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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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2
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Jann P, Neldner S, Neuner F, Mohammed R. Complicated grief and posttraumatic stress after loss and separation under terror conditions. J Trauma Stress 2024; 37:154-165. [PMID: 38009424 DOI: 10.1002/jts.22990] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/22/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
The lives of people in conflict areas are often characterized by the experience of traumatic events frequently accompanied by loss and separation. These can equally trigger symptoms of posttraumatic stress disorder (PTSD) and complicated grief (CG). The aim of the present study was to investigate whether affected individuals could be assigned to distinct classes at symptom-cluster levels of these two disorders. Moreover, we aimed to identify event-related and sociodemographic predictors associated with membership in these pathological classes. Participants were Iraqi internally displaced persons (IDPs; N = 199) who fled their hometowns due to the ISIS conflict and reported having lost an important person within the past 5 years. Based on the PTSD Checklist for DSM-5 (PCL-5) and Inventory of Complicated Grief (ICG), a latent class analysis (LCA) was applied to examine different classes of symptom clusters. Multinomial logistic regression was used to determine which variables predicted assignment to these symptom classes. The impact of loss and separation among IDPs in Iraq manifested in CG symptoms in more than half of the affected population and was often accompanied by PTSD. LCA identified a low-symptoms class (17.6%), CG class (33.7%), PTSD class (12.1%), and comorbid PTSD+CG class (36.7%). The sudden or violent death of a loved one was identified as a distinguishing factor for PTSD. Furthermore, separation was associated with comorbidity. Aid agencies should take these specific factors into account to improve effective and economic aid delivery to IDPs continuously affected by terror.
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Affiliation(s)
- Philipp Jann
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Rezhna Mohammed
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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3
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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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Iffland B, Kley H, Neuner F. Distinct physiological responses to social-evaluative stress in patients with major depressive disorder reporting a history of peer victimization. Biol Psychol 2023; 184:108697. [PMID: 37775029 DOI: 10.1016/j.biopsycho.2023.108697] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Peer victimization is a risk factor for the development of major depressive disorders, but little is known about the mechanisms. This study examined whether peer victimization alters physiological and affective responses to potentially threatening social stimuli. For this purpose, reactions to socially evaluative stimuli of depressive patients and healthy controls with varying histories of peer victimization were compared. In a social conditioning task, we studied heart rate responses to unconditioned socially negative and neutral evaluative video statements, followed by the heart rate reactions to conditioned stimuli, i.e. still images of the faces of the same actors. Diagnosis of depression and peer victimization were both associated with a more pronounced heart rate deceleration in response to unconditioned stimuli, irrespective of valence. The effect of peer victimization was stronger in depressive patients than in healthy controls. However, heart rate responses to the CSs were not related to depression or peer victimization. The results indicate a hypervigilant processing of social stimuli in depressive patients reporting histories of peer victimization. This distinct processing may be associated with inappropriate behavioral and emotional responses to social challenges, putting individuals at risk for depressive symptoms.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Postbox 100131, 33501 Bielefeld, Germany.
| | - Hanna Kley
- 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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Dumke L, Wilker S, Kotterba A, Neuner F. The role of psychotherapists' perceived barriers in providing psychotherapy to refugee patients. Clin Psychol Psychother 2023; 30:1071-1082. [PMID: 37114524 DOI: 10.1002/cpp.2859] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
Access to psychotherapy is critical to improving mental health, but only a small proportion of refugees receive treatment in the regular psychotherapeutic care system in high-income countries. In previous research, outpatient psychotherapists reported several barriers to more frequent treatment of refugee patients. However, it is unclear to what extent these perceived barriers contribute to the poor provision of services to refugees. In a survey of N = 2002 outpatient psychotherapists in Germany, we collected data on perceived treatment barriers and on the integration of refugees into regular psychotherapeutic practice. Half of the psychotherapists reported that they do not treat refugee patients. In addition, therapies provided for refugees were, on average, 20% shorter than for other patients. Regression analyses showed direct negative associations between psychotherapists' overall perception of barriers with the number of refugees treated and the number of sessions offered to refugee patients, even when controlling for sociodemographic and workload-related characteristics. Correlation analyses on the level of specific types of barriers further revealed that particularly language-related barriers and lack of contact with the refugee population are negatively correlated with the number of refugees treated and the number of sessions for refugees. Our findings indicate that the integration of refugees into regular psychotherapeutic care could be improved by measures to connect psychotherapists with refugee patients as well as professional interpreters and to ensure coverage of costs for therapy, interpreters and related administrative tasks.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Anna Kotterba
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Iffland B, Bartsch LM, Kley H, Neuner F. Growing relevance of reports of adolescent cyberbullying victimization among adult outpatients. BMC Public Health 2023; 23:1503. [PMID: 37553618 PMCID: PMC10410929 DOI: 10.1186/s12889-023-16342-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
In the general population, prevalence rates of cyberbullying victimization have continuously increased over the past decades. However, the extent to which these increasing numbers affect clinical populations seeking treatment in outpatient services remains an open question. The present study sought to examine whether the increase of cyberbullying victimization is also reflected by increased reports of cyberbullying victimization in a clinical outpatient population. In addition, we assessed the incremental contribution of experiences of cyberbullying in the prediction of psychological symptoms when controlling for histories of childhood maltreatment and offline peer victimization. For this purpose, we analyzed routine data from N = 827 outpatients who had sought treatment at a University outpatient clinic for psychotherapy between 2012 and 2021 in a cross-sectional study design. Analyses showed that 8.3% of the patients born in the years 1980 to 2002 indicated the experience of cyberbullying victimization in their adolescence. The rate of reported cyberbullying victimization increased from 1 to 3% in patients born in the years 1980 to 1987 to 24% in patients born in the year 2000. A logistic regression revealed that patients born in the years 1995-2002 were up to nineteen times as likely to report cyberbullying victimization as patients born in the years 1980-1982. In addition, hierarchical multiple regression analyses indicated that cyberbullying victimization significantly accounted for an incremental proportion of variance (1%) in the prediction of psychological symptom distress after controlling for child maltreatment and offline peer victimization. In conclusion, this retrospective survey indicates an increase of the clinical relevance of cyberbullying victimization both in frequency of and potential contribution to etiology. Raising attention to cyberbullying in clinical care and research seems to be justified and warranted.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Postbox 100131, 33501 Bielefeld, Germany
| | - Lena M. Bartsch
- Department of Psychology, Bielefeld University, Postbox 100131, 33501 Bielefeld, Germany
| | - Hanna Kley
- 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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Neldner S, Noori R, Mahmood HN, Neuner F, Ibrahim H. Evaluation of Social Acknowledgment and Mental Health Among Kurdish Survivors of Genocide in 1988. JAMA Netw Open 2023; 6:e2328793. [PMID: 37578797 PMCID: PMC10425822 DOI: 10.1001/jamanetworkopen.2023.28793] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
This cross-sectional study assesses whether higher levels of trauma were associated with less perceived social acknowledgment and higher psychopathology among Kurdish survivors of a chemical attack that took place in 1988.
