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Trost K, Ertl V, König J, Rosner R, Comtesse H. Climate change-related concerns in psychotherapy: therapists' experiences and views on addressing this topic in therapy. BMC Psychol 2024; 12:192. [PMID: 38589939 PMCID: PMC11003001 DOI: 10.1186/s40359-024-01677-x] [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: 11/29/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND While adverse impacts of climate change on physical health are well-known, research on its effects on mental health is still scarce. Thus, it is unclear whether potential impacts have already reached treatment practice. Our study aimed to quantify psychotherapists' experiences with patients reporting climate change-related concerns and their views on dealing with this topic in psychotherapy. METHODS In a nationwide online survey, responses were collected from 573 psychotherapists from Germany. Therapists reported on the presence of such patients, their socio-demographic characteristics, and climate change-related reactions. Psychotherapists' views on dealing with this topic in psychotherapy were also assessed. Descriptive statistics were used to analyse the responses. RESULTS About 72% (410/573) of psychotherapists indicated having had patients expressing concerns about climate change during treatment. Out of these therapists, 41% (166/410) stated that at least one patient sought treatment deliberately because of such concerns. Patients were mainly young adults with higher education. Most frequent primary diagnoses were depression, adjustment disorder, and generalized anxiety disorder. Psychotherapists having encountered such patients differed from those without such encounters in their views on potential functional impairment and the necessity to target the concerns in treatment. Although 79% (326/415) of all respondents felt adequately prepared by their current therapeutic skills, 50% (209/414) reported a lack of information on how to deal with such concerns in therapy. CONCLUSIONS Results indicate that psychotherapists are frequently confronted with climate change-related concerns and regard the mental health impact of climate change on their patients as meaningful to psychotherapeutic care. Regular care could be improved by a continuous refinement of the conceptualization and knowledge of the mental health influences of climate change. This would allow providing tailored methods of assessing and addressing climate change-related concerns in practice.
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Affiliation(s)
- Katharina Trost
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.
| | - Verena Ertl
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Julia König
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Eilers R, Ertl V, Kasparik B, Kost A, Rosner R. [Posttraumatic stress disorder in children and adolescents: results of a cross-sectional study on the effects of the newly formulated PTSD and CPTSD diagnoses in the ICD-11]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:409-418. [PMID: 38498186 PMCID: PMC10995073 DOI: 10.1007/s00103-024-03860-2] [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: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND ICD-11 presents narrowed criteria for posttraumatic stress disorder (PTSD) and introduces complex PTSD (CPTSD) with additional difficulties in self-organization (DSO). These changes can have significant effects on the frequency of the diagnosis. The aim of this study was to investigate which ICD-11 symptom clusters cause children and adolescents to miss the diagnosis and whether caregivers are more likely to attribute changes in DSO to developmental level or to the traumatic event, and how these attributions are in turn related to symptom severity. METHODS N = 88 German-speaking children and adolescents (age: 7-17 years) after traumatic events and N = 79 caregivers participated between September 2019 and November 2020 in a survey on PTSD symptom severity (CATS-2) and attribution of DSO symptoms (caregiver questionnaire). RESULTS The ICD-11 criteria (CATS‑2 and a developmentally adapted version) showed lower frequency rates for PTSD as compared to DSM‑5 and ICD-10. The ICD-11 clusters re-experiencing and hyperarousal were met the least often. Changes in DSO symptoms were predominantly rated as event-related. This attribution was associated with higher PTSD and DSO symptom severity in caregiver reports. The age-related attribution was associated with higher DSO-symptom severity, but not PTSD symptom severity in caregiver reports. DISCUSSION In the context of the diagnostic process and the revision of diagnostic instruments for ICD-11 (C)PTSD, development-specific symptoms should be taken into account. The trauma-related differentiation of DSO symptom changes as compared to development-related fluctuations is challenging and therefore requires several sources of information.
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Affiliation(s)
- Rebekka Eilers
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Verena Ertl
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland.
- Katholische Universität Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Deutschland.
| | - Barbara Kasparik
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Anne Kost
- Altonaer Kinderkrankenhaus, Kinder- und Jugendsomatik, Hamburg, Deutschland
| | - Rita Rosner
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
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de Haan A, Meiser-Stedman R, Landolt MA, Kuhn I, Black MJ, Klaus K, Patel SD, Fisher DJ, Haag C, Ukoumunne OC, Jones BG, Flaiyah AM, Catani C, Dawson K, Bryant RA, de Roos C, Ertl V, Foa EB, Ford JD, Gilboa-Schechtman E, Tutus D, Hermenau K, Hecker T, Hultmann O, Axberg U, Jaberghaderi N, Jensen TK, Ormhaug SM, Kenardy J, Lindauer RJL, Diehle J, Murray LK, Kane JC, Peltonen K, Kangaslampi S, Robjant K, Koebach A, Rosner R, Rossouw J, Smith P, Tonge BJ, Hitchcock C, Dalgleish T. Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials. Lancet Child Adolesc Health 2024; 8:28-39. [PMID: 37980918 DOI: 10.1016/s2352-4642(23)00253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. METHODS This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. FINDINGS We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. INTERPRETATION This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. FUNDING Swiss National Science Foundation.
