by a long-lasting civil war and devastated by the Asian tsunami in 2004. METHODS Schoolchildren aged 7 to 11 (N = 359) were interviewed on the basis of standardized measures to assess children's exposure to traumatic events, mental health symptoms, and parenting behavior as perceived by children. All interviews were carried out by local senior counselors. RESULTS Linear regression analyses identified exposure to mass trauma and family violence as significant risk factors of child mental health whereas parental care emerged as a significant factor associated with fewer behavior problems. In addition, parental care significantly moderated the relationship between mass trauma and internalizing behavior problems. CONCLUSIONS Family characteristics seem to be strongly associated with children's mental health even in regions severely affected by mass trauma. This finding is particularly relevant for the development of targeted psychosocial interventions for children and families living in war torn areas.
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Affiliation(s)
| | - Frank Neuner
- Department of Psychology, Bielefeld University, PO Box 100131, , D-33501, Bielefeld, Germany.
| | - Claudia Catani
- Department of Psychology, Bielefeld University, PO Box 100131, , D-33501, Bielefeld, Germany.
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Wieling E, Mehus C, Möllerherm J, Neuner F, Achan L, Catani C. Assessing the feasibility of providing a parenting intervention for war-affected families in northern Uganda. Fam Community Health 2015; 38:252-267. [PMID: 26017003 DOI: 10.1097/fch.0000000000000064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article reports the results of a feasibility study of an intervention, Enhancing Family Connection (EFC), conducted in Northern Uganda in 2012. Enhancing Family Connection's sessions were an adaption of the Parent Management Training, Oregon model. Three interrelated areas of feasibility were assessed: (a) acceptability, (b) usability, and (c) limited efficacy. This study utilized questionnaires and semi-structured interviews completed by mothers and a focal child pre- and post-intervention. Results indicated that mothers found the intervention acceptable to their families and culture and showed promise for Enhancing Family Connection's efficacy in changing parenting behaviors. This study supports continued development of this intervention.
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Affiliation(s)
- Elizabeth Wieling
- University of Minnesota Twin Cities, St. Paul (Drs Wieling and Mehus); Bielefeld University, Bielefeld, Germany (Ms Möllerherm and Drs Neuner and Catani); and vivo Uganda (Ms Achan)
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Franzke I, Wabnitz P, Catani C. Dissociation as a mediator of the relationship between childhood trauma and nonsuicidal self-injury in females: a path analytic approach. J Trauma Dissociation 2015; 16:286-302. [PMID: 25761222 DOI: 10.1080/15299732.2015.989646] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
New theoretical models of nonsuicidal self-injury (NSSI) postulate that symptoms subsequent to childhood maltreatment rather than childhood maltreatment itself may lead to engagement in NSSI. However, little is known concerning which specific syndromes serve as underlying mechanisms. In this study we sought to examine the mediating effects of dissociative, posttraumatic, and depressive symptoms, 3 often comorbid syndromes following childhood trauma. In addition, we aimed to assess differences between women with and without NSSI. A sample of 87 female inpatients with a history of childhood abuse and neglect was divided into 2 subgroups (NSSI: n = 42, no NSSI: n = 45). The assessment included measures of NSSI characteristics; adverse childhood experiences; and posttraumatic, dissociative, and depressive symptoms. The NSSI group reported significantly more cases of childhood maltreatment and higher levels of current dissociative, posttraumatic, and depressive symptoms than patients without NSSI. The results of a path analysis showed that only dissociation mediated the relationship between a history of child maltreatment and NSSI when all 3 psychopathological variables were included in the model. The findings point toward a strong and rather specific association between dissociative experiences and NSSI and therefore have important implications for clinical practice.