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Affiliation(s)
- Sina Neldner
- Clinical Psychology and Psychotherapy Unit, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Razaw Noori
- Independent Researcher, Halabja, Kurdistan Region, Iraq
| | - Harem Nareeman Mahmood
- Clinical Psychology and Psychotherapy Unit, Department of Psychology, Bielefeld University, Bielefeld, Germany
- Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq
| | - Frank Neuner
- Clinical Psychology and Psychotherapy Unit, Department of Psychology, Bielefeld University, Bielefeld, Germany
- Vivo International, Konstanz, Germany
| | - Hawkar Ibrahim
- Clinical Psychology and Psychotherapy Unit, Department of Psychology, Bielefeld University, Bielefeld, Germany
- Vivo International, Konstanz, Germany
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Iffland B, Eilers R, Rosner R, Renneberg B, Steil R, Neuner F. Differentiated processing of emotional cues in adolescents and young adults with ICD-11 PTSD and complex PTSD after child abuse. Brain Behav 2023; 13:e2904. [PMID: 36749180 PMCID: PMC10013947 DOI: 10.1002/brb3.2904] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The recent update of the International Classification of Diseases 11th revision (ICD-11) introduced the diagnosis of complex posttraumatic stress disorder (CPTSD) as a distinct entity from posttraumatic stress disorder (PTSD). Because psychophysiological alterations are a core diagnostic feature of PTSD and CPTSD, the aim of the current study was to examine potential distinctive patterns in cortical and cardiac responses to emotional words in adolescent and young adult patients with PTSD and CPTSD. METHOD Event-related potentials and heart rate responses were studied in 81 adolescent and young adult participants, of which 17 individuals were diagnosed with ICD-11 PTSD and 32 individuals with CPTSD, each after childhood sexual and/or physical abuse. Thirty-two individuals served as healthy controls. The paradigm consisted of a passive reading task with neutral, positive, physically threatening, and socially threatening words. RESULTS Differentiated early processing of emotional words was indicated by differences on P1 and left EPN components. Additionally, PTSD and CPTSD patients presented with specific patterns of heart rate responses to emotional words. In CPTSD patients, heart rate reactions to emotional words were more variable than in PTSD patients. CONCLUSIONS These findings provide early evidence of differentiated cortical and cardiac response patterns in adolescent and young adult patients with CPTSD and PTSD, supporting a nosological distinction between PTSD and complex PTSD. However, due to small and unequal sample sizes, findings presented in the current study are preliminary and require future research.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Rebekka Eilers
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Neuner F. Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging. Clin Psychol Rev 2023; 99:102219. [PMID: 36395560 DOI: 10.1016/j.cpr.2022.102219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
Current theories of psychological trauma assume that posttraumatic symptoms originate from stress reactions caused by extremely adverse life experiences. Since the diagnosis of PTSD is restricted to events that involve threats to the physical or sexual integrity of a person, such as accidents and physical and sexual violence, these theories are not well suited to explain the psychopathological consequences of severe violations of one's social integrity, such as emotional abuse and bullying. However, it is evident that social threats contribute to a broad range of mental disorders and increase symptom severity in patients with posttraumatic stress disorder. The aim of the Physical and Social Trauma (PAST) framework is to extend current memory theories of psychological trauma to incorporate threats to a person's social integrity. Within this perspective, the harmful effects of events that involve social threats result from violations of core social motives such as the need for status and belonging that bring about intense affective reactions, including despair and defeat. Within associative threat structures, these emotions are tied to the stimulus characteristics of the experiences and can be re-activated in social situations. The resulting psychopathology transcends PTSD criteria and other current classifications and suggests a transdiagnostic perspective of psychological trauma. Implications for treatment and further directions for research are discussed.
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Affiliation(s)
- Frank Neuner
- Bielefeld University, Department of Psychology, Postbox 100131, 33501 Bielefeld, Germany.
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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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Santel M, Neuner F, Berg M, Steuwe C, Jobes DA, Driessen M, Beblo T. The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial. Front Psychiatry 2023; 14:1038302. [PMID: 36937739 PMCID: PMC10017970 DOI: 10.3389/fpsyt.2023.1038302] [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] [Received: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting. Objectives We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship. Methods All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time. Results Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05). Conclusions CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials. Trial registration DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).
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Affiliation(s)
- Miriam Santel
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- *Correspondence: Miriam Santel
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michaela Berg
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Carolin Steuwe
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
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Scharpf F, Saupe L, Crombach A, Haer R, Ibrahim H, Neuner F, Peltonen K, Qouta S, Saile R, Hecker T. The network structure of posttraumatic stress symptoms in war‐affected children and adolescents. JCPP Advances 2022. [DOI: 10.1002/jcv2.12124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Florian Scharpf
- Department of Psychology Bielefeld University Bielefeld Germany
- Institute for Interdisciplinary Research on Conflict and Violence Bielefeld University Bielefeld Germany
| | - Laura Saupe
- Department of Psychology University Eichstätt‐Ingolstadt Eichstätt Germany
| | - Anselm Crombach
- Department of Psychology Konstanz University Konstanz Germany
- Department of Psychology Saarland University Saarbrücken Germany
| | - Roos Haer
- Institute of Political Science Leiden University Leiden Netherlands
| | - Hawkar Ibrahim
- Department of Psychology Bielefeld University Bielefeld Germany
| | - Frank Neuner
- Department of Psychology Bielefeld University Bielefeld Germany
| | - Kirsi Peltonen
- Research Center for Child Psychiatry University of Turku Turku Finland
| | - Samir Qouta
- School of Social Sciences and Humanities Doha Instiute for Graduate Studies Al Daayen Qatar
| | - Regina Saile
- Treatment Center for Victims of Torture Ulm Germany
| | - Tobias Hecker
- Department of Psychology Bielefeld University Bielefeld Germany
- Institute for Interdisciplinary Research on Conflict and Violence Bielefeld University Bielefeld Germany
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14
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Dumke L, Neuner F. Othering refugees: Psychotherapists’ attitudes toward patients with and without a refugee background. Psychother Res 2022; 33:654-668. [DOI: 10.1080/10503307.2022.2150097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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15
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Mahmood HN, Ibrahim H, Ismail AA, Neuner F. The mental health of forcibly displaced couples. J Trauma Stress 2022; 35:1598-1607. [PMID: 35907258 DOI: 10.1002/jts.22862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/20/2021] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
Most current research investigating traumatic stress is focused on its effects at the individual level, utilizing the implicit assumption that trauma-related disorders are mutually independent within families and communities. However, there is reason to assume that trauma-related symptoms within couples are influenced by each partner's risk factors and symptoms. Using the actor-partner interdependence model, this study aimed to test whether symptoms of posttraumatic stress disorder (PTSD) and depression were predicted by participants' partner's exposure to traumatic events over and above the influence of the participant's own experiences. For this purpose, we interviewed 687 heterosexual, married Iraqi and Syrian couples in Iraq's Kurdistan region who had been forcefully displaced. We assessed symptoms of PTSD and depression using locally validated scales. Nearly all participants (98.8%) reported exposure to at least one traumatic event, with husbands reporting exposure to a higher number of traumatic events than wives, d = 0.48, p < .001. More than half of the participants met the criteria for a probable PTSD (61.1%) or major depressive disorder diagnosis (60.4%). Within couples, significant actor effects of experienced trauma exposure on personal PTSD and depressive symptoms were observed for both husbands and wives. Further, there were significant partner effects of wives' traumatic experiences on husbands' PTSD and depressive symptoms as well as of husbands' traumatic experiences on wives' PTSD and depressive symptoms. The findings argue for the interdependence of trauma-related symptoms within dyads in a dual-trauma context, suggesting the presence of intracouple transmission of trauma-related symptoms.