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Affiliation(s)
- Anke de Haan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Markus A Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Melissa J Black
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Kristel Klaus
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Shivam D Patel
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - David J Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Christina Haag
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Obioha C Ukoumunne
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK
| | - Benjamin G Jones
- National Institute for Health and Care Research Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, UK; Exploristics, Belfast, UK
| | | | - Claudia Catani
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Carlijn de Roos
- Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands
| | - Verena Ertl
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania Medical School, Philadelphia, PA, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Eva Gilboa-Schechtman
- Emotional Processing Laboratory, Department of Psychology and the Gonda Brain Science Center, Bar-Ilan University, Ramat Gan, Israel
| | - Dunja Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Katharin Hermenau
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, University Medical Centre EWL, Bielefeld University, Bielefeld, Germany
| | - Tobias Hecker
- Division of Clinical Developmental Psychopathology, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Ole Hultmann
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Axberg
- Faculty of Social Studies, VID Specialized University, Oslo, Norway
| | - Nasrin Jaberghaderi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tine K Jensen
- Department of Psychology, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Silje M Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Justin Kenardy
- School of Psychology, University of Queensland, Brisbane, QLD, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ramon J L Lindauer
- Academic Centre for Child and Adolescent Psychiatry, Amsterdam University Medical Center (location AMC), Amsterdam, Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, Netherlands; Department of Child and Adolescent Psychiatry, Public Mental Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Diehle
- WODC-Research and Documentation Centre, Ministry of Justice and Security, The Hague, Netherlands
| | - Laura K Murray
- Department of Mental Health and International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jeremy C Kane
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | - Kirsi Peltonen
- INVEST Research Flagship Centre, University of Turku, Turku, Finland
| | - Samuli Kangaslampi
- Faculty of Social Sciences, Psychology, Tampere University, Tampere, Finland
| | - Katy Robjant
- Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany
| | - Anke Koebach
- Clinical and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany; Development Research Group, Department of Politics and Administration, University of Konstanz, Konstanz, Germany; Vivo International, Konstanz, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa; Centre for Cognitive-Behavioural Therapy, Cape Town, South Africa
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bruce J Tonge
- Centre for Developmental Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
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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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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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König J, Chung S, Ertl V, Doering BK, Comtesse H, Unterhitzenberger J, Barke A. The German Translation of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale: Results from Healthcare Workers during the Second Wave of COVID-19. Int J Environ Res Public Health 2021; 18:9377. [PMID: 34501967 PMCID: PMC8431413 DOI: 10.3390/ijerph18179377] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
Healthcare workers (HCW) are among those most directly affected by the COVID-19 pandemic. Most research with this group has used ad hoc measures, which limits comparability across samples. The Stress and Anxiety to Viral Epidemics-9 scale (SAVE-9) is a nine-item scale first developed in Korea, and has since been translated into several languages. We report on data collected from 484 German HCW between November 2020 and March 2021, during the "second wave" of coronavirus infections. We conducted item analysis, confirmatory factor analysis on the previously found factor solutions of the SAVE-9, examined correlations with established measures of depression, generalized anxiety, and insomnia, and compared scores between different groups of HCW. The psychometric properties of the German SAVE-9 were satisfactory and comparable to previous findings from Korea and Russia. Correlations with mental health measures were positive, as expected. We found some significant differences between groups of HCW on the SAVE-9 which were consistent with the literature but did not appear on the other mental health measures. This suggests that the SAVE-9 taps into specifically work-related stress, which may make it a helpful instrument in this research area.
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Affiliation(s)
- Julia König
- Department of Clinical and Biological Psychology, Catholic University of Eichstaett-Ingolstadt, Ostenstraße 25, 85072 Eichstaett, Germany; (V.E.); (B.K.D.); (H.C.); (J.U.); (A.B.)
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Verena Ertl
- Department of Clinical and Biological Psychology, Catholic University of Eichstaett-Ingolstadt, Ostenstraße 25, 85072 Eichstaett, Germany; (V.E.); (B.K.D.); (H.C.); (J.U.); (A.B.)
| | - Bettina K. Doering
- Department of Clinical and Biological Psychology, Catholic University of Eichstaett-Ingolstadt, Ostenstraße 25, 85072 Eichstaett, Germany; (V.E.); (B.K.D.); (H.C.); (J.U.); (A.B.)
| | - Hannah Comtesse
- Department of Clinical and Biological Psychology, Catholic University of Eichstaett-Ingolstadt, Ostenstraße 25, 85072 Eichstaett, Germany; (V.E.); (B.K.D.); (H.C.); (J.U.); (A.B.)
| | - Johanna Unterhitzenberger
- Department of Clinical and Biological Psychology, Catholic University of Eichstaett-Ingolstadt, Ostenstraße 25, 85072 Eichstaett, Germany; (V.E.); (B.K.D.); (H.C.); (J.U.); (A.B.)
| | - Antonia Barke
- Department of Clinical and Biological Psychology, Catholic University of Eichstaett-Ingolstadt, Ostenstraße 25, 85072 Eichstaett, Germany; (V.E.); (B.K.D.); (H.C.); (J.U.); (A.B.)
