Community violence exposure and post-traumatic stress reactions among Gambian youth: the moderating role of positive school climate

Traumatic experiences assessed with the life events checklist for Kenyan adults

BACKGROUND

Life Events Checklist (LEC-5) has been widely used to assess for exposure to potentially traumatic life events (PTEs), but its psychometric properties have not been evaluated in Kenya. The objectives of this study were to determine the frequency and types of PTEs within this setting and to examine the construct validity of LEC-5 in Kenya.

METHODS

The LEC-5 was administered to 5316 participants in the ongoing multisite case-control study of Neuropsychiatric Genetics of African Populations-Psychosis. We used exploratory factor analysis to assess LEC-5 structure, and conducted confirmatory factor analyses to compare these results with two other models: a six-factor model based on the only prior EFA of the LEC and a theoretical seven-factor model.

RESULTS

The majority (63.4% overall and 64.4% of cases and 62.4% of controls) of participants had experienced at least one PTE in their lifetime. Results of the exploratory factor analyses for LEC-5 yielded a seven-factor solution with eigenvalues greater than one, accounting for 55.3% of the common variance. Based on confirmatory factor analyses, all three models had good fit for our sample, but the theoretical seven-factor model had the best fit.

LIMITATIONS

The study did not assess if the participants perceived experiences as traumatic, we did not carry out test retest reliability or and we did not consider cultural variations in perception of trauma.

CONCLUSION

This study provides evidence of a high prevalence of traumatic life events and for the construct validity of LEC-5 in assessing PTE exposures in a Kenyan setting.

Community violence and internalizing mental health symptoms in adolescents: A systematic review

PURPOSES

Mental disorders are responsible for 16% of the global burden of disease in adolescents. This review focuses on one contextual factor called community violence that can contribute to the development of mental disorders OBJECTIVE: To evaluate the impact of community violence on internalizing mental health symptoms in adolescents, to investigate whether different proximity to community violence (witness or victim) is associated with different risks and to identify whether gender, age, and race moderate this association.

METHODS

systematic review of observational studies. The population includes adolescents (10-24 years), exposition involves individuals exposed to community violence and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers.

RESULTS

A total of 2987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witnessing is less harmful for mental health than being a victim. Age and race did not appear in the results as modifiers, but male gender and family support appear to be protective factors in some studies.

CONCLUSION

This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.

Neighborhoods, Schools, and Adolescent Violence: Ecological Relative Deprivation, Disadvantage Saturation, or Cumulative Disadvantage?

Neighborhood and school socioeconomic "disadvantage" are consequential for youth violence perpetration. This study considers alternative ecological cumulative disadvantage, disadvantage saturation, and relative deprivation hypotheses regarding how the association between neighborhood disadvantage and violence varies by levels of socioeconomic disadvantage in schools. These hypotheses are tested with data from Wave I of Add Health (n = 15,581; 51% Female; Age mean = 15.67, SD = 1.74). Cross-classified multilevel Rasch models are used to estimate the interaction between neighborhood and school disadvantage in predicting adolescent violence. Consistent with the ecological relative deprivation hypothesis, results indicate that the association between neighborhood disadvantage and violence is most pronounced among youth attending low-disadvantage schools. Further, youth exposed to high-disadvantage neighborhoods and low-disadvantage schools tend to be at the greatest risk of perpetrating violence. These patterns are evident among both males and females, and particularly among older youth and those from low-parent education families. This study motivates future investigations considering how adolescents' experiences beyond the neighborhood shape how they engage with and experience the effects of their neighborhoods.

Structural School Characteristics and Neighborhood Risk Factors: Associations with Student-Reported School Climate in a Large, Urban Public School District in the United States

School climate consistently predicts youth academic success, social-emotional well-being, and substance use, and positive school climate can buffer the negative effects of community violence exposure on youth development. Various structural school and neighborhood factors have been associated with school climate, but prior research has not examined these relations comprehensively. We examined the relation between 18 school building and school neighborhood factors with student-reported school climate among 15,833 students in 124 public schools in a large, urban district in the United States. In this sample, attendance rate was most consistently associated with school climate (β = 0.015; p < .001). Teacher years of experience, mobility rate, number of students in special education, adult arrests in the school neighborhood, and service calls for shootings and dirty streets and alleys in the school neighborhood were also significantly associated with various domains of school climate. These findings highlight the need for future longitudinal research on the influence of both school building and school neighborhood factors on school climate for public schools. Schools in our sample had a wide range of school climate scores despite consistently high crime rates and other structural risk factors such as low socioeconomic status throughout the city, so there are implications for researchers and education leaders to work together to identify opportunities for schools to foster positive school climate despite systemic school and/or neighborhood risk factors.