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Affiliation(s)
- Harem Nareeman Mahmood
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koy Sanjaq, Iraq
| | - Hawkar Ibrahim
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo international, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koy Sanjaq, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo international, Konstanz, Germany
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16
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Mahmood HN, Ibrahim H, Ismail AA, Neuner F. Does Time Heal Trauma? 18 Month Follow-Up Study of Syrian Refugees' Mental Health in Iraq's Kurdistan Region. Int J Environ Res Public Health 2022; 19:14910. [PMID: 36429629 PMCID: PMC9690495 DOI: 10.3390/ijerph192214910] [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: 09/26/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
The findings of longitudinal studies on traumatized refugees have shown that factors related to premigration, migration, and post-migration experiences determine changes in mental health over time. The primary aim of this follow-up study was to examine the potential change in the prevalence rates of probable PTSD and depression among Syrian refugees in Iraq. An unselected group of N = 92 Syrian adult refugees was recruited from Arbat camps in Sulaymaniyah Governorate in Iraq's Kurdistan Region, and then interviewed at two different time points between July 2017 and January 2019. Locally validated instruments were used to assess traumatic events and mental health symptoms. The primary results showed no significant change in the mean scores of PTSD and depression symptoms from the first measurement to the second measurement over the course of 18 months. On the individual level, no reliable change was found for either PTSD or depression symptoms in more than three-quarters of the participants (78.3% and 77.2%, respectively). New adversities and traumatic events that occurred over the 18 months between the interviews were a significant predictor of increasing trauma-related symptoms. After the flight from conflict settings, trauma-related disorders seem to be chronic for the majority of Syrian refugees. Further longitudinal studies are needed in order to identify specific risk factors that lead to maintaining or worsening mental health symptoms over time, and to explore effective therapeutic intervention methods for this traumatized population.
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Affiliation(s)
- Harem Nareeman Mahmood
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, 33501 Bielefeld, Germany
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koy Sanjaq 46017, Iraq
| | - Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, 33501 Bielefeld, Germany
- vivo International, 78430 Konstanz, Germany
| | - Azad Ali Ismail
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koy Sanjaq 46017, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, 33501 Bielefeld, Germany
- vivo International, 78430 Konstanz, Germany
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17
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Mohammed R, Neuner F. Putative juvenile terrorists: the relationship between multiple traumatization, mental health, and expectations for reintegration among Islamic State recruited adolescent and young adult fighters. Confl Health 2022; 16:58. [DOI: 10.1186/s13031-022-00489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In several conflicts worldwide children are recruited as fighters in irregular forces. These children need to be reintegrated into the society after the conflict. However, concurrent to various reservations in the communities, the reintegration of former child soldiers is challenged by the fact that many of the affected children were indoctrinated by the armed group and traumatized through war events. Even several years after the defeat of the terrorist organization ISIS in Iraq, systematic efforts towards the reintegration of children who had been recruited by ISIS are notably absent.
Methods
we conducted clinical interviews with a sample of N = 59 adolescents and young adults who were incarcerated for terrorism in the prisons of the Kurdistan Region of Iraq to assess levels and types of trauma exposure, PTSD, depression, readiness to reintegrate and ongoing identification with ISIS.
Results
We found high levels of PTSD and depression that were associated with trauma exposure. The subjective readiness to reintegrate into the communities was associated with trauma exposure and was mediated by depression, even after controlling for the influence of ongoing identification with the armed group.
Conclusion
The study indicates that trauma-related mental ill-health should be considered in efforts to reintegrate young former terrorists.
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18
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Tissue A, Specker P, Hoffman J, Uppal S, Cloitre M, Neuner F, O’Donnell M, Nickerson A. Skills Training in Affective and Interpersonal Regulation for Refugees Integrated With Narrative Exposure Therapy: A Case Study on the Treatment of PTSD and Emotion Dysregulation for Refugees and Asylum-Seekers. Clin Case Stud 2022. [DOI: 10.1177/15346501221133315] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of post-traumatic stress disorder (PTSD) in individuals affected by war and conflict is high, with approximately 1 in 3 refugees and asylum-seekers meeting diagnostic criteria for PTSD. PTSD in refugees and asylum-seekers is associated with significant emotion dysregulation which may arise from chronic trauma exposure and post-migration stressors and lead to impaired day-to-day functioning. There is evidence that treatments that target emotion regulation skills prior to implementing exposure-based therapies lead to improved treatment response and reduced attrition in survivors of interpersonal traumas such as sexual abuse. The current case study details the use of a novel adaptation of one such treatment – Skills Training in Affective and Interpersonal Regulation for refugees and asylum-seekers (STAIR-R). In this case study, we report on the implementation of STAIR-R in combination with Narrative Exposure Therapy (NET) with Sara, a 60-year-old Iraqi woman who presented with high levels of nightmares, avoidance and emotion dysregulation following exposure to war- and conflict-related trauma and post-migration stressors. In this case study, we explore the intersection of emotion regulation skills training (in STAIR-R) and exposure therapy (in NET), and the potential for this combined intervention to improve emotion regulation skills, enhance coping with post-migration stressors and facilitate engagement with exposure-based treatment for PTSD.
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Affiliation(s)
- Avalon Tissue
- University of New South Wales, Sydney, NSW, Australia
| | | | - Joel Hoffman
- University of New South Wales, Sydney, NSW, Australia
| | - Shivani Uppal
- University of New South Wales, Sydney, NSW, Australia
| | - Marylene Cloitre
- National Centre for PTSD (NCPTSD) Dissemination and Training Division VA, Palo Alto, CA, USA
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19
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Ibrahim H, Goessmann K, Neuner F. Sharing for relief: associations of trauma-focused interviews and well-being among war-affected displaced populations in the Middle East. Ethics & Behavior 2022. [DOI: 10.1080/10508422.2022.2122466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University
| | - Katharina Goessmann
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University
- Vivo International, Konstanz, Germany
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20
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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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21
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Iffland B, Neuner F. Peer Victimization Influences Attention Processing Beyond the Effects of Childhood Maltreatment by Caregivers. Front Psychol 2022; 13:784147. [PMID: 35310289 PMCID: PMC8931489 DOI: 10.3389/fpsyg.2022.784147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/26/2022] [Indexed: 12/22/2022] Open
Abstract
Background Different types of maltreatment (emotional, physical, and sexual) lead to distortions in emotion and attention processing. The present study investigated whether the experience of peer victimization in childhood and adolescence has an additional influence on attention processing in adulthood. Methods Two non-clinical samples consisting of individuals with different levels of experiences of maltreatment were recruited. In an evaluative conditioning task, images of faces with neutral emotional expression were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in an emotional Stroop task as well as a dot-probe task. Results In both tasks, hierarchical regression analyses revealed that retrospective reports of relational peer victimization made an incremental contribution to the prediction of attentional biases beyond child maltreatment. In the emotional Stroop task, emotional abuse was the strongest predictor for an attentional bias showing delayed responses to negatively associated faces, while peer victimization was associated with faster responses to negatively associated faces. In the dot-probe task, relational peer victimization was the strongest predictor for an attentional bias. When the attentional bias was examined in more detail, though, peer victimization did not show incremental contributions although emotional abuse remained the strongest predictor for facilitated attention toward negatively associated neutral faces. Conclusion Experiences of peer victimization leave additional cognitive scars beyond effects of childhood maltreatment by caregivers. It is likely that attentional biases in the aftermath of victimization put individuals at risk for the development of psychopathology.