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Affiliation(s)
- Iris Franzke
- a Evangelisches Krankenhaus Bielefeld , Clinic for Psychotherapeutic and Psychosomatic Medicine , Bielefeld , Germany
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Iffland B, Sansen LM, Catani C, Neuner F. Rapid heartbeat, but dry palms: reactions of heart rate and skin conductance levels to social rejection. Front Psychol 2014; 5:956. [PMID: 25221535 PMCID: PMC4148623 DOI: 10.3389/fpsyg.2014.00956] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/11/2014] [Indexed: 12/30/2022] Open
Abstract
Background: Social rejection elicits negative mood, emotional distress, and neural activity in networks that are associated with physical pain. However, studies assessing physiological reactions to social rejection are rare and results of these studies were found to be ambiguous. Therefore, the present study aimed to examine and specify physiological effects of social rejection. Methods: Participants (n = 50) were assigned to either a social exclusion or inclusion condition of a virtual ball-tossing game (Cyberball). Immediate and delayed physiological [skin conductance level (SCL) and heart rate] reactions were recorded. In addition, subjects reported levels of affect, emotional states, and fundamental needs. Results: Subjects who were socially rejected showed increased heart rates. However, social rejection had no effect on subjects' SCLs. Both conditions showed heightened arousal on this measurement. Furthermore, psychological consequences of social rejection indicated the validity of the paradigm. Conclusions: Our results reveal that social rejection evokes an immediate physiological reaction. Accelerated heart rates indicate that behavior activation rather than inhibition is associated with socially threatening events. In addition, results revealed gender-specific response patterns suggesting that sample characteristics such as differences in gender may account for ambiguous findings of physiological reactions to social rejection.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University Bielefeld, Germany
| | - Lisa M Sansen
- Department of Psychology, Bielefeld University Bielefeld, Germany ; Christoph-Dornier-Stiftung für Klinische Psychologie Bielefeld, Germany
| | - Claudia Catani
- Department of Psychology, Bielefeld University Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University Bielefeld, Germany
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Morath J, Gola H, Sommershof A, Hamuni G, Kolassa S, Catani C, Adenauer H, Ruf-Leuschner M, Schauer M, Elbert T, Groettrup M, Kolassa IT. The effect of trauma-focused therapy on the altered T cell distribution in individuals with PTSD: evidence from a randomized controlled trial. J Psychiatr Res 2014; 54:1-10. [PMID: 24726027 DOI: 10.1016/j.jpsychires.2014.03.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 03/07/2014] [Accepted: 03/09/2014] [Indexed: 12/22/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with a reduced ratio of naïve cytotoxic T lymphocytes, an increased ratio of memory cytotoxic T lymphocytes, and a reduced proportion of FoxP3(+) regulatory T lymphocytes. This study investigated whether these immunological alterations are reversible through an evidence-based psychotherapeutic treatment. Therefore, 34 individuals with PTSD were randomly assigned to either a treatment condition of 12 sessions narrative exposure therapy (NET) or a waitlist control (WLC) group. PTSD symptoms were significantly reduced in the NET group, but not in the WLC group, four months post-therapy (effect size: Hedges' g = -1.61). One year after therapy, PTSD symptoms were improved even further in the NET group compared to baseline (Hedges' g = -1.96). This symptom improvement was mirrored in an increase in the originally reduced proportion of regulatory T cells (Tregs) in the NET group at the one-year follow-up, when comparing subgroups matched for baseline Treg numbers. However, no changes were found for the initially reduced proportion of CD45RA(+)CCR7(+) naïve T lymphocytes. In conclusion, NET was effective in reducing trauma-related PTSD symptoms and had a positive effect on the proportion of Tregs cells, thus demonstrating an effect of psychotherapy on an immunological level. Yet, the shift in the proportion of naïve and memory T lymphocytes in individuals with PTSD, discussed in the literature as a correlate of premature immunosenescence, was not reversible and thus might render these patients permanently more susceptible to infectious diseases.
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Affiliation(s)
- Julia Morath
- Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany
| | - Hannah Gola
- Clinical and Biological Psychology, Institute of Psychology and Education, University of Ulm, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | - Annette Sommershof
- Division of Immunology, Department of Biology, University of Konstanz, 78457 Konstanz, Germany
| | - Gilava Hamuni
- Clinical and Biological Psychology, Institute of Psychology and Education, University of Ulm, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | | | - Claudia Catani
- Clinical Psychology and Psychotherapy, University of Bielefeld, Germany
| | - Hannah Adenauer
- Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany
| | - Martina Ruf-Leuschner
- Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany
| | - Maggie Schauer
- Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany
| | - Thomas Elbert
- Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany
| | - Marcus Groettrup
- Division of Immunology, Department of Biology, University of Konstanz, 78457 Konstanz, Germany; Biotechnology Institute Thurgau at the University of Konstanz, 8280 Kreuzlingen, Switzerland
| | - Iris-Tatjana Kolassa
- Center of Excellence for Psychotraumatology, Clinical Psychology and Neuropsychology, University of Konstanz, Germany; Clinical and Biological Psychology, Institute of Psychology and Education, University of Ulm, Albert-Einstein-Allee 47, 89069 Ulm, Germany.