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Mehus CJ, Wieling E, Thomas Oloya O, Laura A, Ertl V. The impact of alcohol misuse on fathering in Northern Uganda: An ethnographic study of fathers. Transcult Psychiatry 2021; 58:14-26. [PMID: 32727316 DOI: 10.1177/1363461520943315] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Acholi people of northern Uganda experienced decades of conflict. Alcohol misuse is high among northern Ugandan men. This is common in displaced or post-war communities. Because parents are often the most significant and proximal influence in a child's development, it is important to understand the relationships between parental behavioral health and parenting. The purpose of this ethnographic study was to understand the impact of alcohol misuse on fathering, from fathers' perspectives. We collected qualitative data from several sources, including in-depth interviews with 19 fathers. Informants identified three ways in which a father can "overdrink": drinking to drunkenness, spending too much money on alcohol, or spending too much time drinking alcohol. Fathers described the specific ways in which overdrinking impacted each of the three primary roles of a father, which were identified as providing, educating, and creating a stable home. Of the negative effects of overdrinking, a compromised ability to provide for basic needs was described as the most salient. The findings suggest that support for families in this region should include support for father's substance misuse, as a father's overdrinking is widely understood to be problematic for the entire family.
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Affiliation(s)
| | | | | | | | - Verena Ertl
- Katholische Universität Eichstätt-Ingolstadt and vivo International, 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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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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Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide. BMC Med 2018; 16:154. [PMID: 30208905 PMCID: PMC6136186 DOI: 10.1186/s12916-018-1140-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In August 2014, the Islamic State of Iraq and Syria (ISIS), a terrorist organization, attacked the Yazidi's ancestral homeland in northwestern Iraq. Among other atrocities, they abducted thousands of women and girls and traded many of them into sexual slavery. The aim of this study is to determine the mental health of women and girl survivors of these events in relation to enslavement and experiences with genocide-related events, as well as perceived social rejection in their community. METHODS Between February and July 2017, trained local assessors interviewed a sample of 416 Yazidi women and girls (65 of whom had survived sexual enslavement), aged between 17 and 75 years, and living in internally displaced person camps in the Kurdistan Region of Iraq. Post-traumatic stress disorder (PTSD) and depression symptoms were assessed using validated Kurdish versions of standard instruments. Scales for trauma exposure and perceived rejection were developed for the purpose of this study. RESULTS Participants reported a high number of traumatic events. More than 80% of girls and women, and almost all participants who were formerly enslaved, met criteria for a probable DSM-5 PTSD diagnosis. Trauma exposure and enslavement predicted poor mental health. In addition, among formerly enslaved girls and women, perceived social rejection in their community mediated the relationship between traumatic enslavement events and depression symptoms. CONCLUSIONS In a context of maximum adversity, enslavement and war-related events contribute to high levels of PTSD and depression. Perceived social rejection seems to play a role in the relationship between trauma exposure and mental health among abducted genocide survivors. Providing psychosocial support and treatment for Yazidi people is essential and urgently required.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany. .,Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq. .,vivo International, Konstanz, Germany.
| | - Verena Ertl
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
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Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC Psychiatry 2018; 18:259. [PMID: 30115040 PMCID: PMC6097219 DOI: 10.1186/s12888-018-1839-z] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 08/07/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The Posttraumatic Stress Disorder Checklist (PCL) is a valid and reliable self-report measure for the assessment of Posttraumatic Stress Disorder (PTSD). Recently the PCL was updated according to the DSM-5 criteria for PTSD. So far only a few studies have examined the psychometric properties of the PCL-5, and all of these are restricted to populations living in industrialized countries. The aim of this study was to determine the psychometric properties and diagnostic utility of the PCL-5 as a screening instrument for war-affected displaced Kurdish and Arab populations. The specific goal was to determine a contextually valid cut-off score for a probable diagnosis of PTSD. METHODS The PCL-5 was translated into Arabic and two Kurdish dialects. Trained interviewers administered these translations as assisted self-reports to 206 adults living in camps for displaced people in Iraq, together with depression and war-exposure instruments. Two weeks later, 98 randomly chosen subjects were reassessed by expert clinical psychologists. In the absence of a gold-standard instrument with proven validity in this context, the expert interviewers applied the PCL-5 items in the form of a clinical interview and used a DSM-5-algorithm to determine a diagnosis of PTSD. Receiver operator characteristics (ROC) were performed to determine a valid cutoff-score. RESULTS The internal consistency of the PCL-5 was high (alpha = .85) and the instrument showed an adequate convergent validity. Using the cut-off score of 23, the PCL-5 achieved the optimal balance of sensitivity and specificity (area under the curve = .82, p < .001; sensitivity = .82, specificity = .70). CONCLUSIONS Given that the comparison of the two assessments included both a re-test interval and validation by different interviewers, our results indicate that the PCL-5 can be recommended as an assessment and screening instrument for Kurdish and Arab populations.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany. .,vivo international, Konstanz, Germany. .,Department of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq, Iraq.
| | - Verena Ertl
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Claudia Catani
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Azad Ali Ismail
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,grid.440835.eDepartment of Clinical Psychology, Koya University, Koya, Kurdistan Region of Iraq Iraq
| | - Frank Neuner
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany ,vivo international, Konstanz, Germany
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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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Wieling E, Mehus C, Yumbul C, Möllerherm J, Ertl V, Laura A, Forgatch M, Neuner F, Catani C. Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda. Fam Process 2017; 56:376-392. [PMID: 26503176 DOI: 10.1111/famp.12189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.
