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Papola D, Prina E, Ceccarelli C, Cadorin C, Gastaldon C, Ferreira MC, Tol WA, van Ommeren M, Barbui C, Purgato M. Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2024; 5:CD014300. [PMID: 38770799 DOI: 10.1002/14651858.cd014300.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health. OBJECTIVES To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour. MAIN RESULTS We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults. AUTHORS' CONCLUSIONS To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
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Affiliation(s)
- Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Madalena C Ferreira
- Public Health Unit, Médio Ave Local Health Unit, Vila Nova de Famalicão, Portugal
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mark van Ommeren
- Department of Mental Health, Brain Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Bangpan M, Felix L, Soliman F, D’Souza P, Jieman AT, Dickson K. The impact of mental health and psychosocial support programmes on children and young people's mental health in the context of humanitarian emergencies in low- and middle-income countries: A systematic review and meta-analysis. Glob Ment Health (Camb) 2024; 11:e21. [PMID: 38572260 PMCID: PMC10988149 DOI: 10.1017/gmh.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/20/2023] [Accepted: 01/30/2024] [Indexed: 04/05/2024] Open
Abstract
Humanitarian emergencies pose a significant global health challenge for children and young people's mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low- and middle-income countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments.
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Affiliation(s)
- Mukdarut Bangpan
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, United Kingdom
| | - Lambert Felix
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, United Kingdom
| | - Farida Soliman
- Linguistics Department, Queen Mary University of London, London, United Kingdom
| | - Preethy D’Souza
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, United Kingdom
| | - Anna-Theresa Jieman
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, United Kingdom
| | - Kelly Dickson
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, United Kingdom
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Leresche E, Hossain M, De Rubeis ML, Hermans V, Burtscher D, Rossi R, Lonsdale C, Singh NS. How is the implementation of empirical research results documented in conflict-affected settings? Findings from a scoping review of peer-reviewed literature. Confl Health 2023; 17:39. [PMID: 37605198 PMCID: PMC10464477 DOI: 10.1186/s13031-023-00534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Implementation science scholars argue that knowing 'what works' in public health is insufficient to change practices, without understanding 'how', 'where' and 'why' something works. In the peer reviewed literature on conflict-affected settings, challenges to produce research, make decisions informed by evidence, or deliver services are documented, but what about the understanding of 'how', 'where' and 'why' changes occur? We explored these questions through a scoping review of peer-reviewed literature based on core dimensions of the Extended Normalization Process Theory. We selected papers that provided data on how something might work (who is involved and how?), where (in what organizational arrangements or contexts?) and why (what was done?). We searched the Global Health, Medline, Embase databases. We screened 2054 abstracts and 128 full texts. We included 22 papers (of which 15 related to mental health interventions) and analysed them thematically. We had the results revised critically by co-authors experienced in operational research in conflict-affected settings. Using an implementation science lens, we found that: (a) implementing actors are often engaged after research is produced to discuss feasibility; (b) new interventions or delivery modalities need to be flexible; (c) disruptions affect how research findings can lead to sustained practices; (d) strong leadership and stable resources are crucial for frontline actors; (e) creating a safe learning space to discuss challenges is difficult; (f) feasibility in such settings needs to be balanced. Lastly, communities and frontline actors need to be engaged as early as possible in the research process. We used our findings to adapt the Extended Normalization Process Theory for operational research in settings affected by conflicts. Other theories used by researchers to document the implementation processes need to be studied further.