Factors That Protect Children From Community Violence: Applying the INSPIRE Model to a Sample of South African Children

Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009-2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies-positive parenting, basic necessities, formal social support, and school structural support-and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct p < .001; adjusted odds ratio [AOR] = .57; indirect p < .01; AOR = .62), formal support (direct p < .05; AOR = .83; indirect p < .05; AOR = .73), and school support (direct p < .001; AOR = .53; indirect p < .001; AOR = .49). Combined interventions in direct and indirect community violence analyses demonstrated that children reporting a higher number of strategies were less likely to have experienced community violence. This outcome extends the results of longitudinal studies in South Africa highlighting social protection with care as a means to overcome structural deprivation strains, thereby reducing the likelihood of children's exposure to community violence. Moreover, these findings uphold the INSPIRE model as an effective cross-sectoral approach to prevent and reduce the community violence that children experience.

The relationship between exposure of Palestinian youth to community violence and internalizing and externalizing symptoms: Do gender and social support matter?

BACKGROUND

Youth exposure to community violence (ECV) in the Palestinian society is an alarming problem. Yet, there is serious scarcity of research on its mental health consequences.

OBJECTIVES

The study examined the relationships between youth ECV and internalizing and externalizing symptoms as well as the moderating and mediating effects of gender and support from family and teachers on these relationships.

PARTICIPANTS, SETTING, AND METHOD

A cross-sectional survey was conducted among a systematic random sample of 1930 Palestinian junior and senior high school pupils (912 boys, 1018 girls, aged 12-19-year- old), using a self-administered questionnaire.

RESULTS

The results revealed that the more Palestinian youth were exposed to community violence (CV) the more they demonstrated internalizing and externalizing symptoms. Palestinian boys who were victims of CV reported higher levels of externalizing symptoms, while girls reported higher levels of internalizing symptoms. Adolescents with higher levels of family support and teacher support reported lower levels of internalizing and externalizing symptoms. We have also found that gender can moderate the effects of CV victimization on internalizing symptoms and that family support can mediates the relationship between CV victimization and internalizing symptoms and moderate the relationships between ECV (both victimization and witnessing) and externalizing symptoms.

CONCLUSIONS

The moderating and mediating effects of gender and social support on the relationship between ECV and mental health consequences are discussed. The implications of the results for future research and for prevention and intervention as well as the strengths and limitations of the study are also discussed.

National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA.

METHODS AND FINDINGS

The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies.

CONCLUSIONS

In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.

Resilience and adjustment trajectories amongst children in displacement-affected communities in Zarqa, Jordan

BACKGROUND

The experiences of protracted conflict and displacement are clear threats to children's developmental progress. Understanding the factors that shape the trajectories of children's well-being and adjustment in such contexts is important for informing interventions.

METHODS

We collected data at three time points from a sample of Syrian refugee and Jordanian children (n=650) residing in Zarqa, Jordan who met eligibility criteria for humanitarian programming. We assessed primary outcomes of protection concerns, caregiver stress, mental health, and developmental assets at three time points: baseline (T1), three months later (T2), and fifteen months after baseline (T3).

RESULTS

Over the fifteen-month study period (T1-T3) child protection concerns and mental health symptoms improved, caregiver stress remained constant, and developmental assets deteriorated. School attendance was independently associated with improvements in protection concerns (β = -1.05, P=0.01), caregiver stress (β = -0.66, P =0.02), and developmental assets (β = 3.84, P =0.02). Concern over lost livelihoods significantly predicted higher protection concerns (β = 4.08, P <0.001) and caregiver stress (β = 2.32, P <0.001). Attending child-focused programming did not significantly impact primary outcomes.

CONCLUSIONS

This study documents the capacity for adjustment and adaptation of children in the context of protracted displacement. The significant influences of attending school and concern over lost livelihoods on observed trajectories indicate the importance of addressing structural factors, such as education and employment, in supporting processes of resilience in these populations. Programmatic activities for children may secure valuable shorter-term impacts but here, as elsewhere, failed to impact outcomes longer-term.

Risk or resource: Does school climate moderate the influence of community violence on children's social-emotional development in the Democratic Republic of Congo?