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Affiliation(s)
- Elizabeth Wieling
- Family Social Science, University of Minnesota, St. Paul, MN
- Victims Voice International (vivo.org), Gulu, Uganda
| | | | - Cigdem Yumbul
- Family Social Science, University of Minnesota, St. Paul, MN
| | - Julia Möllerherm
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Verena Ertl
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Achan Laura
- Victims Voice International (vivo.org), Gulu, Uganda
| | - Marion Forgatch
- Oregon Social Learning Center, Implementation Sciences International Incorporated, Eugene, OR
| | - Frank Neuner
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Claudia Catani
- Victims Voice International (vivo.org), Gulu, Uganda
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Steuwe C, Rullkötter N, Ertl V, Berg M, Neuner F, Beblo T, Driessen M. Effectiveness and feasibility of Narrative Exposure Therapy (NET) in patients with borderline personality disorder and posttraumatic stress disorder - a pilot study. BMC Psychiatry 2016; 16:254. [PMID: 27439618 PMCID: PMC4955150 DOI: 10.1186/s12888-016-0969-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This pilot study focused on the feasibility and potential effectiveness of a protocol based on Narrative Exposure Therapy (NET) that was integrated into a standard inpatient program to treat patients with comorbid Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD). METHODS Eleven patients (1 male, 10 female) without previous stabilization periods or the absence of intentional self-injury received NET during a ten-week inpatient program. Patients were assessed again at post-treatment and a 12-month follow-up. RESULTS Drop-out rates during treatment were low, with 90.9 % completing NET. Furthermore, acceptance of NET was high, with only one patient rejecting treatment. The program was safe because it did not lead to aggravations in symptom severity at either the post-treatment or 12-month follow-up. Additionally, the rate of self-harming behaviors throughout the treatment phase was low (18.2 %). In fact, treatment was associated with positive effects on PTSD and BPD symptom severity as well as secondary outcome measures, including depression, dissociation and quality of life. CONCLUSIONS The present study found that NET is feasible and safe in an inpatient setting for treating highly burdened patients with BPD and PTSD. There is also evidence for the potential effectiveness of NET in this highly burdened population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02517723 . Registered 6 January 2014.
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Affiliation(s)
- Carolin Steuwe
- />Clinic of Psychiatry and Psychotherapy, Bethel, Bielefeld University, Bielefeld, Germany
| | | | | | - Michaela Berg
- />Clinic of Psychiatry and Psychotherapy, Bethel, Bielefeld, Germany
| | | | - Thomas Beblo
- />Clinic of Psychiatry and Psychotherapy, Bethel, Bielefeld, Germany
| | - Martin Driessen
- />Clinic of Psychiatry and Psychotherapy, Bethel, Bielefeld, Germany
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15
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Ertl V, Saile R, Neuner F, Catani C. Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and psychopathology in a post-conflict context. BMC Psychiatry 2016; 16:202. [PMID: 27342048 PMCID: PMC4921056 DOI: 10.1186/s12888-016-0905-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It is likely that alcohol use and abuse increase during and after violent conflicts. The most prominent explanation of this phenomenon has been referred to as self-medication hypothesis. It predicts that psychotropic substances are consumed to deal with conflict-related psychic strains and trauma. In northern Uganda, a region that has been affected by a devastating civil war and is characterized by high levels of alcohol abuse we examined the associations between war-trauma, childhood maltreatment and problems related to alcohol use. Deducing from the self-medication hypothesis we assumed alcohol consumption moderates the relationship between trauma-exposure and psychopathology. METHODS A cross-sectional epidemiological survey targeting war-affected families in post-conflict northern Uganda included data of male (n = 304) and female (n = 365) guardians. We used standardized questionnaires in an interview format to collect data on the guardians' socio-demography, trauma-exposure, alcohol consumption and symptoms of alcohol abuse, PTSD and depression. RESULTS Symptoms of current alcohol use disorders were present in 46 % of the male and 1 % of the female respondents. A multiple regression model revealed the unique contributions of emotional abuse in the families of origin and trauma experienced outside the family-context in the prediction of men's alcohol-related symptoms. We found that alcohol consumption moderated the dose-effect relationship between trauma-exposure and symptoms of depression and PTSD. Significant interactions indicated that men who reported more alcohol-related problems experienced less increase in symptoms of PTSD and depression with increasing trauma-exposure. CONCLUSIONS The gradual attenuation of the dose-effect the more alcohol-related problems were reported is consistent with the self-medication hypothesis. Hence, the functionality of alcohol consumption has to be considered when designing and implementing addiction treatment in post-conflict contexts.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany. .,vivo international, Konstanz, Germany. .,Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, P.O. Box 100131, 33501, Bielefeld, Germany.
| | - Regina Saile
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany ,vivo international, Konstanz, Germany
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Winkler N, Ruf-Leuschner M, Ertl V, Pfeiffer A, Schalinski I, Ovuga E, Neuner F, Elbert T. From War to Classroom: PTSD and Depression in Formerly Abducted Youth in Uganda. Front Psychiatry 2015; 6:2. [PMID: 25788887 PMCID: PMC4348469 DOI: 10.3389/fpsyt.2015.00002] [Citation(s) in RCA: 11] [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: 11/23/2014] [Accepted: 01/05/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Trained local screeners assessed the mental-health status of male and female students in Northern Ugandan schools. The study aimed to disclose potential differences in mental health-related impairment in two groups, former child soldiers (n = 354) and other war-affected youth (n = 489), as well as to separate factors predicting mental suffering in learners. METHODS Participants were randomly selected. We used the Post-Traumatic Diagnostic Scale to assess symptoms of post-traumatic stress disorder (PTSD) and for potential depression the respective section of the Hopkins Symptom Checklist with a locally validated cut-off. RESULTS Almost all respondents had been displaced at least once in their life. 30% of girls and 50% of the boys in the study reported past abduction history. Trauma exposure was notably higher in the group of abductees. In former child soldiers, a PTSD rate of 32% was remarkably higher than that for non-abductees (12%). Especially in girls rates of potential depression were double those in the group of former abductees (17%) than in the group of non-abductees (8%). In all groups, trauma exposure increased the risk of developing PTSD. A path-analytic model for developing PTSD and potential depression revealed both previous trauma exposure as well as duration of abduction to have significant influences on trauma-related mental suffering. Findings also suggest that in Northern Ugandan schools trauma spectrum disorders are common among war-affected learners. CONCLUSIONS Therefore, it is suggested the school context should be used to provide mental-health support structures within the education system for war-affected youth at likely risk of developing war-related mental distress.