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Affiliation(s)
- Enrica Leresche
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mazeda Hossain
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Global Health, Nottingham Trent University, Nottingham, UK
| | | | - Veerle Hermans
- LuxOR, Médecins Sans Frontières Operational Centre Brussels, Luxembourg, Luxembourg
| | - Doris Burtscher
- Médecins Sans Frontières Vienna Evaluation Unit, Vienna, Austria
| | - Rodolfo Rossi
- Centre for Operational Research and Experience (CORE), International Committee of the Red Cross, Geneva, Switzerland
| | - Cordelia Lonsdale
- Elrha's Research for Health in Humanitarian Crises Programme, Cardiff, UK
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Jordans MJD, Bakolis I, Arnous M, Koppenol-Gonzalez GV, Tossyeh F, Chen A, Miller KE. Effectiveness of the caregiver support intervention on child psychosocial wellbeing among Syrian refugees in Lebanon: Mediation and secondary analysis of a Randomized Controlled Trial. Child Abuse Negl 2023:106335. [PMID: 37400323 DOI: 10.1016/j.chiabu.2023.106335] [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] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/07/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND War and violence have a serious negative impact on the wellbeing and mental health of many children. Caregivers play an important role in mitigating or exacerbating this impact. OBJECTIVE This study evaluates the impact of the nine session Caregiver Support Intervention on improving children's wellbeing and examines putative mediators of changes in children's psychosocial wellbeing. PARTICIPANTS AND SETTING 240 female caregivers were randomly allocated (1:1) to the CSI or a waitlist control comparison condition. The study was implemented in Lebanon, in an area characterized by high levels of poverty and a high number of the Syrian refugees. METHODS A parallel group Randomized Controlled Trial reporting on caregiver-reported child-level wellbeing. We used a combination of the Kid- and Kiddy-KINDL (parent version) for index children ages three to 12. Putative mediators of the CSI on children's psychosocial wellbeing included harsh parenting, caregiver psychological distress, caregiver wellbeing. Measurements were conducted at baseline, post-intervention and 3-months follow-up. RESULTS We demonstrated a statistically significant change in caregiver reported children's psychosocial wellbeing at post-intervention (Mdiff =4.39, 95 % CI = 1.12, 7.65, p < 0.01, d = 0.28) but not at follow-up (Mdiff = -0.97, 95 % CI = -4.27, 2.32, p > 0.05). The proportion of the total effect of the CSI intervention on child psychosocial wellbeing mediated by caregiver distress, caregiver wellbeing and harsh parenting was 77 %. CONCLUSION The CSI holds potential for down-stream short-term effect on improving children's psychosocial wellbeing, beyond the previously reported positive caregiver outcomes. This effect was not sustained three months post intervention. The study confirms caregiver wellbeing and parenting support as dual pathways mediating child psychosocial wellbeing. Prospective trial registration: ISRCTN22321773.
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Affiliation(s)
- M J D Jordans
- Research and Development, War Child Holland, Amsterdam, the Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, the Netherlands; Health Service and Population Research Department & Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - I Bakolis
- Health Service and Population Research Department & Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | | | - A Chen
- Department of Psychology, Harvard University, United States of America
| | - K E Miller
- Research and Development, War Child Holland, Amsterdam, the Netherlands; Faculty of Education, University of British Columbia, Canada
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Gebretsadik GG, Abraha M, Bereket T, Hailemariam F, Gebrearegay F, Hagos T, Assefa M, Berhe K, Gebregziabher H, Adhanu AK, Haileselassie M, Gebregziabher M, Mulugeta A. Prevalence and multi-level factors associated with acute malnutrition among children aged 6-59 months from war affected communities of Tigray, Northern Ethiopia, 2021: a cross-sectional study. Confl Health 2023; 17:10. [PMID: 36934256 PMCID: PMC10024843 DOI: 10.1186/s13031-023-00508-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/09/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Armed conflicts greatly affect the health, nutrition, and food security of conflict affected settings particularly children. However, no empirical data exist regarding context specific factors contributing towards acute malnutrition in the war-torn Tigray, Ethiopia. Thus, this study aimed to identify individual and community level factors associated with acute malnutrition among children aged 6-59 months from armed conflict affected settings of Tigray, Ethiopia. METHODS A community based cross-sectional study was conducted among 3,614 children aged 6-59 months in Tigray, from July 15 to Aug 15, 2021. Study participants were selected using a two-stage random sampling method. A structured questionnaire was used to