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Potthast N, Neuner F, Catani C. The contribution of emotional maltreatment to alcohol dependence in a treatment-seeking sample. Addict Behav 2014; 39:949-58. [PMID: 24561015 DOI: 10.1016/j.addbeh.2014.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 01/19/2014] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
Studies reporting a link between child maltreatment and addiction have typically focused on physical and sexual abuse. In contrast, emotional maltreatment has rarely been studied in substance-abusing samples although it is associated with a wide range of dysfunction. The current study aimed to determine the specific impact of different types of maltreatment and peer victimization on alcohol dependence and to examine the potentially mediating role of psychopathology. A sample of treatment seeking adults with alcohol dependence (N=72) underwent an extensive clinical examination including both a standardized interview and self-report measures. Child maltreatment, peer victimization, severity of alcohol dependence, and general psychopathology were assessed. Regression analyses revealed that emotional maltreatment was the strongest predictor of alcohol dependence severity whereas a unique contribution of peer victimization was not found. Our findings suggest that emotional maltreatment might have a major role in the etiology of AD that seems to exceed the contribution of other abuse and victimization experiences. Thereby, the study underscores the need for considering child maltreatment experiences in the prevention and treatment of AD.
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Iffland B, Sansen LM, Catani C, Neuner F. The trauma of peer abuse: effects of relational peer victimization and social anxiety disorder on physiological and affective reactions to social exclusion. Front Psychiatry 2014; 5:26. [PMID: 24672491 PMCID: PMC3957367 DOI: 10.3389/fpsyt.2014.00026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/03/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social exclusion elicits emotional distress, negative mood, and physiological stress. Recent studies showed that these effects were more intense and persisting in socially anxious subjects. The present study examined whether the abnormal reactions of socially anxious subjects can be traced back to previous experiences of relational peer victimization during childhood and adolescence. METHODS Participants (N = 74) were patients with a diagnosis of social anxiety disorder as well as healthy controls. The patient and control groups were subdivided into two subgroups according to the subject's reports about previous relational peer victimization. Immediate and delayed physiological (skin conductance level and heart rate) and affective reactions to a simulated social exclusion in a ball-toss game (Cyberball) were recorded. RESULTS Overall, subjects' immediate reactions to social exclusion were an increase in skin conductance and a reduction of positive affect. Regardless of the diagnostic status, subjects with a history of relational peer victimization showed a more intense self-reported affective change that was accompanied by a blunted skin conductance response. However, the mood of the subjects with a history of peer victimization recovered during a 15 min waiting period. A diagnosis of social anxiety disorder did not affect the reactions to social exclusion on any measure. CONCLUSION Findings indicate that stress reactions to social exclusion depend more on previous experiences of peer victimization than on a diagnosis of social anxiety disorder. The findings indicate that memories of negative social experiences can determine the initial stress reaction to social threats.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Lisa Margareta Sansen
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Christoph-Dornier-Stiftung für Klinische Psychologie, Bielefeld, Germany
| | - Claudia Catani
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Olema DK, Catani C, Ertl V, Saile R, Neuner F. The hidden effects of child maltreatment in a war region: correlates of psychopathology in two generations living in Northern Uganda. J Trauma Stress 2014; 27:35-41. [PMID: 24478246 DOI: 10.1002/jts.21892] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Adverse life experiences are a major risk factor for psychopathology. Studies from industrialized countries have consistently shown the detrimental effects of child maltreatment on the mental health of the victims. Research in war-affected populations, however, has mostly been restricted to the psychological damage caused by the war. Both war trauma and child maltreatment have rarely been studied simultaneously. In a comparative study of 2 generations living in severely war-affected regions in Northern Uganda, we determined the relationship between both trauma types and posttraumatic stress disorder (PTSD), anxiety, depression, and suicide ideation. A total of 100 adolescents, 50 with and 50 without a history of abduction by the rebel army with both their parents (100 mothers and 100 fathers) living in camps in northern Uganda were interviewed. The study showed that both generations were severely affected by war and child maltreatment. Both trauma types were independently correlated with psychological disorders in the adolescent group. Only child maltreatment, however, not war violence, accounted for PTSD symptoms in the parent group (β = .253, p = .002). We conclude that, even in the context of severe war, the impact of child maltreatment on psychological disorders surpasses the damage of war trauma.