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22
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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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23
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Ertl V, Groß M, Mwaka SO, Neuner F. Treating alcohol use disorder in the absence of specialized services - evaluation of the moving inpatient Treatment Camp approach in Uganda. BMC Psychiatry 2021; 21:601. [PMID: 34852824 PMCID: PMC8638348 DOI: 10.1186/s12888-021-03593-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gap between service need and service provision for alcohol-related disorders is highest in resource-poor countries. However, in some of these contexts, local initiatives have developed pragmatic interventions that can be carried out with limited specialized personnel. In an uncontrolled treatment study, we aimed to evaluate the feasibility, acceptability, safety, costs and potential effects of an innovative locally developed community-based program (the Treatment Camp) that is based on an inpatient clinic that moves from community to community. METHODS Out of 32 treatment-seeking individuals 25 took part in the one-week Treatment Camp that included detoxification and counseling components. Re-assessments took place 5 and 12 months after their participation. We explored the course of a wide range of alcohol-related indicators, using the Alcohol Use Disorders Identification Test (AUDIT) as primary outcome complemented by a timeline follow-back approach and the Obsessive Compulsive Drinking Scale. Additionally, we assessed impaired functioning, alcohol-related stigmatization, symptoms of common mental health disorders and indicators of family functioning as reported by participants' wives and children. RESULTS All alcohol-related measures decreased significantly after the Treatment Camp and remained stable up to the 12-month-assessment with high effect sizes ranging from 0.89 to 3.49 (Hedges's g). Although 92% of the participants had lapsed at least once during the follow-up period, 67% classified below the usually applied AUDIT cutoff for hazardous drinking (≥ 8) and no one qualified for the dependent range (≥ 20) one year after treatment. Most secondary outcomes including impaired functioning, alcohol-related stigmatization, symptoms of depression and indicators of family functioning followed the same trajectory. CONCLUSIONS We found the Treatment Camp approach to be acceptable, feasible, safe and affordable (approx. 111 USD/patient) and we could obtain preliminary evidence of its efficacy. Due to its creative combination of inpatient treatment and monitoring by medical personnel with local mobility, the Treatment Camp appears to be more accessible and inclusive than other promising interventions for alcohol dependent individuals in resource-poor contexts. Effects of the approach seem to extend to interactions within families, including a reduction of dysfunctional and violent interactions.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Biopsychology, Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstraße 25, 85072, Eichstätt, Germany.
- vivo international (www.vivo.org), Konstanz, Germany.
| | - Melissa Groß
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Samuel Okidi Mwaka
- Program for Prevention, Awareness, Counseling and Treatment of Alcoholism (PACTA; www.pactaguluganda.org.ug), Plot 1 Burcoro Road, Wiaworanga, Gulu, Uganda
| | - Frank Neuner
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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Abstract
Background: Prevalence rates of posttraumatic stress disorder and depression are high among refugees in Germany. However, knowledge on subjective as well as objective need for psychotherapy and utilization of psychotherapeutic treatment is scarce. Both structural and personal barriers regarding utilization of mental health services must be addressed in order to increase treatment efficiency. Objective: The aim of this study was to determine the objective as well as the perceived need for treatment, the utilization of mental health care among refugees in the past 12 months, and the perceived barriers to treatment. Method: By means of face-to-face interviews, an unselected convenience sample of 177 adult refugees were interviewed in either Arabic, Farsi, Kurmancî, English, or German. The general sample was reached through social workers. In addition to the Refugee Health Screener-15 (RHS-15), utilization of psychotherapeutic and psychiatric care as well as the subjective needs and barriers to treatment were assessed. Results: According to the RHS-15 54.8% of participants (n = 97) suffered from relevant mental health problems. However, although 28 (28.9%) of the 97 participants who scored above the RHS-15 cut-off perceived a need for therapy, none of them had received psychotherapy as recommended by the German S3 Guidelines. Missing information about mental health and language difficulties were the most frequently cited barriers to mental health services. Conclusions: Psychologically distressed refugees do not receive sufficient treatment. The reduction of barriers to treatment as well as extension of mental health services to lower thresholds should be considered in the future.
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Affiliation(s)
- Victoria S Boettcher
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Anna C Nowak
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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25
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Iffland B, Klein F, Schindler S, Kley H, Neuner F. "She finds you abhorrent" - The impact of emotional context information on the cortical processing of neutral faces in depression. Cogn Affect Behav Neurosci 2021; 21:426-444. [PMID: 33721228 PMCID: PMC8121719 DOI: 10.3758/s13415-021-00877-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
Depression is associated with abnormalities in patterns of information processing, particularly in the context of processing of interpersonal information. The present study was designed to investigate the differences in depressive individuals in cortical processing of facial stimuli when neutral faces were presented in a context that involved information about emotional valence as well as self-reference. In 21 depressive patients and 20 healthy controls, event-related potentials (ERPs) were recorded during the presentation of neutral facial expressions, which were accompanied by affective context information that was either self- or other-related. Across conditions, depressive patients showed larger mean P100 amplitudes than healthy controls. Furthermore, mean late positive potential (LPP) amplitudes of depressive patients were larger in response to faces in self-related than in other-related context. In addition, irrespective of self-reference, mean LPP responses of depressive patients to faces presented after socially threatening sentences were larger compared with faces presented after neutral sentences. Results regarding self-reference supported results of previous studies indicating larger mean amplitudes in self-related conditions. Findings suggest a general heightened initial responsiveness to emotional cues and a sustained emotion processing of socially threatening information in depressive patients.
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Affiliation(s)
- Benjamin Iffland
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany.
| | - Fabian Klein
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany
| | - Sebastian Schindler
- Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Münster, Germany
| | - Hanna Kley
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany
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26
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Goessmann K, Ibrahim H, Saupe LB, Neuner F. Toward a Contextually Valid Assessment of Partner Violence: Development and Psycho-Sociometric Evaluation of the Gendered Violence in Partnerships Scale (GVPS). Front Psychol 2021; 11:607671. [PMID: 33505338 PMCID: PMC7829677 DOI: 10.3389/fpsyg.2020.607671] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Abstract
This article presents a new measure for intimate partner violence (IPV), the Gendered Violence in Partnerships Scale (GVPS). The scale was developed in the Middle East with the aim to contribute to the global perspective on IPV by providing a contextual assessment tool for partner violence against women in violent-torn settings embedded in a patriarchal social structure. In an effort to generate a scale including IPV items relevant to the women of the population, a pragmatic step-wise procedure, with focus group discussions and expert panels, was performed. The study’s analyses resulted in an 18-item checklist featuring four subscales of the GVPS that are based on a new typology of male-to-female partner violence presenting an alternative to the commonly used classification by type of abuse (i.e., physical, psychological, sexual acts). Therein, dominating behaviors, existential threats, impulsive aggression, and aggravated physical assault were identified as reflective of the lived realities of women in the war-torn Middle East, which was confirmed in factor analysis. The scale’s psychometric properties were assessed with data from 1,009 displaced women in Iraq, and associations with measures of psychopathology were determined. Implications for IPV assessment and prevention possibilities in humanitarian contexts and beyond are discussed.