collect data by interviewing mothers/caregivers. Mid upper arm circumference (MUAC) measurements were taken from upper left arm of the children using MUAC tapes. Multivariable multilevel logistic regression analysis was used to determine factors associated with acute malnutrition. Adjusted Odds ratio (AOR) with 95% CI were estimated to describe the strength of associations at p < 0.05. RESULTS More than half (52.5%) of the sampled children were males in sex. Immediately after the first nine months into the conflict, the prevalence of severe, moderate, and global acute malnutrition was very high (5.1%, 21.8%, and 26.9%, respectively) in Tigray. The lowest and highest burden of child acute malnutrition was reported from Mekelle zone (13.3%) and Southeastern zone (36.7%), respectively. Individual-level factors such as older child age (AOR = 0.13, 95% CI: 0.10, 0.18), female child sex (AOR = 1.24, 95% CI 1.05, 1.480.95), Vitamin-A supplementation (AOR = 1.3, 95% CI: 1.05, 1.65), and history of diarrhea (AOR = 1.22, 95%CI: 1.02, 1.53) and community-level factors like unimproved drinking water source (AOR = 1.31, 95%CI: 1.08, 1.58), unimproved toilet facility (AOR = 1.24, 95% CI: 1.01, 1.52), and severe food insecurity (AOR = 1.55, 95% CI: 1.16. 2.07) were significantly associated with childhood acute malnutrition. CONCLUSIONS The burden of acute malnutrition is a severe public health problem in Tigray. To prevent the untimely suffering and death of children, regular nutrition screening, speedy, and appropriate referral of all malnourished children to nutritional services and large-scale humanitarian assistance including access to food; nutrition supplies; water, sanitation and hygiene supplies; and health care in a timely manner are required. In the prevailing armed conflict, these have been very difficult to achieve. Thus, immediate international intervention is needed.
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Affiliation(s)
| | - Mahlet Abraha
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tedros Bereket
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Ferehiwot Hailemariam
- Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Freweini Gebrearegay
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tigist Hagos
- Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Kidanemaryam Berhe
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hadush Gebregziabher
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Amaha Kahsay Adhanu
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mekonnen Haileselassie
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Miller KE, Chen A, Koppenol-Gonzalez GV, Bakolis I, Arnous M, Tossyeh F, El Hassan A, Saleh A, Saade J, Nahas N, Abboud M, Jawad L, Jordans MJD. Supporting parenting among Syrian refugees in Lebanon: a randomized controlled trial of the caregiver support intervention. J Child Psychol Psychiatry 2023; 64:71-82. [PMID: 35837815 DOI: 10.1111/jcpp.13668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parenting interventions in humanitarian settings have prioritized the acquisition of parenting knowledge and skills, while overlooking the adverse effects of stress and distress on parenting-a key mediator of refugee children's mental health. We evaluated the effectiveness of the Caregiver Support Intervention (CSI), which emphasizes caregiver wellbeing together with training in positive parenting. METHODS We conducted a two-arm randomized controlled trial of the CSI with Syrian refugees in Lebanon, with an intent-to-treat design, from September 2019-December 2020. A total of 480 caregivers from 240 families were randomized to the CSI or a waitlist control group (1:1). Retention from baseline to endline was 93%. Data on parenting and caregiver psychological wellbeing were collected at baseline, endline, and three-month follow-up. Prospective trial registration: ISRCTN22321773. RESULTS We did not find a significant change on overall parenting skills at endline (primary outcome endpoint) (d = .11, p = .126) or at follow-up (Cohen's d = .15, p = .054). We did find a significant effect on overall parenting skills among participants receiving the full intervention-the sub-sample not interrupted by (COVID-19) (d = 0.25, p < .05). The CSI showed beneficial effects in the full sample at endline and follow-up on harsh parenting (d = -.17, p < .05; d = .19, p < .05), parenting knowledge (d = .63, p < .001; d = .50, p < .001), and caregiver distress (d = -.33, p < .001; d = .23, p < .01). We found no effects on parental warmth and responsiveness, psychosocial wellbeing, stress, or stress management. Changes in caregiver wellbeing partially mediated the impact of the CSI on harsh parenting, accounting for 37% of the reduction in harsh parenting. CONCLUSIONS The CSI reduced harsh parenting and caregiver distress, and demonstrated the value of addressing caregiver wellbeing as a pathway to strengthening parenting in adversity. These effects were achieved despite a pandemic-related lockdown that impacted implementation, a severe economic crisis, and widespread social unrest. Replication under less extreme conditions may more accurately demonstrate the intervention's full potential.