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Affiliation(s)
- Nina Winkler
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Vivo International (www.vivo.org)
| | - Martina Ruf-Leuschner
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Vivo International (www.vivo.org)
| | - Verena Ertl
- Vivo International (www.vivo.org)
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Anett Pfeiffer
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Vivo International (www.vivo.org)
| | - Inga Schalinski
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Emilio Ovuga
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Frank Neuner
- Vivo International (www.vivo.org)
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Vivo International (www.vivo.org)
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Abstract
In recent years, different approaches to large-scale mental health service provision for children in war-affected, mainly low- and middle-income, countries have been developed. Some school-based programs aiming at both strengthening resilience and reducing symptoms of trauma-related distress have been evaluated. In an article published in BMC Medicine, Tol and colleagues integrate their findings of the efficacy of universal school-based intervention across four countries and do not recommend classroom-based intervention as a treatment of trauma-related symptoms, since no consistent positive effects were found. On the contrary, for some children this type of universal intervention may impair recovery. Since universal school-based programs similar to the one evaluated here are widely implemented, Tol et al.'s results are highly relevant to inform the field of mental health service provision in war-affected countries.
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Affiliation(s)
- Verena Ertl
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Post BOX: 100131, 33501 Bielefeld, Germany.
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Olema DK, Catani C, Ertl V, Saile R, Neuner F. The hidden effects of child maltreatment in a war region: correlates of psychopathology in two generations living in Northern Uganda. J Trauma Stress 2014; 27:35-41. [PMID: 24478246 DOI: 10.1002/jts.21892] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Adverse life experiences are a major risk factor for psychopathology. Studies from industrialized countries have consistently shown the detrimental effects of child maltreatment on the mental health of the victims. Research in war-affected populations, however, has mostly been restricted to the psychological damage caused by the war. Both war trauma and child maltreatment have rarely been studied simultaneously. In a comparative study of 2 generations living in severely war-affected regions in Northern Uganda, we determined the relationship between both trauma types and posttraumatic stress disorder (PTSD), anxiety, depression, and suicide ideation. A total of 100 adolescents, 50 with and 50 without a history of abduction by the rebel army with both their parents (100 mothers and 100 fathers) living in camps in northern Uganda were interviewed. The study showed that both generations were severely affected by war and child maltreatment. Both trauma types were independently correlated with psychological disorders in the adolescent group. Only child maltreatment, however, not war violence, accounted for PTSD symptoms in the parent group (β = .253, p = .002). We conclude that, even in the context of severe war, the impact of child maltreatment on psychological disorders surpasses the damage of war trauma.
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Affiliation(s)
- David Kani Olema
- Department of Psychology, Mbarara University of Science and Technology, Mbarara, Uganda; vivo international e.V, Konstanz, Germany
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Saile R, Ertl V, Neuner F, Catani C. Does war contribute to family violence against children? Findings from a two-generational multi-informant study in Northern Uganda. Child Abuse Negl 2014; 38:135-46. [PMID: 24239222 DOI: 10.1016/j.chiabu.2013.10.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/02/2013] [Accepted: 10/15/2013] [Indexed: 05/12/2023]
Abstract
After 20 years of civil war in Northern Uganda, the continuity of violence within the family constitutes a major challenge to children's healthy development in the post-conflict era. Previous exposure to trauma and ongoing psychopathology in guardians potentially contribute to parental perpetration against children and dysfunctional interactions in the child's family ecology that increase children's risk of maltreatment. In order to investigate distal and proximal risk factors of child victimization, we first aimed to identify factors leading to more self-reported perpetration in guardians. Second, we examined factors in the child's family environment that promote child-reported experiences of maltreatment. Using a two-generational design we interviewed 368 children, 365 female guardians, and 304 male guardians from seven war-affected rural communities in Northern Uganda on the basis of standardized questionnaires. We found that the strongest predictors of self-reported aggressive parenting behaviors toward the child were guardians' own experiences of childhood maltreatment, followed by female guardians' victimization experiences in their intimate relationship and male guardians' posttrautmatic stress disorder (PTSD) symptoms and alcohol-related problems. Regarding children's self-report of victimization in the family, proximal factors including violence between adults in the household and male guardians' PTSD symptom severity level predicted higher levels of maltreatment. Distal variables such as female guardians' history of childhood victimization and female guardians' exposure to traumatic war events also increased children's report of maltreatment. The current findings suggest that in the context of organized violence, an intergenerational cycle of violence persists that is exacerbated by female guardians' re-victimization experiences and male guardians' psychopathological symptoms.