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Affiliation(s)
- David Kani Olema
- Department of Psychology, Mbarara University of Science and Technology, Mbarara, Uganda; vivo international e.V, Konstanz, Germany
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Saile R, Ertl V, Neuner F, Catani C. Does war contribute to family violence against children? Findings from a two-generational multi-informant study in Northern Uganda. Child Abuse Negl 2014; 38:135-46. [PMID: 24239222 DOI: 10.1016/j.chiabu.2013.10.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/02/2013] [Accepted: 10/15/2013] [Indexed: 05/12/2023]
Abstract
After 20 years of civil war in Northern Uganda, the continuity of violence within the family constitutes a major challenge to children's healthy development in the post-conflict era. Previous exposure to trauma and ongoing psychopathology in guardians potentially contribute to parental perpetration against children and dysfunctional interactions in the child's family ecology that increase children's risk of maltreatment. In order to investigate distal and proximal risk factors of child victimization, we first aimed to identify factors leading to more self-reported perpetration in guardians. Second, we examined factors in the child's family environment that promote child-reported experiences of maltreatment. Using a two-generational design we interviewed 368 children, 365 female guardians, and 304 male guardians from seven war-affected rural communities in Northern Uganda on the basis of standardized questionnaires. We found that the strongest predictors of self-reported aggressive parenting behaviors toward the child were guardians' own experiences of childhood maltreatment, followed by female guardians' victimization experiences in their intimate relationship and male guardians' posttrautmatic stress disorder (PTSD) symptoms and alcohol-related problems. Regarding children's self-report of victimization in the family, proximal factors including violence between adults in the household and male guardians' PTSD symptom severity level predicted higher levels of maltreatment. Distal variables such as female guardians' history of childhood victimization and female guardians' exposure to traumatic war events also increased children's report of maltreatment. The current findings suggest that in the context of organized violence, an intergenerational cycle of violence persists that is exacerbated by female guardians' re-victimization experiences and male guardians' psychopathological symptoms.
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Affiliation(s)
- Regina Saile
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
| | - Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
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Stenmark H, Catani C, Neuner F, Elbert T, Holen A. Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study. Behav Res Ther 2013; 51:641-7. [PMID: 23916633 DOI: 10.1016/j.brat.2013.07.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/20/2013] [Accepted: 07/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression. METHOD Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion. RESULTS Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers. CONCLUSIONS The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.
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Affiliation(s)
- Håkon Stenmark
- Dept. of Neuroscience, Norwegian University of Science and Technology, 7489 Trondheim, Norway; Centre on Violence, Traumatic Stress and Suicide Prevention, Mid-Norway, St. Olav University Hospital, Schwacks Gt. 1, 7030 Trondheim, Norway.
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Saile R, Neuner F, Ertl V, Catani C. Prevalence and predictors of partner violence against women in the aftermath of war: A survey among couples in Northern Uganda. Soc Sci Med 2013; 86:17-25. [DOI: 10.1016/j.socscimed.2013.02.046] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 12/14/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022]
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Wabnitz P, Gast U, Catani C. Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders. Eur J Psychotraumatol 2013; 4:21452. [PMID: 24298325 PMCID: PMC3842452 DOI: 10.3402/ejpt.v4i0.21452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. METHODS Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. RESULTS Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. CONCLUSION Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients.
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Affiliation(s)
- Pascal Wabnitz
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
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Sansen L, Iffland B, Catani C, Neuner F. Entwicklung und Evaluation des Fragebogens zu belastenden Sozialerfahrungen in der Peergroup (FBS). Zeitschrift für Klinische Psychologie und Psychotherapie 2013. [DOI: 10.1026/1616-3443/a000184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Theoretischer Hintergrund: Im deutschsprachigen Raum liegt kein geeignetes Instrument zur retrospektiven Erfassung von Peerviktimisierung vor. Fragestellung: Ziele der Studie waren die Entwicklung und Evaluation einer Ereignisliste, mit der belastende Sozialerfahrungen in der Peergroup retrospektiv erfasst werden können. Methode: Der Fragebogen zu belastenden Sozialerfahrungen (FBS) wurde nach inhaltlichen Überlegungen erstellt. Die psychometrischen Eigenschaften wurden mittels einer Internetbefragung (N = 995) überprüft. Ergebnisse: Die Stichprobe war hinsichtlich psychischer Symptomatik und sozialer Ängstlichkeit überdurchschnittlich belastet. Die Stabilität der Angaben kann als zufriedenstellend beurteilt werden. Die Konstruktvalidität wird durch Zusammenhänge des FBS mit psychischer Symptombelastung und sozialen Ängsten bestätigt. Signifikant höhere FBS-Werte der hoch Sozialängstlichen verglichen mit den niedrig Sozialängstlichen liefern Hinweise auf diskriminative Validität. Schlussfolgerung: Der Einsatz des FBS in Forschung und Praxis kann empfohlen werden. Weitere Validierungsstudien an klinischen und nicht klinischen Stichprobe stehen aus.