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Affiliation(s)
- Katharina Goessmann
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Hawkar Ibrahim
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq.,Vivo International, Konstanz, Germany
| | - Laura B Saupe
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,Vivo International, Konstanz, Germany
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Weitkämper A, Kellner M, Iffland JR, Driessen M, Kley H, Neuner F, Iffland B. Childhood Maltreatment in Individuals With Schizophrenia Spectrum Disorders: The Impact of Cut-Off Scores on Prevalence Rates. Front Psychiatry 2021; 12:692492. [PMID: 34295277 PMCID: PMC8291124 DOI: 10.3389/fpsyt.2021.692492] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Childhood maltreatment is a common phenomenon in various psychiatric disorders. Accordingly, patients with disorders from the schizophrenia spectrum (SSD) appear to have high prevalence rates of childhood maltreatment. However, the interpretation and comparability of prevalence rates is impeded by methodological weaknesses and differences such as measures and thresholds used in previous studies. Therefore, we aimed to provide and compare systematically captured data on prevalence rates of all common types of childhood maltreatment in patients with SSD using a standardized and well-established questionnaire and the most frequently used thresholds. The sample consisted of 48 patients with a primary diagnosis of SSD. 58.3-77.1% of the sample experienced at least one type of childhood maltreatment. Prevalence rates for physical abuse, physical neglect, and emotional abuse were dependent on the thresholds used, while equal rates were found for emotional neglect and sexual abuse. Physical neglect (46-67%), and emotional abuse (44-48%) were most commonly reported, followed by emotional neglect (38%), physical abuse (25-38%), and sexual abuse (25%). Additionally, high levels of peer victimization were reported by SSD patients. It appears that childhood maltreatment is a common phenomenon in SSD, even though methodological details, especially cut-off scores, have a substantial impact on the prevalence rates that are determined. Therefore, the methodology of studies should be closely examined when drawing conclusions from presented prevalence rates.
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Affiliation(s)
- Angelina Weitkämper
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michael Kellner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital Herford, Herford, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany
| | - Hanna Kley
- Department of Clinical Psychology and Psychotherapy, Outpatient Clinic, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Benjamin Iffland
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Ibrahim H, Neuner F. Network structure of DSM-5 PTSD symptoms: Results from cross-national survey among Iraqi and Syrian displaced people. Asian J Psychiatr 2020; 54:102307. [PMID: 32717632 DOI: 10.1016/j.ajp.2020.102307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022]
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.
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany; vivo International, Konstanz, Germany.
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Abstract
IMPORTANCE Yazidi women in northern Iraq have experienced severe human rights violations through attacks by the so-called Islamic State group, with severe consequences for their health. However, no studies to date have investigated how war-related and gender-based violence, including partner violence, are associated with mental health disorders in this population. OBJECTIVE To evaluate the associations between Yazidi women's experiences of violence (ie, war violence, partner violence, enslavement) and their mental health. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 326 women was conducted in camps for displaced persons in the Kurdistan region of Iraq between January and July 2017. Participants were married women from the Yazidi population in northern Iraq who were affected by Islamic State attacks. Participants were selected via household-randomized sampling. Data analysis was conducted from December 2018 to September 2019. EXPOSURES Experiences of enslavement, war-related events, and intimate partner violence were measured with event checklists. MAIN OUTCOMES AND MEASURES Posttraumatic stress disorder (PTSD) and depression levels were measured using culturally validated instruments. RESULTS A total of 326 women (mean [SD] age, 34.3 [12.9] years) participated in the study. Almost all participants reported the experience of at least 1 war-related violent event (325 [99.7%]), 54 (16.6%) reported a history of abduction and sexual slavery, and 215 (66.0%) reported the experience of at least 1 type of intimate partner violence in the past year. There were no significant differences between women who did and did not experience abduction regarding exposure to intimate partner violence. Rates of PTSD and depression symptoms were high among the whole sample, and women who experienced abduction reported significantly higher levels of psychopathology than those who did not (mean [SD] PTSD score: 61.48 [12.38] vs 47.61 [14.42]; t324 = -6.91; P < .001; mean [SD] depression score: 3.07 [0.68] vs 2.43 [0.68]; t324 = -6.78; P < .001). Multivariate hierarchical regressions revealed that psychopathology was associated with exposure to war-related events (PTSD: β = 0.29; P < .001; depression: β = 0.27; P < .001) as well as with exposure to gender-based violence in Islamic State captivity (PTSD: β = 0.19; P = .001; depression: β = 0.28, P < .001) and in their marriage (PTSD: β = 0.13; P = .008; depression: β = 0.18; P < .001). CONCLUSIONS AND RELEVANCE In this study, interviewed Yazidi women often experienced intimate partner violence as well as war-related and gender-based violence under Islamic State attacks and enslavement, experiences that were associated with mental health impairment. The findings underline the importance of also addressing gender-based violence within health care approaches for war-affected populations.
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Affiliation(s)
- Katharina Goessmann
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Hawkar Ibrahim
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany
- Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq
- Vivo International, Konstanz, Germany
| | - Frank Neuner
- Department of Psychology, Clinical Psychology, and Psychotherapy, Bielefeld University, Bielefeld, Germany
- Vivo International, Konstanz, Germany
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Preusse M, Neuner F, Ertl V. Effectiveness of Psychosocial Interventions Targeting Hazardous and Harmful Alcohol Use and Alcohol-Related Symptoms in Low- and Middle-Income Countries: A Systematic Review. Front Psychiatry 2020; 11:768. [PMID: 32903779 PMCID: PMC7438922 DOI: 10.3389/fpsyt.2020.00768] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In low- and middle-income countries (LMIC), the mismatch between the number of individuals needing and those receiving treatment for alcohol use disorders (AUD) is substantial. In order to provide suggestions for the scaling up of effective service provision we systematically reviewed the current evidence on the effectiveness of AUD-focused psychosocial interventions in LMIC. METHODS We used a systematic review methodology following the PRISMA guidelines. Twelve electronic databases listing published and grey literature were searched and only randomized-controlled trials (RCTs) were included. Where possible, effect sizes were calculated using Hedges' g indices. RESULTS Twenty-one RCTs conducted in 15 different LMIC between 1992 and 2018 fulfilled inclusion criteria. Most studies employed brief one-on-one interventions facilitated by trained primary care staff. Eighty-six percent of RCTs based their interventions on the principles of motivational interviewing (MI) with the majority supplementing MI-based interventions with alcohol-tailored elements of cognitive-behavioral therapy (CBT). The remaining RCTs employed CBT-components exclusively. Just over 40% of studies included in quantitative analyses (n=17) yielded an at least medium-sized effect (g≥.50) of the respective intervention compared to alcohol-related and unrelated control conditions or waiting list. Only half of the trials implementing the widely applied MI-based approaches (or MI-based approaches blended with CBT-elements) were superior to their respective control conditions. CONCLUSION To date, a relatively small number of RCTs investigating AUD-focused treatments has been conducted in LMIC. The majority of between condition effect size estimates were small and no type of intervention can clearly be recommended over another. No RCTs were conducted in conflict-affected areas in LMIC although they would merit particular attention since AUD is often linked to trauma-related mental health disorders. More RCTs in LMIC are required and alternatives to MI-based approaches should be investigated. This systematic review summarizes properties of effective interventions and provides implications for future research.