Exposure to community violence is thought to create risk for the social and emotional development of children, including those children living in low-income, conflict-affected countries. In the absence of other types of community resources, schools may be one of the few community resources that can help buffer children from the negative effects of community violence exposure. We sampled 8,300 students ranging in age from 6-18 years in 123 schools from the eastern Democratic Republic of Congo to examine whether and how two distinct dimensions of positive school climate can protect two key features of children's social-emotional development in the presence of community violence. Multi-level models tested the hypothesis that students' perceptions of a positive school climate moderated the relation between community violence and self-reported mental health problems and peer victimization. Findings support the hypothesis. Specifically, a positive school climate protected against mental health problems and peer victimization in the presence of high community violence. Students who experienced high community violence and a negative school climate generally demonstrated the worst development. We find complex interactions between the dimensions of school climate and exposure to violence on student social-emotional development that highlight the salience of children's contexts for developmental studies in low-income countries. We use dynamic developmental systems theory and differential impact to discuss the dual potential of schools as a buffer against the effects of violence or as a source of compounded risk.

Positive School Climate as a Moderator of Violence Exposure for Colombian Adolescents

In Colombia, many adolescents have experienced violence related to the decades-long armed conflict in the country and have witnessed or been directly victimized by violence in their communities, often related to gang activity or drug trafficking. Exposure to violence, both political and community violence, has detrimental implications for adolescent development. This study used data from 1857 Colombian adolescents in an urban setting. We aim to understand the relations between exposure to violence and adolescent outcomes, both externalizing behaviors and developmental competence, and then to understand whether school climate (i.e., safety, connectedness, services) moderates these relations. Results demonstrate that armed conflict, community violence victimization, and witnessing community violence are positively associated with externalizing behaviors, but only armed conflict is negatively associated with developmental competence. School safety, connectedness, and services moderate the relation between community violence witnessing and externalizing behaviors. School services moderates the relation between community violence victimization and developmental competence. As students perceived more positive school climate, the effects of community violence exposure on outcomes were weakened. This study identifies potential levers for intervention regarding how schools can better support violence-affected youth through enhancements to school safety, connectedness, and services.

Community violence exposure and determinants of adolescent mental health: A school-based study of a post-conflict area in Indonesia

INTRODUCTION

Studies have shown the adverse impact of exposure to community violence on adolescent health. However, most of the studies were conducted in high-income countries. This study aimed at assessing the community violence exposure and the determinants of mental health problems among adolescents in Ambon, a post-conflict area in Indonesia.

MATERIAL AND METHODS

We conducted a cross-sectional, school-based study involving 511 of 10th-graders from six randomly selected high schools in Kotamadya Ambon. Our participants were assessed using a set of questionnaires including the Strength Difficulties Questionnaire (SDQ) to measure mental health problems, and the child version of the Screen for Adolescent Violence Exposure (KID-SAVE) to measure community violence exposure. The hierarchical regression analyses were used to explore the determinants of mental health problems.

RESULTS

In this study, boys reported more exposure to community violence (both in frequency and severity) than girls. Meanwhile, the girls reported higher emotional problems than boys. The hierarchical regression analyses revealed that in the total sample and among boys, the community violence exposure was associated with mental health problems. However, it was the perceived impact of community violence exposure which showed an association with mental health problems among girls.

CONCLUSIONS

This study revealed the high community violence exposure among adolescents living in a post-conflict setting in Indonesia. The study also found gender differences in the determinants of mental health problems among adolescents who were exposed to CVE.

Experience of gender-based violence to students in public and private secondary schools in Ilorin, Nigeria

OBJECTIVE

To determine and compare prevalence of Gender based Violence (GBV) in public and private secondary schools students and to identify factors associated with experience of GBV by the students.

DESIGN

Comparative cross-sectional survey of using a 60 item self-administered questionnaire.

SETTING

Ten public and private secondary schools in Ilorin South Local Government area of Kwara State.

PARTICIPANTS

640 students, (320 each) from public and private schools. Main outcome variable: Prevalence and factors influencing experience of physical, sexual and psychological violence.