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Affiliation(s)
- Lisa Sansen
- Universität Bielefeld
- Christoph-Dornier-Stiftung für Klinische Psychologie
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Abstract
Ziel: Die vorliegende narrative Übersichtsarbeit geht der Frage nach, welche Rolle traumatische Lebenserfahrungen und damit assoziierte Traumafolgestörungen bezüglich der Ätiologie und Pathogenese von Suchterkrankungen spielen und welche Implikationen sich daraus für die therapeutische Praxis ableiten. Ergebnisse: Die aktuelle empirische Befundlage belegt ein gehäuftes gemeinsames Auftreten von traumatischen Erfahrungen und substanzbezogenen Störungen sowie eine erhöhte Komorbidität von Posttraumatischer Belastungsstörung und Suchterkrankungen. Befunde aus Interview- und Fragebogenstudien sowie aus experimentellen Untersuchungen mit komorbiden Patienten zeigen, dass Betroffene psychotrope Substanzen als Selbstmedikation einsetzen, um ihre traumabedingte Symptomatik zu lindern. Es entsteht ein komplexes, sich gegenseitig aufrechterhaltendes Wechselspiel zwischen Traumafolge- und Suchtsymptomatik, welches die Behandlung deutlich erschwert. Schlussfolgerungen: Zur Unterbrechung dieses Wechselspiels erscheint ersten Befunden zufolge ein von Beginn an integrativer, traumafokussierter Behandlungsansatz besonders geeignet. Auch wenn diesbezüglich erste erfolgsversprechende traumakonfrontative Therapieansätze entwickelt wurden, stehen größere prospektive Untersuchungen sowie randomisiert kontrollierte Therapiestudien diesbezüglich noch aus und sollten einen Schwerpunkt zukünftiger Forschung auf diesem Gebiet bilden.
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Affiliation(s)
- Nadine Potthast
- Klinische Psychologie, Fakultät für Psychologie, Universität Bielefeld
- Christoph-Dornier-Stiftung Bielefeld
| | - Claudia Catani
- Klinische Psychologie, Fakultät für Psychologie, Universität Bielefeld
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Iffland B, Sansen LM, Catani C, Neuner F. Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based internet survey. BMC Psychiatry 2012; 12:49. [PMID: 22632167 PMCID: PMC3528417 DOI: 10.1186/1471-244x-12-49] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 05/09/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies reported that social phobia is associated with a history of child maltreatment. However, most of these studies focused on physical and sexual maltreatment whilst little is known about the specific impact of emotional abuse and neglect on social anxiety. We examined the association between emotional maltreatment, including parental emotional maltreatment as well as emotional peer victimization, and social anxiety symptoms in subjects with various degrees of social anxiety. METHODS The study was conducted as a web-based Internet survey of participants (N = 995) who had social anxiety symptoms falling within the high range, and including many respondents who had scores in the clinical range. The assessment included measures of child maltreatment, emotional peer victimization, social anxiety symptoms and general psychopathology. RESULTS Regression and mediation analyses revealed that parental emotional maltreatment and emotional peer victimization were independently related to social anxiety and mediated the impact of physical and sexual maltreatment. Subjects with a history of childhood emotional maltreatment showed higher rates of psychopathology than subjects with a history of physical maltreatment. CONCLUSIONS Although our findings are limited by the use of an Internet survey and retrospective self-report measures, data indicated that social anxiety symptoms are mainly predicted by emotional rather than physical or sexual types of victimization.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Postbox 100131, 33501 Bielefeld, Germany.