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Affiliation(s)
- Melissa Preusse
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Verena Ertl
- vivo international, Konstanz, Germany
- Department of Clinical Psychology and Biopsychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
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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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Santel M, Beblo T, Neuner F, Berg M, Hennig-Fast K, Jobes DA, Driessen M. Collaborative Assessment and Management of Suicidality (CAMS) compared to enhanced treatment as usual (E-TAU) for suicidal patients in an inpatient setting: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:183. [PMID: 32321477 PMCID: PMC7178967 DOI: 10.1186/s12888-020-02589-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/23/2019] [Accepted: 04/07/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that has been shown to reduce suicidal ideation and overall symptom distress. CAMS has not been previously evaluated in a standard acute inpatient mental health care setting with only short treatment times for suicidal patients. In this randomized controlled trial (RCT) we are investigating whether CAMS is more effective than Enhanced-Treatment as Usual (E-TAU) in reducing suicidal thoughts as primary outcome variable. We are also investigating depressive symptoms, general symptom relief, and the quality of the therapeutic alliance as secondary outcomes. METHODS/DESIGN This RCT is designed as a single-center, two-armed, parallel group observer-blinded clinical effectiveness investigation. We are recruiting and randomizing 60 participants with different diagnoses, who are admitted as inpatients because of acute suicidal thoughts or behaviors into the Clinic for Psychiatry and Psychotherapy, Ev. Hospital Bethel in Bielefeld, Germany. The duration of treatment will vary depending on patients' needs and clinical assessments ranging between 10 and 40 days. Patients are assessed four times, at admission, discharge, 1 month, and 5 months post-discharge. The primary outcome measure is the Beck Scale for Suicide Ideation. Other outcome measures are administered as assessment timepoints including severity of psychiatric symptoms, depression, reasons for living, and therapeutic relationship. DISCUSSION This effectiveness study is being conducted on an acute ward in a psychiatric clinic where patients have multiple problems and diagnoses. Treatment is somewhat limited, and therapists have a large caseloads. The results of this study can thus be generalizable to a typical inpatient psychiatric hospital settings. TRIAL REGISTRATION This clinical trial has been retrospectively registered with the German Clinical Trials Register; registration code/ DRKS-ID: DRKS00013727 (on January 12, 2018). In addition, the study was also registered with the International Clinical Trials Registry Platform of the World Health Organization (identical registration code). Registry Name: "Evaluation von CAMS versus TAU bei suizidalen Patienten - Ein stationärer RCT".
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Affiliation(s)
- Miriam Santel
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany.
| | - Thomas Beblo
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany
| | - Frank Neuner
- grid.7491.b0000 0001 0944 9128Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michaela Berg
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany
| | | | - David A. Jobes
- grid.39936.360000 0001 2174 6686Department of Psychology, The Catholic University of America, Washington, DC USA
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, Ev. Hospital Bethel, Bielefeld, Germany
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Iffland B, Neuner F. Varying Cognitive Scars - Differential Associations Between Types of Childhood Maltreatment and Facial Emotion Processing. Front Psychol 2020; 11:732. [PMID: 32373037 PMCID: PMC7177008 DOI: 10.3389/fpsyg.2020.00732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/24/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Distorted cognitive processing has been found among survivors of child maltreatment. However, different types of abuse and neglect may bring about differences in emotion and attention processing. The present study aimed to detect differential associations between various types of childhood maltreatment and attentional biases in facial emotion processing. Methods A non-clinical sample was recruited on University campus and consisted of 67 individuals with varying degrees of maltreatment. In an evaluative conditioning task, images of faces with neutral emotional expressions were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in a face in the crowd recognition task in which the familiar faces had to be recognized within a crowd of unfamiliar neutral faces. Results In multiple linear regression analyses controlling for the intercorrelatedness of types of maltreatment, differential relationships between types of maltreatment and attentional bias were found. While emotional abuse was associated with faster detection of negatively associated faces, emotional neglect was associated with an impaired recognition of familiar stimuli regardless of the emotional content. Conclusion Results indicated that interindividual differences in cognitive biases may be due to the activation of diverse cognitive schemas based on differential experiences of maltreatment.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Sansen LM, Saupe LB, Steidl A, Fegert JM, Hoffmann U, Neuner F. Development and randomized-controlled evaluation of a web-based training in evidence-based trauma therapy. Professional Psychology: Research and Practice 2020. [DOI: 10.1037/pro0000262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Brühl A, Kley H, Grocholewski A, Neuner F, Heinrichs N. Child maltreatment, peer victimization, and social anxiety in adulthood: a cross-sectional study in a treatment-seeking sample. BMC Psychiatry 2019; 19:418. [PMID: 31882002 PMCID: PMC6935074 DOI: 10.1186/s12888-019-2400-4] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood adversities, especially emotional abuse, emotional neglect, and peer victimization are considered to be crucial risk factors for social anxiety disorder (SAD). We investigated whether particular forms of retrospectively recalled childhood adversities are specifically associated with SAD in adulthood or whether we find similar links in other anxiety or depressive disorders. METHODS Prevalences of adversities assessed with the Childhood Trauma Questionnaire (CTQ) and a questionnaire of stressful social experiences (FBS) were determined in N = 1091 outpatients. Adversity severities among patients with SAD only (n = 25), specific phobia only (n = 18), and generalized anxiety disorder only (n = 19) were compared. Differences between patients with anxiety disorders only (n = 62) and depressive disorders only (n = 239) as well as between SAD with comorbid depressive disorders (n = 143) and SAD only were tested. RESULTS None of the adversity types were found to be specifically associated with SAD and severities did not differ among anxiety disorders but patients with depressive disorders reported more severe emotional abuse, physical abuse, and sexual abuse than patients with anxiety disorders. SAD patients with a comorbid depressive disorder also reported more severe adversities across all types compared to SAD only. CONCLUSION Findings indicate that particular forms of recalled childhood adversities are not specifically associated with SAD in adulthood. Previously established links with SAD may be better explained by comorbid depressive symptoms.
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Affiliation(s)
- Antonia Brühl
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Strasse 2, 28359, Bremen, Germany. .,Department of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Outpatient clinic, Technische Universität Braunschweig, Humboldtstr. 33, 38106, Braunschweig, Germany.
| | - Hanna Kley
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Outpatient clinic, Bielefeld University, Morgenbreede 2-4, 33615 Bielefeld, Germany
| | - Anja Grocholewski
- 0000 0001 1090 0254grid.6738.aDepartment of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Outpatient clinic, Technische Universität Braunschweig, Humboldtstr. 33, 38106 Braunschweig, Germany
| | - Frank Neuner
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Outpatient clinic, Bielefeld University, Morgenbreede 2-4, 33615 Bielefeld, Germany
| | - Nina Heinrichs
- 0000 0001 2297 4381grid.7704.4Department of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Strasse 2, 28359 Bremen, Germany ,0000 0001 1090 0254grid.6738.aDepartment of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Outpatient clinic, Technische Universität Braunschweig, Humboldtstr. 33, 38106 Braunschweig, Germany
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Mahmood HN, Ibrahim H, Goessmann K, Ismail AA, Neuner F. Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq. Confl Health 2019; 13:51. [PMID: 31728157 PMCID: PMC6842196 DOI: 10.1186/s13031-019-0238-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 04/16/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background Since the Syrian civil war began in March 2011, more than half of the Syrian population was forced to escape from their homes, and more than 5 million of them fled their country. The aim of the present study is to estimate the psychological consequences of this conflict among the refugee population who fled to Iraq. Method In 2017, a team of locally trained psychologists and social workers interviewed 494 married couples (988 individuals) who were Syrian Kurdish refugees in the Kurdistan Region of Iraq. Validated Kurdish Kurmanji and Arabic versions of post-traumatic stress disorder (PTSD) Checklist for DSM-5 and depression section of Hopkins Symptom Checklist-25 were used for assessing PTSD and depression symptoms. Results Almost all of the participants (98.5%) had experienced at least one traumatic event and 86.3% of them experienced three or more traumatic event types. The prevalence of probable PTSD was about 60%. Gender, length of time in the camp, area in which participants were grown up, and the number of traumatic event types were significant predictors for the presence of PTSD symptoms. Approximately the same rate of participants (59.4%) experienced probable depression, which was associated with gender, age, time spent in the camp, and the number of traumatic event types. Conclusion PTSD and depression are prevalent among refugees exposed to traumatic events, and various variables play important roles. The pattern of risk factors in this population is consistent with findings from war-affected populations in other regions and should be considered for intervention within this population and more broadly.