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Affiliation(s)
- Regina Saile
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
| | - Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
| | - Frank Neuner
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
| | - Claudia Catani
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Germany; Vivo (Victim's Voice) International, Allensbach, Germany
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Saile R, Neuner F, Ertl V, Catani C. Prevalence and predictors of partner violence against women in the aftermath of war: A survey among couples in Northern Uganda. Soc Sci Med 2013; 86:17-25. [DOI: 10.1016/j.socscimed.2013.02.046] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 12/14/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022]
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Zwissler B, Hauswald A, Koessler S, Ertl V, Pfeiffer A, Wöhrmann C, Winkler N, Kissler J. Memory control in post-traumatic stress disorder: evidence from item method directed forgetting in civil war victims in Northern Uganda. Psychol Med 2012; 42:1283-1291. [PMID: 22011378 DOI: 10.1017/s0033291711002273] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Traumatized individuals and particularly post-traumatic stress disorder (PTSD) patients are characterized by memory disturbances that suggest altered memory control. The present study investigated the issue using an item method, directed forgetting (DF) paradigm in 51 civil war victims in Uganda. All participants had been exposed to severe traumatic stress and 26 additionally suffered from PTSD. METHOD In an item cued, DF paradigm photographs were presented, each followed by an instruction to either remember or forget it. A recognition test for all initially presented photographs and thematically similar distracters followed. DF patterns were compared between the non-PTSD and the PTSD groups. Post-experimental ratings of picture valence and arousal were collected and correlated with DF. RESULTS Results revealed DF, that is, reduced recognition for 'to-be-forgotten' items in the non-PTSD but not in the PTSD group. Moreover, in the non-PTSD, but not in the PTSD group, false alarms were reduced for 'to-be-remembered' items. Finally, DF was reduced in those participants who rated the pictures as more arousing, the PTSD group giving, on average, higher arousal ratings. CONCLUSIONS Data indicate that DF is reduced in PTSD and that the reduction is related to stimulus arousal. Furthermore, individuals with PTSD are characterized by a more global encoding style than individuals without PTSD, reflected in a higher false alarm rate. In sum, traumatized individuals with (but not without) PTSD are impaired in their ability to selectively control episodic memory encoding. This impairment may contribute to clinical features of the disorder such as intrusions and flashbacks.
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Affiliation(s)
- B Zwissler
- Department of Psychology, University of Konstanz, Germany
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Neuner F, Pfeiffer A, Schauer-Kaiser E, Odenwald M, Elbert T, Ertl V. Haunted by ghosts: prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda. Soc Sci Med 2012; 75:548-54. [PMID: 22580073 DOI: 10.1016/j.socscimed.2012.03.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/06/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
Phenomena of spirit possession have been documented in many cultures. Some authors have argued that spirit possession is a type of psychopathology, and should be included as a category in diagnostic manuals of mental disorders. However, there are hardly any quantitative studies that report the prevalence of spirit possession on a population level and that provide evidence for its validity as a psychopathological entity. In an epidemiological study that was carried out in 2007 and 2008 with N = 1113 youths and young adults aged between 12 and 25 years in war-affected regions of Northern Uganda we examined the prevalence, predictors and outcomes of cen, a local variant of spirit possession. Randomly selected participants were interviewed using a scale of cen, measures of psychopathology (PTSD and depression) as well as indicators of functional outcome on different levels, including suicide risk, daily activities, perceived discrimination, physical complaints and aggression. We found that cen was more common among former child soldiers then among subjects without a history of abduction. Cen was related to extreme levels of traumatic events and uniquely predicted functional outcome even when the effects of PTSD and depression were controlled for. Our findings show that a long-lasting war that is accompanied by the proliferation of spiritual and magical beliefs and propaganda can lead to high levels of harmful spirit possession. In addition, we provide evidence for the incremental validity of spirit possession as a trauma-related psychological disorder in this context.
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Affiliation(s)
- Frank Neuner
- Bielefeld University, Department of Psychology, Postbox 100131, 33501 Bielefeld, Germany.
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Abstract
CONTEXT The psychological rehabilitation of former child soldiers and their successful reintegration into postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers. OBJECTIVE To assess the efficacy of a community-based intervention targeting symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization. Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention. INTERVENTION Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities. MAIN OUTCOME MEASURES Change in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation, feelings of guilt, and perceived stigmatization. RESULTS PTSD symptom severity (range, 0-148) was significantly more improved in the narrative exposure therapy group than in the academic catch-up (mean change difference, -14.06 [95% confidence interval, -27.19 to -0.92]) and waiting-list (mean change difference, -13.04 [95% confidence interval, -26.79 to 0.72]) groups. Contrast analyses of the time × treatment interaction of the mixed-effects model on PTSD symptom change over time revealed a superiority of narrative exposure therapy compared with academic catch-up (F(1,234.1) = 5.21, P = .02) and wait-listing (F(1,228.3) = 5.28, P = .02). Narrative exposure therapy produced a larger within-treatment effect size (Cohen d = 1.80) than academic catch-up (d = 0.83) and wait-listing (d = 0.81). CONCLUSION Among former Ugandan child soldiers, short-term trauma-focused treatment compared either with an academic catch-up program including supportive counseling or with wait-listing resulted in greater reduction of PTSD symptoms. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00552006.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, PO Box 100131, 33501 Bielefeld, Germany.