| | - Lisa M Sansen
- Department of Psychology, Bielefeld University, Postbox 100131, , 33501, Bielefeld, Germany,Christoph-Dornier-Stiftung für Klinische Psychologie, Bielefeld, Germany
| | - Claudia Catani
- Department of Psychology, Bielefeld University, Postbox 100131, , 33501, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Postbox 100131, , 33501, Bielefeld, Germany
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Hensel-Dittmann D, Schauer M, Ruf M, Catani C, Odenwald M, Elbert T, Neuner F. Treatment of traumatized victims of war and torture: a randomized controlled comparison of narrative exposure therapy and stress inoculation training. Psychother Psychosom 2012; 80:345-52. [PMID: 21829046 DOI: 10.1159/000327253] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the present randomized controlled trial was to compare the outcome of 2 active treatments for posttraumatic stress disorder (PTSD) as a consequence of war and torture: narrative exposure therapy (NET) and stress inoculation training (SIT). METHODS Twenty-eight PTSD patients who had experienced war and torture, most of them asylum seekers, received 10 treatment sessions of either NET or SIT at the Outpatient Clinic for Refugees, University of Konstanz, Germany. Posttests were carried out 4 weeks after treatment, and follow-up tests were performed 6 months and 1 year after treatment. The main outcome measure was the PTSD severity score according to the Clinician-Administered PTSD Scale (CAPS) at each time point. RESULTS A significant reduction in PTSD severity was found for NET, but not for SIT. A symptom reduction in the NET group occurred between pretest and the 6-month follow-up examination, the effect size being d = 1.42 (for SIT: d = 0.12), and between pretest and the 1-year follow-up, the effect size being d = 1.59 (for SIT: d = 0.19). The rates and scores of major depression and other comorbid disorders did not decrease significantly over time in either of the 2 treatment groups. CONCLUSIONS The results indicate that exposure treatments like NET lead to a significant PTSD symptom reduction even in severely traumatized refugees and asylum seekers.
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Affiliation(s)
- D Hensel-Dittmann
- Department of Psychology, University of Konstanz and Center for Psychiatry Reichenau, Konstanz, Germany.
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Adenauer H, Catani C, Gola H, Keil J, Ruf M, Schauer M, Neuner F. Narrative exposure therapy for PTSD increases top-down processing of aversive stimuli--evidence from a randomized controlled treatment trial. BMC Neurosci 2011; 12:127. [PMID: 22182346 PMCID: PMC3258226 DOI: 10.1186/1471-2202-12-127] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/19/2011] [Indexed: 11/18/2022] Open
Abstract
Abstract Registration of the clinical trial Number: NCT00563888 Name: "Change of Neural Network Indicators Through Narrative Treatment of PTSD in Torture Victims" ULR: http://www.clinicaltrials.gov/ct2/show/NCT00563888
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Affiliation(s)
- Hannah Adenauer
- Department of Psychology, University of Konstanz, Konstanz, 78457, Germany.
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Abstract
This study examines the impact of children's exposure to natural disaster against the backdrop of exposure to other traumatic events and psychosocial risks. One thousand three hundred ninety-eight Sri Lankan children aged 9-15 years were interviewed in 4 cross-sectional studies about exposure to traumatic life events related to the war, the tsunami experience, and family violence. Symptoms of posttraumatic stress disorder, somatic complaints, psychosocial functioning, and teacher reports of school grades served as outcome measures. A global outcome variable of "positive adaptation" was created from a combination of these measures. Data showed extensive exposure to adversity and traumatic events among children in Sri Lanka. Findings of regression analyses indicated that all 3 event types--tsunami and disaster, war, and family violence--significantly contributed to poorer child adaptation.
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Affiliation(s)
- Claudia Catani
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Post Box 100131, 33501 Bielefeld, Germany.
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Adenauer H, Pinösch S, Catani C, Gola H, Keil J, Kissler J, Neuner F. Early processing of threat cues in posttraumatic stress disorder-evidence for a cortical vigilance-avoidance reaction. Biol Psychiatry 2010; 68:451-8. [PMID: 20619396 DOI: 10.1016/j.biopsych.2010.05.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 05/04/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The present study investigated the influence of posttraumatic stress disorder (PTSD) on early visual processing of affective stimuli in survivors of war and torture. METHODS Trauma-exposed refugees with (n = 36) and without (n = 21) PTSD as well as unexposed control subjects (n = 16) participated in a magnetoencephalography study with pictures that varied in emotional content. RESULTS We found evidence for a biphasic cortical response in patients with PTSD in comparison with the two control groups. In response to aversive (relative to neutral or positive) pictures, PTSD patients showed elevated cortical activity over right prefrontal areas as early as 130-160 msec after stimulus onset followed by a decrease of the affect-related response in the parieto-occipital cortex at 206-256 msec. CONCLUSIONS The increased early activity in the right prefrontal cortex most likely represents an enhanced alarm response or the fear network toward aversive stimuli in PTSD, whereas the subsequent decreased activation in right parieto-occipital areas in response to aversive pictures seems to reflect the tendency to disengage from emotional content. This finding is consistent with the hypothesis of a vigilance-avoidance reaction pattern to threat in anxiety disorders and helps to reconcile contradicting results of over- and under-responsiveness in the sensory processing of threatening stimuli in PTSD.