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Affiliation(s)
- Kenneth E Miller
- Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC, Canada.,War Child, Research and Development Department, Amsterdam, The Netherlands
| | - Alexandra Chen
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | | | | | | | | | - Nayla Nahas
- Department of Psychology, University of Balamand, Tripoli, Lebanon
| | | | | | - Mark J D Jordans
- Department of Psychology, Harvard University, Cambridge, MA, USA.,Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
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Hecker T, Kyaruzi E, Borchardt J, Scharpf F. Factors Contributing to Violence Against Children: Insights From a Multi-informant Study Among Family-Triads From Three East-African Refugee Camps. J Interpers Violence 2022; 37:NP14507-NP14537. [PMID: 33926287 DOI: 10.1177/08862605211013960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parental violence poses a considerable, yet mitigable risk for the mental health and well-being of refugee children living in resource-poor refugee camps. However, little is known about potential risk factors for parental violence in these settings. Using an ecological systems perspective and a multi-informant approach, we investigated ontogenic (parental childhood experiences of violence), microsystem (parents' and children's psychopathology) and exosystem (families' monthly household income) risk factors for child-directed parental violence in a sample of 226 Burundian families living in refugee camps in Tanzania. Data were collected through individual structured clinical interviews with mothers, fathers, and children. In the child-report path model [χ2 (6) = 7.752, p = .257, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.036 (p = .562)], children's posttraumatic stress disorder (PTSD) symptoms, externalizing symptoms and paternal PTSD symptoms were positively associated with violence by both parents. Maternal psychosocial impairment was positively associated with child-reported paternal violence. In the parent-report path model [χ2 (6) = 7.789, p = .254, CFI = 0.97, RMSEA = 0.036 (p = .535)], children's externalizing problems as well as a lower monthly household income were positively related to maternal violence. Each parent's childhood victimization was positively linked to their use of violence against children. Maternal psychosocial impairment and paternal alcohol abuse were positively associated with paternal violence. Child and paternal psychopathology, maternal psychosocial impairment, parents' childhood victimization, and families' socioeconomic status may be important targets for prevention and intervention approaches aiming to reduce parental violence against refugee children living in camps.