RESULTS

At least one form of GBV was experienced by 89.1% of public and 84.8% private schools students (p=0.32). Psychological violence was commonest type of GBV experienced (Public -72.5% vs. Private -69.2%; p=0.37), while sexual violence was least (Public -41.4% vs. Private -37.4%; p=0.3). Females were less likely to experience physical violence (OR 0.3; 95% CI 0.2-0.4) and psychological violence (aOR 0.6; 95%CI 0.4-0.8). Students who were in a relationship and who had history of parental violence were more likely to experience sexual (aOR 1.7; 95%CI 1.2-2.4) and aOR 1.5; 95%CI 1.2-2.2) and psychological (aOR 1.3; 95%CI 1.1-1.5 and aOR 1.3; 95%CI respectively) violence.

CONCLUSIONS

GBV was a common experience of students in both groups of schools. Multi-disciplinary interventions emphasising ending physical and psychological violence among private school students and sexual violence in public school are recommended. Interventions that involve the parents, school authorities and students on non-violence conflict resolution are urgently required. Parents and students who perpetrate violence should be referred for counselling.

FUNDING

Author funded.

School violence, perceptions of safety and school attendance: results from a cross-sectional study in Rwanda and Uganda

Background

Adolescents displaced by conflict face a number of risks, and access to education has potential to have multiple protective aspects in humanitarian settings. Yet, the impact of violence experienced at school by adolescents in humanitarian contexts is poorly understood, especially in terms of impacts on educational outcomes.

Methods

A household survey of adolescents in a refugee camp in Rwanda (n=274) and in two refugee settlements in Uganda (n=763) was conducted. Multiple logistic regression models were used to assess the influence of violence experienced at school on school attendance, feelings of fear and feelings of safety at school.

Results

In multiple logistic regression models, adjusting for socio-demographic variables, exposure to school violence was significantly associated with feelings of safety at school (adjusted odds ratio (AOR)=2.29, 95% confidence interval (CI)=1.20-4.38) and days of school missed (AOR=3.28, 95% CI=1.54-7.01) in Rwanda. In Uganda, exposure to violence was significantly associated with all outcomes: school fear (AOR=2.26, 95% CI=1.48-3.44), school safety (AOR=1.90, 95% CI=1.23-2.92) and school attendance (AOR=2.39, 95% CI=1.52-3.74). Gender-stratified analyses indicated that in both contexts exposure to school violence is significantly associated with school attendance, school fear, and school safety for girls, but the association is weaker amongst boys (with experience of violence significantly associated with school attendance for boys in Uganda, but not for other outcomes and not in Rwanda).

Conclusions

This study presents some initial and novel findings on the relationships between violence experienced at school and educational outcomes amongst adolescents displaced by conflict.

The relationship of school climate, teacher defending and friends on students' perceptions of bullying in high school

The purpose of this study was to examine the relationship of school climate, teacher defending, and friends on bullying and victimization. Participants were 2273 high school students from 3 public schools (an all girls, all boys boarding, and a co-ed day) in Kenya. A structural equation model was used to examine relationships between school climate, teacher behavior toward bullying, and student demographic characteristics, and bullying. Results revealed that a positive school climate was associated with less bullying behavior and victimization. In addition, when students reported that teachers stop bullying by students, bullying behavior and victimization scores were lower. Contrary to previous research these results showed that residents of a boys only boarding school were less likely to report bullying behavior than residents of an all girls school, or students at a co-educational institution. Furthermore, there were no differences in bullying behavior or victimization by gender or grade level. Implications of these results are discussed.

Effect of the good school toolkit on school staff mental health, sense of job satisfaction and perceptions of school climate: Secondary analysis of a cluster randomised trial

The Good School Toolkit, a complex behavioural intervention delivered in Ugandan primary schools, has been shown to reduce school staff-perpetrated physical violence against students. We aimed to assess the effect of this intervention on staff members' mental health, sense of job satisfaction and perception of school climate. We analysed data from a cluster-randomised trial administered in 42 primary schools in Luwero district, Uganda. The trial was comprised of cross-sectional baseline (June/July 2012) and endline (June/July 2014) surveys among staff and students. Twenty-one schools were randomly selected to receive the Toolkit, whilst 21 schools constituted a wait-listed control group. We generated composite measures to assess staff members' perceptions of the school climate and job satisfaction. The trial is registered at clinicaltrials.gov (NCT01678846). No schools dropped out of the study and all 591 staff members who completed the endline survey were included in the analysis. Staff in schools receiving the Toolkit had more positive perspectives of their school climate compared to staff in control schools (difference in mean scores 2.19, 95% Confidence Interval 0.92, 3.39). We did not find any significant differences for job satisfaction and mental health. In conclusion, interventions like the Good School Toolkit that reduce physical violence by school staff against students can improve staff perceptions of the school climate, and could help to build more positive working and learning environments in Ugandan schools.