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Affiliation(s)
- Hannah Adenauer
- Department of Psychology, University of Konstanz, Konstanz, Germany.
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Ruf M, Schauer M, Neuner F, Catani C, Schauer E, Elbert T. Narrative exposure therapy for 7- to 16-year-olds: a randomized controlled trial with traumatized refugee children. J Trauma Stress 2010; 23:437-45. [PMID: 20684019 DOI: 10.1002/jts.20548] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The authors examined the effectiveness of narrative exposure therapy for children (KIDNET) in treating posttraumatic stress disorder (PTSD) in refugee children living in exile. Twenty-six children traumatized by organized violence were randomly assigned to KIDNET or to a waiting list. Significant treatment by time interactions on all PTSD-relevant variables indicated that the KIDNET group, but not the controls, showed a clinically significant improvement in symptoms and functioning. Success of the KIDNET group remained stable at 12-month follow-up. This study confirms previous findings that, if left untreated, PTSD in children may persist for an extended period. However, it also shows that it is possible to effectively treat chronic PTSD and restore functioning in traumatized refugee children in only 8 treatment sessions.
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Affiliation(s)
- Martina Ruf
- University of Konstanz and Vivo, Konstanz, Germany.
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Margreth A, Catani C, Schiaffino S. Isolation of microsome-bound phosphofructokinase from frog skeletal muscle and its inhibition by calcium ions. Biochem J 2010; 102:35-7C. [PMID: 16742471 PMCID: PMC1270353 DOI: 10.1042/bj1020035c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Margreth
- Institute of General Pathology and 'G. Vernoni' Research Unit for the Study of Physiopathology, National Research Council, University of Padua, Italy
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Adenauer H, Catani C, Keil J, Aichinger H, Neuner F. Is freezing an adaptive reaction to threat? Evidence from heart rate reactivity to emotional pictures in victims of war and torture. Psychophysiology 2010; 47:315-22. [DOI: 10.1111/j.1469-8986.2009.00940.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Catani C, Adenauer H, Keil J, Aichinger H, Neuner F. Pattern of cortical activation during processing of aversive stimuli in traumatized survivors of war and torture. Eur Arch Psychiatry Clin Neurosci 2009; 259:340-51. [PMID: 19360450 DOI: 10.1007/s00406-009-0006-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 03/20/2009] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been associated with an altered processing of threat-related stimuli. In particular, an attentional bias towards threat cues has been consistently found in behavioral studies. However, it is unclear whether increased attention towards threat cues translates into preferential processing as neurophysiological studies have yielded inconsistent findings. The aim of the present study was to investigate the neocortical activity related to the processing of aversive stimuli in patients with PTSD. 36 survivors of war and torture with PTSD, 21 Trauma Controls and 20 Unexposed Subjects participated in a visual evoked magnetic field study using flickering pictures of varying affective valence as stimulus material. Minimum norm source localization was carried out to estimate the distribution of sources of the evoked neuromagnetic activity in the brain. Statistical permutation analyses revealed reduced steady-state visual evoked field amplitudes over occipital areas in response to aversive pictures for PTSD patients and for Trauma Controls in comparison to unexposed subjects. Furthermore, PTSD patients showed a hyperactivation of the superior parietal cortex selectively in response to aversive stimuli, which was related to dissociative symptoms as well as to torture severity. The results indicate a different pattern of cortical activation driven by aversive stimuli depending on the experience of multiple traumatic events and PTSD. Whereas, a decreased visual processing of aversive stimuli seems to be associated with trauma exposure in general, the superior parietal activity might represent a specific process linked to the diagnosis of PTSD.
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Affiliation(s)
- Claudia Catani
- Clinical Psychology and Psychotherapy Unit, Department of Psychology, University of Bielefeld, 33501 Bielefeld, Germany.
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