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Affiliation(s)
- Tobias Hecker
- Bielefeld University, Bielefeld, Germany
- University of Zurich, Switzerland
| | - Edna Kyaruzi
- Dar Es Salaam University College of Education, Dar es Salaam, Tanzania
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Stark L, Seff I, Yu G, Salama M, Wessells M, Allaf C, Bennouna C. Correlates of Suicide Ideation and Resilience Among Native- and Foreign-Born Adolescents in the United States. J Adolesc Health 2022; 70:91-98. [PMID: 34412951 DOI: 10.1016/j.jadohealth.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Nearly 20% of U.S. adolescents have considered suicide. Yet, gaps remain in understanding correlates of resilience and suicide risk, especially among populations born outside the United States who may face unique migration- and acculturation-related stressors. This study adds to the literature by exploring correlates of suicide ideation among a diverse population. METHODS This study analyzes quantitative data (N = 357) from the Study of Adolescent Lives after Migration to America, in Detroit and Harrisonburg. More than 40% of the sample was born outside the United States, with the majority born in the Middle East and North Africa. Path analysis was used to model dual outcomes of resilience and suicide ideation using measures of hope, school belonging, stressful life events, and being born outside the United States. RESULTS Suicide ideation and resilience were negatively correlated (ß = -.236[.069]; p < .001). Adolescents with greater hope (ß = .367; p < .001) and school belonging (ß = .407; p < .001) reported higher resilience, while lower levels of school belonging correlated with higher levels of suicide ideation (ß = -.248; p = .009). More stressful life events were associated with suicide ideation (ß = .243; p < .001), while fewer were correlated with resilience (ß = -.106; p = .003). Being born outside the United States was associated with suicide ideation (ß = .186; P-.015), with this finding driven by those from the Middle East and North Africa region, who faced significantly increased risk of suicide ideation (ß = .169; p = .036). CONCLUSIONS Findings suggest that adolescents born in the Middle East and North Africa region may represent a vulnerable group needing targeted and culturally responsive interventions to destigmatize mental health and psychosocial well-being, boost existing sources of resilience, and encourage help-seeking behaviors.
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Affiliation(s)
- Lindsay Stark
- Brown School at Washington University in St. Louis, St. Louis, Missouri.
| | - Ilana Seff
- Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Mariam Salama
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael Wessells
- Mailman School of Public Health, Columbia University, New York, New York
| | | | - Cyril Bennouna
- Department of Political Science, Brown University, Providence, Rhode Island
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Abstract
Child maltreatment is an international public health problem. The aftermath can appear in multiple aspects of individual health and development, including decreased physical and emotional function, posttraumatic stress disorder (PTSD), and suicide attempts. However, there is lack of evidence regarding the quality of life of maltreated children. This study aims to examine the association between children's maltreatment experience and their quality of life. This study employed a cross-sectional design and surveyed 1,093 primary school children (including migrant children and nonmigrant children) in Shanghai, China. The Parent-Child Conflict Tactics Scale (CTSPC) and Pediatrics Quality of Life Inventory were used to measure children's experiences of child maltreatment and their quality of life. Corporal punishment (89.47%) was the most prevalent form of child maltreatment, followed by physical assault (80.21%), psychological abuse (65.00%), and neglect (52.26%). Children's migration status was not associated with their quality of life; however, social capital factors were all associated with increased levels of quality of life. Children's victimization experience, including severe to very severe physical assault (β = -3.34/-3.80, p < .001), psychological assault (β = -3.74, p < .001), corporal punishment (β = -2.46, p < .01), and neglect (β = -4.31, p < .001), was associated with their decreased quality of life. The results show that child maltreatment threatens the quality of life of children. There is a need for developing effective interventions to prevent child maltreatment and reduce the adverse outcomes among children with maltreatment experiences.
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Affiliation(s)
- Xiaoyue Sun
- East China University of Science and Technology, Shanghai, China
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10
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Papadopoulos I, Lazzarino R, Sakellaraki O, Dadãu V, Apostolara P, Kuckert-Wöstheinrich A, Mauceri M, Kouta C. Empowering refugee families in transit: the development of a culturally competent and compassionate training and support package. J Res Nurs 2021; 27:200-214. [PMID: 35813174 PMCID: PMC9264421 DOI: 10.1177/17449871211018736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Refugee parents who fled conflicts suffered violence and traumas and face huge challenges in supporting the health and welfare of their children while in transit. Aims To describe the development of a culturally competent and compassionate training and support package (TSP) for nurses, social and health care workers and volunteers, with a focus on parenting needs among unsettled refugees fleeing conflict. Methods The multi-method approach included: a scoping review covering parenting needs of refugees fleeing conflict zones; collection of stories from refugee parents, healthcare workers and volunteers via a mobile application; discussions between team members; a piloted and evaluated curriculum. Results High levels of family distress and deterioration of parental identity were identified. Informed by these results, the curriculum is articulated along 20 bite-sized learning units, covering four age stages of childhood as well as targeting adults’ well-being. Pilot training was evaluated positively, confirming feasibility and usefulness of the TSP. Conclusions Unsettled refugee parents fleeing conflicts face psycho-social and practical difficulties negatively affecting their parenting skills. The care workforce should be trained in order to provide culturally competent and compassionate support to help these families. Open access digital platforms are promising as autodidactic and self-help tools among hard-to-reach populations.