The role of fortitude in relation to exposure to violence among adolescents living in lower socio-economic areas in South Africa

OBJECTIVE

There is compelling evidence that a significant proportion of adolescents exposed to violence do not develop trauma-related symptoms, but adapt successfully. This differential vulnerability has propelled research into identifying factors that promote coping. This study focused on the role of fortitude in the relationship between violence and trauma-related symptoms among South African adolescents living in two low-income communities. Fortitude is derived from positive cognitive appraisals of the self, the family and external sources of support.

METHOD

Adolescents (n = 498) completed an adapted version of the Harvard Trauma Scale (HTS) and the Fortitude Questionnaire (FORQ).

RESULTS

Moderated regression analysis demonstrated that fortitude had a health-sustaining and stress-buffering role. Adolescents who displayed high levels of fortitude had lower levels of trauma symptoms in relation to exposure to violence (stress-buffering) and were able to maintain their levels of wellbeing irrespective of the nature and extent of such exposure (health-sustaining).

CONCLUSION

The study provides evidence for fortitude as a protective factor by highlighting the role of specific cognitive appraisals related to fortitude in facilitating adaptation in relation to trauma. The study also underscores the relevance of using clinical interventions that target problematic cognitive appraisals and strengthen perceptions of coping.

Children's exposure to community and war violence and mental health in four African countries

In this article we review the mental health consequences of children's exposure to community and war violence (ETV) in four African countries: South Africa, Sierra Leone, Gambia and Rwanda. A focus on Africa is particularly pressing because of children's high levels of community and war ETV in countries therein. Regions of Africa present important macro-contexts for understanding children's various types of violence exposure amidst war and economic disadvantage. Findings of the review across 20 quantitative studies from 2004 to 2015 indicate consistent associations between exposure to war and community violence and children's symptoms of Post-traumatic Stress disorder (PTSD), depression, and aggression. School climate and family support mitigate these ETV influences upon children: however, more research is needed on the buffering effects of such resources. The effects of war violence are mediated by perceived discrimination in communities post-conflict. We integrate findings across studies to synthesize knowledge on children's ETV in Africa around a model of its correlates, mediators, and moderators in relation to mental health. Emerging research points to avenues for prevention and future inquiry.

The impact of neighborhood disorganization on neighborhood exposure to violence, trauma symptoms, and social relationships among at-risk youth

Previous research has demonstrated that exposure to violence (ETV) is a serious concern across the north-south socioeconomic divide. While studies have found that social support is a protective factor for youth exposed to violence and trauma, little is known about the impact of trauma symptoms on forming and maintaining social relationships which are key to accessing a vital social resource that fosters resilience in youth experiencing trauma symptomatology. Building on previous models that examine the impact of neighborhoods on exposure to violence and trauma, the current study examines the impact of neighborhood disorganization on ETV among youth and ETV's effects on trauma symptoms and social relationships. Data were collected on 2242 juvenile justice-involved youth with behavioral health issues in 11 urban and rural counties in the Midwestern United States. Using structural equation modeling (SEM), our data demonstrated that living in highly disorganized neighborhoods was associated with higher levels of ETV and that ETV was positively associated with trauma symptoms. Mediational analysis showed that trauma symptoms strongly mediated the effect of ETV on social relationships. Freely estimating structural paths by gender revealed that hypothesized associations between these variables were stronger for females than males. Findings here highlight the need to provide trauma-informed care to help youth to build and maintain social relationships. Identification and treatment of trauma symptoms that is culturally informed is a critical first step in ensuring that identified protective factors in local contexts, such as social relations and social support, have opportunities to minimize the impact of ETV among youth across northern and southern nations.