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Ertl V, Pfeiffer A, Saile R, Schauer E, Elbert T, Neuner F. Validation of a mental health assessment in an African conflict population. ACTA ACUST UNITED AC 2011. [DOI: 10.1037/2157-3883.1.s.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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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Ertl V, Pfeiffer A, Saile R, Schauer E, Elbert T, Neuner F. Validation of a mental health assessment in an African conflict population. Psychol Assess 2010; 22:318-24. [PMID: 20528059 DOI: 10.1037/a0018810] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the validity of the assessment of posttraumatic stress disorder (PTSD) and depression within the context of an epidemiological mental health survey among war-affected adolescents and young adults in northern Uganda. Local language versions of the Posttraumatic Diagnostic Scale (PDS) and the Depression section of the Hopkins Symptom Checklist (DHSCL) were administered by trained local interviewers. Correlations with probable predictor variables (i.e., trauma exposure), outcomes (e.g., impaired functioning), and local idioms of distress (i.e., spirit possession) were determined to estimate criterion-related construct validity. To assess convergent validity, expert clinicians reinterviewed a subsample using structured interviews (the Clinician Administered PTSD Scale [CAPS] and the Mini International Neuropsychiatric Interview [MINI]). Depression and PTSD symptoms as assessed by the local interviewers correlated with the context variables as predicted. After optimizing the scoring algorithm, we found good agreement between the PDS-based diagnoses and expert diagnoses. However, the concordance for depression diagnoses was not satisfactory. Results show that mental health assessments in African languages can produce reliable and valid data but that caution is warranted in the unevaluated transfer of cutoff scores and scoring algorithms.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, 33501 Bielefeld, Germany.
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Kolassa IT, Ertl V, Eckart C, Glöckner F, Kolassa S, Papassotiropoulos A, de Quervain DJF, Elbert T. Association study of trauma load and SLC6A4 promoter polymorphism in posttraumatic stress disorder: evidence from survivors of the Rwandan genocide. J Clin Psychiatry 2010; 71:543-7. [PMID: 20441718 DOI: 10.4088/jcp.08m04787blu] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [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: 10/09/2008] [Accepted: 01/02/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE As exposure to different types of traumatic stressors increases, the occurrence of posttraumatic stress disorder (PTSD) increases. However, because some people exhibit either surprising resilience or high vulnerability, further influencing factors have been conjectured, such as gene-environment interactions. The SLC6A4 gene, which encodes serotonin transporter, has been identified as predisposing toward differential emotional processing between genotypes of its promoter polymorphism. METHOD We investigated 408 refugees from the Rwandan genocide and assessed lifetime exposure to traumatic events, PTSD (according to DSM-IV) status, and genotype of the SLC6A4 promoter polymorphism. The study was conducted from March 2006 to February 2007. RESULTS The prevalence of PTSD approached 100% when traumatic exposure reached extreme levels. However, persons homozygous for the short allele of the SLC6A4 promoter polymorphism showed no dose-response relationship but were at high risk for developing PTSD after very few traumatic events. This genotype influence vanished with increasing exposure to traumatic stressors. CONCLUSION We find evidence for a gene-environment interplay for PTSD and show that genetic influences lose importance when environmental factors cause an extremely high trauma burden to an individual. In the future, it may be important to determine whether the effectiveness of therapeutic interventions in PTSD is also modulated by the SLC6A4 genotype.
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Affiliation(s)
- Iris-Tatjana Kolassa
- Clinical Psychology and Neuropsychology and Zukunftskolleg, University of Konstanz, Universitätsstrasse 10, 78457 Konstanz, Germany.
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Kolassa IT, Kolassa S, Ertl V, Papassotiropoulos A, De Quervain DJF. The risk of posttraumatic stress disorder after trauma depends on traumatic load and the catechol-o-methyltransferase Val(158)Met polymorphism. Biol Psychiatry 2010; 67:304-8. [PMID: 19944409 DOI: 10.1016/j.biopsych.2009.10.009] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [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: 04/12/2009] [Revised: 09/15/2009] [Accepted: 10/01/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND The risk for posttraumatic stress disorder (PTSD) depends on the number of traumatic event types experienced in a dose-response relationship, but genetic factors are known to also influence the risk of PTSD. The catechol-O-methyltransferase (COMT) Val158Met polymorphism has been found to affect fear extinction and might play a role in the etiology of anxiety disorders. METHODS Traumatic load and lifetime and current diagnosis of PTSD and COMT genotype were assessed in a sample of 424 survivors of the Rwandan Genocide living in the Nakivale refugee camp in southwestern Uganda. RESULTS Higher numbers of different lifetime traumatic event types led to a higher prevalence of lifetime PTSD in a dose-response relationship. However, this effect was modulated by the COMT genotype: whereas Val allele carriers showed the typical dose-response relationship, Met/Met homozygotes exhibited a high risk for PTSD independently of the severity of traumatic load. CONCLUSIONS The present findings indicate a gene-environment interaction between the human COMT Val158Met polymorphism and the number of traumatic event types experienced in the risk of developing PTSD.
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Onyut LP, Neuner F, Ertl V, Schauer E, Odenwald M, Elbert T. Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement - an epidemiological study. Confl Health 2009; 3:6. [PMID: 19470171 PMCID: PMC2695430 DOI: 10.1186/1752-1505-3-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 05/26/2009] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to establish the prevalence of posttraumatic stress disorder (PTSD) and depression among Rwandese and Somali refugees resident in a Ugandan refugee settlement, as a measure of the mental health consequences of armed conflict, as well as to inform a subsequent mental health outreach program. The study population comprised a sample from 14400 (n = 519 Somali and n = 906 Rwandese) refugees resident in Nakivale refugee settlement in South Western Uganda during the year 2003. Methods The Posttraumatic Diagnostic Scale (PDS) and the Hopkins Symptom Checklist 25 were used to screen for posttraumatic stress disorder and depression. Results Thirty two percent of the Rwandese and 48.1% of the Somali refugees were found to suffer from PTSD. The Somalis refugees had a mean of 11.95 (SD = 6.17) separate traumatic event types while the Rwandese had 8.86 (SD = 5.05). The Somalis scored a mean sum score of 21.17 (SD = 16.19) on the PDS while the Rwandese had a mean sum score of 10.05 (SD = 9.7). Conclusion Mental health consequences of conflict remain long after the events are over, and therefore mental health intervention is as urgent for post-conflict migrant populations as physical health and other emergency interventions. A mental health outreach program was initiated based on this study.