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Affiliation(s)
- Irena Papadopoulos
- Head of the Research Centre, Department of Mental Health and Social Work, Middlesex University, UK
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Runa Lazzarino
- Anthropologist, Department of Mental Health and Social Work, Middlesex University, UK
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Ourania Sakellaraki
- Independent Consultant, Greece
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Victor Dadãu
- President, EDUNET Association, Romania
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Paraskevi Apostolara
- Lecturer, Nursing Department, National and Kapodistrian University of Athens, Greece
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Andrea Kuckert-Wöstheinrich
- Lecturer, Nursing Department, Vorarlberg University of Applied Sciences, Austria; Senior Project Manager, St. Augustinus Gruppe, Germany
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Manuela Mauceri
- Neuroscientist and Social Psychologist, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Italy
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Christiana Kouta
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
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11
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Piñeros-Ortiz S, Moreno-Chaparro J, Garzón-Orjuela N, Urrego-Mendoza Z, Samacá-Samacá D, Eslava-Schmalbach J. Mental health consequences of armed conflicts in children and adolescents: An overview of literature reviews. Biomedica 2021; 41:424-448. [PMID: 34559491 PMCID: PMC8525875 DOI: 10.7705/biomedica.5447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
Introduction: Armed conflicts affect the mental health of children and adolescents. Their outcomes in these populations have been documented identifying vulnerability and significant biopsychosocial damage as the most common factors. Objective: To identify and synthesize the mental health consequences of armed conflicts in children and adolescents. Materials and methods: We carried out a comprehensive and systematic search of reviews published until July 2019 in the MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, and LILACS databases, as well as in additional sources. The information was retrieved and analyzed narratively by describing the characteristics and objectives of the studies and the mental health consequences of armed conflicts in three periods of time: pre-armed conflict, during the armed conflict, and post-conflict. Results. Out of 587 potentially relevant studies, we finally selected 72. In the pre-armed conflict period, we described in detail the psychological experiences and the anticipatory somatic symptoms. During the conflict, we identified regressive, behavioral, and cognitive symptoms such as enuresis, fear, sadness, aggression, hyperactivity, and inattention, among others. Direct mental health consequences such as adjustment disorders, depression, anxiety, and post-traumatic stress were also identified. Finally, in the postconflict period, we referred to the transmission of mental health consequences and resilience processes. On the other hand, we reviewed in depth the potential consequences of armed conflicts on biopsychosocial development, morality, identity, culture, education, and society. Conclusion. The development of mental health consequences due to the exposure to armed conflicts in these populations is a complex process that depends on the stage of the exposure, the length of the conflict, and contextual factors.
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Affiliation(s)
- Sandra Piñeros-Ortiz
- Grupo de Investigación Violencia y Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Departamento de Psiquiatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Jaime Moreno-Chaparro
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Escuela de Medicina, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D. C., Colombia.
| | - Nathaly Garzón-Orjuela
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Zulma Urrego-Mendoza
- Grupo de Investigación Violencia y Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia,Bogotá, D.C., Colombia.
| | - Daniel Samacá-Samacá
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Javier Eslava-Schmalbach
- Grupo de Investigación en Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia, Bogotá, D. C., Colombia.