Relationship between particular areas of victimization and mental health in the context of multiple victimizations in Spanish adolescents

The main objective of this paper is to study the relationship between different areas of victimization (e.g., sexual victimization) and psychological symptoms taking into account the full range of victimizations adolescents suffer. The final aim is to contribute further evidence regarding the bias that those studies which focus on just one area of victimization may be introducing into our psychological knowledge. A total of 923 adolescents (62.4% girls) between 14 and 18 years old were recruited from seven secondary schools in Catalonia, Spain. The Youth Self-report and the Juvenile Victimization Questionnaire were employed to assess psychological problems (internalizing and externalizing symptoms) and victimization, respectively. The large majority of adolescents reported having experienced more than one area of victimization. However, Conventional Crime area was the one that was more reported in isolation. Overall, the explicative power of a particular area of victimization was greatly reduced or even lost its significance when the other areas were taken into account. However, some areas remained significant and were different by gender. Clinicians and researchers should take into account the whole range of victimizations adolescents suffer when intending to understand the psychological aftermaths of victimization. Some areas of victimization appear to be more important at explaining particular psychological symptoms, those being Peer and Sibling Victimization in the case of boys, and both Conventional Crime and Internet Victimization in the case of girls.

A study on reintegration of street children in Burundi: experienced violence and maltreatment are associated with mental health impairments and impeded educational progress

Street children are exposed to violence, and subsist in poor and generally precarious conditions. In conflict regions, institutional care facilities are often the only well established way to care for vulnerable children. Providing access to school education is considered to be key to allow successful integration into society. However, adverse effects of psychological disorders may pose another serious obstacle. In semi-structured interviews in a sample of 112 Burundian male youths (mean age = 15.9 years), we assessed exposure to traumatic stressors, regularly and recently occurring violence as well as prevalence of posttraumatic stress disorder (PTSD), depression, substance dependence, suicidal risk, and progress in school. Former street children (n = 32) and other vulnerable children (n = 50) in a residential center were compared to children living in the streets (n = 15) or with families (n = 15). While the children living in the center were less regularly exposed to violence and reported less substance dependence than street children, PTSD symptoms were common among the former street children. Furthermore, we provided empirical evidence that for the children living in the center, recently experienced violence – mostly minor physical conflicts, psychological violence and neglect – was associated with increased PTSD symptomatology and impeded progress in school. In a population of children who experienced many traumatic incidences and a lot of violence, even minor violent events may trigger and reinforce PTSD symptoms. Hence controlling exposure to violence and addressing mental ill-health in vulnerable children is mandatory for reintegration.

The 39-item Child Exposure to Community Violence (CECV) scale: exploratory factor analysis and relationship to PTSD symptomatology in trauma-exposed children and adolescents

BACKGROUND

Exposure to multiple forms of community violence in youth is associated with a wide range of negative health outcomes. A number of scales measuring community violence exposure have been developed, including the Child Exposure to Community Violence Checklist (CECV).

PURPOSE

This study examined the psychometric properties of an adapted version of the CECV in a South African sample of trauma-exposed youths. In addition, the study assessed the relationship between exposure to community violence and posttraumatic stress disorder (PTSD) symptomatology.

METHODS

Trauma-exposed youth completed two self-report instruments, namely, the CECV and the Child PTSD Checklist (CPC), on a single occasion. Exploratory factor analysis (EFA) was used to investigate the factor structure of the CECV, and the association between CECV and CPC scores was also explored.

RESULTS

EFA of the CECV revealed three factors that accounted for 38.66 % of variance in the model and consisted of 29 of the original 39 items. Reliability of the three factors ranged from moderate to excellent (α = 0.682 to α = 0.892). Exposure to community violence was positively correlated with posttraumatic stress symptomatology (r = 0.464, p < 0.001). Adolescents attending high school reported significantly higher levels of exposure to community violence than did children in primary school.

CONCLUSION

Findings provide support for the conceptualization of exposure to community violence as comprising distinct, multiple factors. Levels of exposure to community violence and family violence were high. We found a highly significant, positive association between exposure to community violence and PTSD symptomatology, providing evidence for the convergent validity of the CECV.

Impact of poly-victimization on mental health: the mediator and/or moderator role of self-esteem

The current study examines the relationship between the total kinds of victimization (TKV) experienced, self-esteem, and internalizing symptoms (IS) and externalizing symptoms (ES). It also explores the mediator and/or moderator role of two self-esteem facets: self-liking (SL) and self-competence (SC). The sample comprised 736 adolescents recruited from eight secondary schools in Catalonia, Spain. The Rosenberg Self-Esteem Scale, the Youth Self Report, and the Juvenile Victimization Questionnaire were used to assess self-esteem facets (SL and SC), psychological distress (IS and ES), and the TKV suffered. This article has several innovative features. On one hand, it considers that self-esteem is comprised of two different but related factors: SL and SC. On the other hand, it is the first study to provide evidence for the mediator/moderator role of SL and SC between victimization and psychological symptoms, taking account of the TKV experienced. Results suggest that SL is more relevant to mental health than SC. A low sense of being a worthy social being (SL) is more closely related to both victimization and poor mental health than a low sense of personal efficacy (SC). Moreover, SL seems to partially mediate the relationship between TKV and both IS and ES, whereas SC only acts as a partial mediator for the TKV-IS relationship in girls. At the same time, SL acts as a partial moderator of the TKV-IS relationship in boys. These findings support the importance of self-esteem in buffering the impact of victimization on mental health and may indicate that proper prevention and treatment policies should focus on adolescents' sense of being a good person, according to their own criteria of worth.