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Neuner F, Onyut PL, Ertl V, Odenwald M, Schauer E, Elbert T. Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. J Consult Clin Psychol 2009; 76:686-94. [PMID: 18665696 DOI: 10.1037/0022-006x.76.4.686] [Citation(s) in RCA: 244] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether trained lay counselors can carry out effective treatment of posttraumatic stress disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277 Rwandan and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors. Strictly manualized narrative exposure therapy (NET) was compared with more flexible trauma counseling (TC) and a no-treatment monitoring group (MG). Fewer participants (4%) dropped out of NET treatment than TC (21%). Both active treatment groups were statistically and clinically superior to MG on PTSD symptoms and physical health but did not differ from each other. At follow-up, a PTSD diagnosis could not be established anymore in 70% of NET and 65% TC participants, whereas only 37% in MG did not meet PTSD criteria anymore. Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement.
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Affiliation(s)
- Frank Neuner
- Department of Clinical Psychology, University of Konstanz, Konstanz, Germany.
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de Quervain DJF, Kolassa IT, Ertl V, Onyut PL, Neuner F, Elbert T, Papassotiropoulos A. A deletion variant of the alpha2b-adrenoceptor is related to emotional memory in Europeans and Africans. Nat Neurosci 2007; 10:1137-9. [PMID: 17660814 DOI: 10.1038/nn1945] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 06/25/2007] [Indexed: 11/09/2022]
Abstract
Emotionally arousing events are recalled better than neutral events. This phenomenon, which helps us to remember important and potentially vital information, depends on the activation of noradrenergic transmission in the brain. Here we show that a deletion variant of ADRA2B, the gene encoding the alpha2b-adrenergic receptor, is related to enhanced emotional memory in healthy Swiss subjects and in survivors of the Rwandan civil war who experienced highly aversive emotional situations.
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Onyut LP, Neuner F, Schauer E, Ertl V, Odenwald M, Schauer M, Elbert T. Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: two case reports and a pilot study in an African refugee settlement. BMC Psychiatry 2005; 5:7. [PMID: 15691374 PMCID: PMC549194 DOI: 10.1186/1471-244x-5-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 02/03/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little data exists on the effectiveness of psychological interventions for children with posttraumatic stress disorder (PTSD) that has resulted from exposure to war or conflict-related violence, especially in non-industrialized countries. We created and evaluated the efficacy of KIDNET, a child-friendly version of Narrative Exposure Therapy (NET), as a short-term treatment for children. METHODS Six Somali children suffering from PTSD aged 12-17 years resident in a refugee settlement in Uganda were treated with four to six individual sessions of KIDNET by expert clinicians. Symptoms of PTSD and depression were assessed pre-treatment, post-treatment and at nine months follow-up using the CIDI Sections K and E. RESULTS Important symptom reduction was evident immediately after treatment and treatment outcomes were sustained at the 9-month follow-up. All patients completed therapy, reported functioning gains and could be helped to reconstruct their traumatic experiences into a narrative with the use of illustrative material. CONCLUSIONS NET may be safe and effective to treat children with war related PTSD in the setting of refugee settlements in developing countries.
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Affiliation(s)
- Lamaro P Onyut
- vivo Uganda, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
- University of Konstanz, Centre for Psychiatry Reichenau, Haus 22, Feursteinstr. 55, D-78479 Reichenau-Lindenbühl, Germany
| | - Frank Neuner
- vivo Uganda, Mbarara, Uganda
- University of Konstanz, Centre for Psychiatry Reichenau, Haus 22, Feursteinstr. 55, D-78479 Reichenau-Lindenbühl, Germany
| | - Elisabeth Schauer
- vivo Uganda, Mbarara, Uganda
- University of Konstanz, Centre for Psychiatry Reichenau, Haus 22, Feursteinstr. 55, D-78479 Reichenau-Lindenbühl, Germany
| | - Verena Ertl
- University of Konstanz, Centre for Psychiatry Reichenau, Haus 22, Feursteinstr. 55, D-78479 Reichenau-Lindenbühl, Germany
| | - Michael Odenwald
- vivo Uganda, Mbarara, Uganda
- University of Konstanz, Centre for Psychiatry Reichenau, Haus 22, Feursteinstr. 55, D-78479 Reichenau-Lindenbühl, Germany
| | - Maggie Schauer
- vivo Uganda, Mbarara, Uganda
- University of Konstanz, Centre for Psychiatry Reichenau, Haus 22, Feursteinstr. 55, D-78479 Reichenau-Lindenbühl, Germany
| | - Thomas Elbert
- vivo Uganda, Mbarara, Uganda
- University of Konstanz, Centre for Psychiatry Reichenau, Haus 22, Feursteinstr. 55, D-78479 Reichenau-Lindenbühl, Germany
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