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Affiliation(s)
- Harem Nareeman Mahmood
- 1Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,3Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq, Iraq
| | - Hawkar Ibrahim
- 1Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo international, Konstanz, Germany.,3Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq, Iraq
| | - Katharina Goessmann
- 1Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Azad Ali Ismail
- 3Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq, Iraq
| | - Frank Neuner
- 1Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo international, Konstanz, 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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Iffland B, Klein F, Rosner R, Renneberg B, Steil R, Neuner F. Cardiac reactions to emotional words in adolescents and young adults with PTSD after child abuse. Psychophysiology 2019; 57:e13470. [PMID: 31456251 DOI: 10.1111/psyp.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/04/2018] [Revised: 07/09/2019] [Accepted: 08/08/2019] [Indexed: 01/31/2023]
Abstract
Post-traumatic stress disorder (PTSD) is associated with alterations in cardiac reactivity to threat cues. Meta-analyses have summarized that adults with PTSD have increased heart rates in response to trauma-related stimuli. However, the opposite effect (i.e., cardiac hyporeactivity) has recently been reported in subgroups of PTSD patients. In children and adolescents with PTSD, reports of cardiac alterations are rare and ambiguous. So far, most studies in adolescents and young adults are restricted to victims of accidents, even though PTSD is highly prevalent in victims of child maltreatment. The present study aimed at investigating cardiac reactions in adolescents and young adults with PTSD after child abuse. Cardiac responses to standardized emotional words were studied in 39 adolescent and young adult PTSD patients after childhood sexual and/or physical abuse as compared to 39 healthy control subjects (age range: 15-20 years). The experimental paradigm consisted of a passive reading task with neutral, positive, physically threatening, and socially threatening (swear) words. Results showed that cardiac reactions to negative stimuli, particularly physically threatening stimuli, were less pronounced in PTSD patients than in controls. Moreover, cardiac reactions in response to socially threatening words were less variable in the PTSD group. No differences between and within groups were present in reaction to neutral or positive stimuli. Findings suggest that a physiologically blunted subtype of PTSD may already manifest during adolescence and young adulthood. Moreover, the results of the present study emphasize the relevance of individual trauma history for physiological reactions.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Fabian Klein
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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40
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Goessmann K, Ibrahim H, Saupe LB, Ismail AA, Neuner F. The contribution of mental health and gender attitudes to intimate partner violence in the context of war and displacement: Evidence from a multi-informant couple survey in Iraq. Soc Sci Med 2019; 237:112457. [PMID: 31387009 DOI: 10.1016/j.socscimed.2019.112457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/01/2019] [Revised: 07/09/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE Intimate partner violence is a prevalent issue in refugee and internally displaced populations in post-war and migration settings including camps in the Middle East. In this context, partner violence has been associated with war-related trauma, camp factors, individual characteristics, and gender attitudes. OBJECTIVE With a dual-informant survey among a sample of Iraqi couples residing in a camp for displaced people in the Kurdistan Region of Iraq (N = 92) this study investigated the relationship between war-related psychopathology, attitudes towards women, and male-perpetrated partner violence. METHOD Moderated regression analysis was applied using information from both partners to predict partner violence reported by wives. RESULTS Over 58% of the women in this sample reported past-year exposure to partner violence. Further analyses revealed significant main effects of men's self-reported psychopathology (posttraumatic stress disorder and depression) and their own gender attitudes on partner violence. In a multivariate regression, moderating effects were found, as higher psychopathology levels and inequitable gender attitudes in men interacted in the prediction of male-perpetrated partner violence. CONCLUSIONS This study highlights the high prevalence of partner violence among Iraqi displaced women. In addition, the results show an interplay of several violence-impelling factors in war-affected men. This emphasizes the importance of addressing both mental health issues and gender attitudes in the efforts to reduce or end violence against women in post-war settings.
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Affiliation(s)
- Katharina Goessmann
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.
| | - Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany; Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq, Iraq; Vivo International, Konstanz, Germany.
| | - Laura Bebra Saupe
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.
| | - Azad Ali Ismail
- Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq, Iraq.
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany; Vivo International, Konstanz, Germany.
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Klein F, Schindler S, Neuner F, Rosner R, Renneberg B, Steil R, Iffland B. Processing of affective words in adolescent PTSD-Attentional bias toward social threat. Psychophysiology 2019; 56:e13444. [PMID: 31343077 DOI: 10.1111/psyp.13444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/07/2018] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 01/24/2023]
Abstract
Post-traumatic stress disorder (PTSD) is associated with a hypersensitivity to potential threat. This hypersensitivity manifests through differential patterns of emotional information processing and has been demonstrated in behavioral and neurophysiological experimental paradigms. However, the majority of research has been focused on adult patients with PTSD. To examine possible differences in underlying neurophysiological patterns for adolescent patients with PTSD after childhood sexual and/or physical abuse (CSA/CPA), ERP correlates of emotional word processing in 38 healthy participants and 40 adolescent participants with PTSD after experiencing CSA/CPA were studied. The experimental paradigm consisted of a passive reading task with neutral, positive (e.g., paradise), physically threatening (e.g., torment), and socially threatening (i.e., swearing, e.g., son of a bitch) words. A modulation of P3 amplitudes by emotional valence was found, with positive words inducing less elevated amplitudes over both groups. Interestingly, in later processing, the PTSD group showed augmented early late positive potential (LPP) amplitudes for socially threatening stimuli, while there were no modulations within the healthy control group. Also, region-specific emotional modulations for anterior and posterior electrode clusters were found. For the anterior LPP, highest activations have been found for positive words, while socially and physically threatening words led to strongest modulations in the posterior LPP cluster. There were no modulations by group or emotional valence at the P1 and EPN stage. The findings suggest an enhanced conscious processing of socially threatening words in adolescent patients with PTSD after CSA/CPA, pointing to the importance of a disjoined examination of threat words in emotional processing research.