Exposure to violence in relation to depressive symptoms among male and female adolescent students in Cambodia

PURPOSE

In spite of the apparent increases in family and community violence, research into its effects on adolescent mental health has received limited attention in Cambodia. This study examines the association between exposure to violence and depressive symptoms among adolescents controlling for the effects of several factors in family and school domains.

METHODS

We randomly selected 993 male and 950 female students proportionally from 11 junior high schools and high schools in Battembang provincial city. Students were questioned about the violence to which they were subjected and which they witnessed in their family and community. The Asian adolescent depression scale was used to measure depressive symptoms.

RESULTS

In this study, 27.9% of male students and 21.5% of female students had been victimized in at least one case of family violence, while 18.0% of male and 5.8% of female students had been victimized in at least one case of community violence. After adjustment, increased levels of depressive symptoms were significantly associated with being the victim of or witnessing family or community violence among both male and female students. However, the positive association between the levels of depressive symptoms and being a witness to community violence was found only in female students.

CONCLUSIONS

Efforts to prevent depression in adolescent students should focus on reducing family and community violence; such efforts should also consider gender differences.

Effects of poly-victimization on self-esteem and post-traumatic stress symptoms in Spanish adolescents

This study aims to provide evidence concerning the effects of experiencing multiple forms of victimization (poly-victimization) on self-esteem and post-traumatic stress symptoms in Spanish adolescents. A total of 722 adolescents were recruited from seven secondary schools in Catalonia, Spain. The Rosenberg Self-Esteem Scale, the Youth Self Report and the Juvenile Victimization Questionnaire were employed to assess self-esteem, post-traumatic stress symptoms and victimization, respectively. Participants were divided into three groups (non-victim, victim and poly-victim groups) according to the total number of different kinds of victimization experienced. Results showed that 88.4 % of adolescents had been exposed to at least one kind of victimization. Poly-victimization was associated with a higher number of post-traumatic stress symptoms in both boys and girls. Also, self-liking was significantly lower in the poly-victim group, whereas self-competence was equivalent across the three victimization groups. Girls were approximately twice as likely to report child maltreatment (OR = 1.92) and sexual victimization (OR = 2.41) as boys. In conclusion, the present study adds evidence on the importance of taking account of the full burden of victimizations suffered when studying victimization correlates. Also, it highlights the importance of prevention policies to focus particularly on preserving adolescents' sense of social worth.

Gender-based violence and mental disorders in female college students

PURPOSE

To assess the association between gender-based violence and DSM-IV Axis I disorders in female college students.

METHODS

A stratified random sample of 1,043 college women (average age 22.2 years) participated in the study. We collected sociodemographic, socioeconomic and academic information as well as information on the participants' experience of gender-based violence victimization. The presence of mental disorders during the 12 months preceding the study was assessed by clinically trained interviewers applying the Structured Clinical Interview for DSM-IV Axis I disorders-Clinician Version (SCID-CV).

RESULTS

15.2% of the participants reported lifetime gender-based violence victimization. Almost two-thirds of the victims had suffered some Axis I disorder during the past year, a significantly larger proportion than among non-victims (OR = 3.72; 95% CI 2.61-5.30). Mood disorders and anxiety disorders were both significantly more common among victims than non-victims (OR = 4.26; 95% CI 2.81-6.46 and OR = 1.97; 95% CI 1.20-3.24, respectively). The most prevalent individual disorder among victims was major depressive disorder (26.41%). Among victims of purely psychological violence, the overall rate of Axis I disorder was similar to the rate among other victims (67 and 61%, respectively).

CONCLUSIONS

Among female university students, the experience of physical or psychological gender-based violence is associated with mental disorder. These findings suggest the need for treatment and prevention interventions designed specifically for this population.