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Affiliation(s)
- Fabian Klein
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sebastian Schindler
- Department of Affective Neuropsychology, Bielefeld University, Bielefeld, Germany.,Institute of Medical Psychology and Systems Neuroscience, University of Muenster, Muenster, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Benjamin Iffland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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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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43
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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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Iffland B, Weitkämper A, Weitkämper NJ, Neuner F. Attentional avoidance in peer victimized individuals with and without psychiatric disorders. BMC Psychol 2019; 7:12. [PMID: 30795803 PMCID: PMC6387543 DOI: 10.1186/s40359-019-0284-1] [Citation(s) in RCA: 4] [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: 09/04/2018] [Accepted: 02/13/2019] [Indexed: 12/28/2022] Open
Abstract
Background Attentional biases are a relatively robust phenomenon among clinical populations but less pronounced in healthy participants. However, regarding the components of attentional biases and the directions of attention allocation, there are several inconsistencies in the literature. The present study examined whether these inconsistencies can be traced back to previous experiences of relational peer victimization in clinical populations. Methods Participants were subjects with a diagnosed psychiatric disorder (n = 30) and healthy controls (n = 31). Additionally, the sample was divided into two subgroups according to the participants’ reports of previous relational peer victimization (high peer victimization: n = 28; low peer victimization: n = 33). Attentional biases were measured by the Emotional Stroop task and a dot-probe task. Results In both samples, peer victimized participants showed delayed response times when color-naming negative and positive compared to neutral adjectives in the Emotional Stroop task. Likewise, the dot-probe task indicated attentional avoidance of both negative and positive words in peer victimized participants with and without a psychiatric disorder. Interestingly, presence of a psychiatric disorder did not have a significant effect on attentional biases. Conclusion Both tasks could detect that attentional processes were linked to the experience of peer victimization rather than to the current diagnostic status of the participants. Attentional avoidance of emotional stimuli may prevent victimized individuals from responding adequately to environmental stimuli, which may increase the risk for the development of psychopathology.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany.
| | - Angelina Weitkämper
- Department of Psychology, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany
| | - Nicolai J Weitkämper
- 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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45
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Sansen LM, Saupe LB, Steidl A, Fegert JM, Hoffmann U, Neuner F. Daring to process the trauma: using a web-based training to reduce psychotherapists' fears and reservations around implementing trauma-focused therapy. Eur J Psychotraumatol 2019; 10:1696590. [PMID: 31853333 PMCID: PMC6913602 DOI: 10.1080/20008198.2019.1696590] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022] Open
Abstract
Although trauma-focused interventions are the first-line therapies for patients with posttraumatic stress disorder (PTSD), they are not frequently used in clinical practice. Factors preventing therapists from applying trauma-focused methods include a lack of training and negative attitudes towards trauma-focused therapy. The aim of the present study was to investigate which factors predict willingness to carry out trauma-focused therapy and to examine whether a web-based training is able to reduce negative attitudes and reservations about these interventions. In a wait-list controlled evaluation study, therapists (N = 499) were randomized into an intervention or a wait-list control group. Results show that trauma-treatment specific competencies and overcoming pre-existing concerns towards trauma-focused therapy significantly predict therapists' willingness to utilize trauma-focused interventions. Thus, the content alignment of the web-based course is appropriate for improving therapists' willingness to conduct trauma-focused therapy. A retrospective examination of therapists after the training and a comparison of fears and reservations before and after the training demonstrate a significant reduction of fears and reservations. In terms of perceived contraindications, no effects of the web-based training were found. The present study provides compelling evidence that web-based training in evidence-based PTSD therapy is able to reduce reservations that may prevent therapists from applying evidence-based trauma-focused interventions.
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Affiliation(s)
- Lisa M Sansen
- Faculty of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Laura B Saupe
- Faculty of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Annika Steidl
- Faculty of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Ulrike Hoffmann
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Frank Neuner
- Faculty of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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46
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Iffland B, Wiggert N, Neuner F, Blechert J. Neutral is negative enough-Peer victimization influences cardiac, facial-muscular and experiential reactions to both negative evaluative and neutral social stimuli. Biol Psychol 2018; 139:152-162. [PMID: 30296467 DOI: 10.1016/j.biopsycho.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/13/2017] [Revised: 08/04/2018] [Accepted: 10/03/2018] [Indexed: 01/24/2023]
Abstract
Physiological stress responses vary as a function of adverse childhood experiences. However, previous studies concentrate on familial sources of childhood adversity. Potential long-term effects of peer victimization on physiology and affective responses are less known. This study examined cardiac, facial-muscular, and experiential responses to social evaluative stimuli in ninety-four healthy subjects with various degrees of experienced peer victimization. In a social conditioning task, peer victimization was associated with similarly attenuated cardiac and facial-muscular responses to negative and neutral stimuli, while differentiated physiological responses to negative and neutral stimuli were found in subjects without peer victimization. Overall, increased ratings of arousal, valence and disapproval for negative compared to neutral stimuli were found. Contrary to the physiological response, peer victimization was associated with more negative ratings of negative stimuli one month after acquisition. The results suggest that the physiological and experiential reactivity towards both negative and neutral social stimuli is affected by the experience of peer victimization. Peer victimization causes generalized autonomic dysregulation and memory recall biases during social learning impeding adequate response preparation to social stressors.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany.
| | - Nicole Wiggert
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Neuruppin, Germany.
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Postbox 100131, 33501, Bielefeld, Germany.
| | - Jens Blechert
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
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47
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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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48
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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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Labudda K, Illies D, Bien CG, Neuner F. Interictal dysphoric disorder: Further doubts about its epilepsy-specificity and its independency from common psychiatric disorders. Epilepsy Res 2018; 141:13-18. [DOI: 10.1016/j.eplepsyres.2018.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/10/2018] [Accepted: 01/22/2018] [Indexed: 02/06/2023]
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50
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Ertl V, Preuße M, Neuner F. Are Drinking Motives Universal? Characteristics of Motive Types in Alcohol-Dependent Men from Two Diverse Populations. Front Psychiatry 2018; 9:38. [PMID: 29487544 PMCID: PMC5816937 DOI: 10.3389/fpsyt.2018.00038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/22/2017] [Accepted: 01/29/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Since alcohol use disorders are among the most prevalent and destructive mental disorders, it is critical to address factors contributing to their development and maintenance. Drinking motives are relevant driving factors for consumption. Identifying groups of drinkers with similar motivations may help to specialize intervention components and make treatment more effective and efficient. We aimed to identify and describe distinct motive types of drinkers in dependent males from two diverse cultures (Uganda and Germany) and to explore potential differences and similarities in addiction-related measures. Moreover, we investigated specific links between motive types and childhood maltreatment, traumatic experiences, and symptoms of comorbid psychopathologies. METHODS To determine distinct drinking motive types, we conducted latent class analyses concerning drinking motives (Drinking Motive Scale) in samples of treatment-seeking alcohol-dependent men (N = 75). Subsequently we compared the identified motive types concerning their alcohol consumption and alcohol-related symptoms (Alcohol Use Disorders Identification Test), history of childhood maltreatment (Childhood Trauma Questionnaire), trauma exposure (Violence, War and Abduction Exposure Scale), psychopathology (Posttraumatic Stress Diagnostic Scale, Depression-section of the Hopkins Symptom Checklist, and Brief Symptom Inventory) and deficits in emotion regulation (Difficulties in Emotion Regulation Scale). RESULTS We found two congruent drinking motive types in both contexts. Reward-oriented drinking motives like the generation of positive feelings and enhancing performance were endorsed almost equally by both motive types, whereas high relief motive endorsement characterized one group, but not the other. The relief motive type drank to overcome aversive feelings, withdrawal, and daily hassles and was characterized by higher adversity in general. Emotional maltreatment in childhood and psychopathological symptoms were reported to a significantly greater extent by relief drinkers (effect sizes of comparisons ranging from r = 0.25 to r = 0.48). However, the motive types did not differ significantly on alcohol consumption or alcohol-related symptoms and traumatic experiences apart from childhood maltreatment. CONCLUSION The chronology of addiction development and patterns of drinking motivation seem to be similar across cultures, i.e., that motive targeting interventions might be applicable cross-culturally. Addressing comorbid symptomatology should be a key treatment component for relief drinkers, whereas finding alternatives for the creation of positive feelings and ways to counteract boredom and inactivity should be a general treatment element.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Melissa Preuße
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
- vivo international, Konstanz, Germany
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