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12
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Stark L, Robinson MV, Gillespie A, Aldrich J, Hassan W, Wessells M, Allaf C, Bennouna C. Supporting mental health and psychosocial wellbeing through social and emotional learning: A participatory study of conflict-affected youth resettled to the U.S. BMC Public Health 2021; 21:1620. [PMID: 34488688 PMCID: PMC8419992 DOI: 10.1186/s12889-021-11674-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 08/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A growing literature has drawn attention to the central role that schools play in supporting the adjustment of resettled refugee youth and promoting their mental health and psychosocial wellbeing. In particular, the recent proliferation of school-based social and emotional learning (SEL) initiatives presents an opportunity to strengthen supports for resettled adolescents. This participatory research study aims to understand how high school students resettled from countries in the Middle East and North Africa region are experiencing the challenges and opportunities of acculturation and the ways in which they believe schools can better support them in this process. METHODS We analyzed primary data collected during focus group discussions as part of the SALaMA study. During these discussions, we used participatory ranking methodology to elicit adolescents' suggestions on how high schools can better support students both academically and psychosocially after resettlement. Fourteen focus group discussions were held with male (n = 38) and female (n = 31) adolescents aged 14-20 years, who were selected purposively across six public high schools in Harrisonburg, Virginia, Austin, Texas, and Detroit, Michigan. Participants offered suggestions and then ranked them in order of importance using consensus ranking. RESULTS Thematic analysis of the PRM results across sites produced a wealth of suggestions centered around three broad themes, namely: skills related to navigating social and academic challenges, culturally responsive teaching, and socially and culturally equitable learning environments. CONCLUSIONS Findings reported illustrate limitations of the conventional, universal SEL model and shed light on how schools can adapt transformative SEL strategies to serve their students better, especially newcomers from conflict-affected countries.
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Affiliation(s)
- Lindsay Stark
- Brown School at Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Mackenzie V Robinson
- Brown School at Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Alli Gillespie
- Brown School at Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | | | - Wafa Hassan
- Global Educational Excellence, Ann Arbor, USA
| | - Michael Wessells
- Mailman School of Public Health, Columbia University, New York, USA
| | - Carine Allaf
- Qatar Foundation International, Washington, D.C., USA
| | - Cyril Bennouna
- Department of Political Science, Brown University, Providence, USA
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13
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Scharpf F, Mueller SC, Masath FB, Nkuba M, Hecker T. Psychopathology mediates between maltreatment and memory functioning in Burundian refugee youth. Child Abuse Negl 2021; 118:105165. [PMID: 34171582 DOI: 10.1016/j.chiabu.2021.105165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The detrimental impact of child maltreatment on children and adolescents' academic achievement and later socioeconomic wellbeing is well known. However, it is still unclear (1) whether maltreatment is actually linked to youth's long- and short-term memory deficits and (2) whether potential impairments are due to maltreatment per se or related psychopathology. OBJECTIVE Based on the Attentional Control Theory, we investigated a mediational model in which maltreatment would be related to psychopathology (internalizing symptoms, posttraumatic stress symptoms, posttraumatic cognitions), which would in turn be related to impaired memory functioning. PARTICIPANTS AND SETTING We drew on a sample of 155 Burundian refugee youth (aged 11 to 15) currently living in refugee camps in Tanzania and at high risk of experiencing ongoing maltreatment by parents. METHODS Youth reported on their experiences of maltreatment and psychopathology in structured clinical interviews and completed visuospatial memory tasks involving a short-term and a working memory component (Corsi Block Tapping Test) and delayed recall from long-term memory (Rey-Osterrieth Complex Figure). RESULTS Structural equation modeling showed that psychopathology mediated the association between increased maltreatment and reduced working memory capacity (β = -0.07, p = .02), with a trend towards mediation for short-term memory (β = -0.05, p = .06). Higher levels of maltreatment, but not psychopathology, were directly linked to long-term memory deficits (β = -0.20, p = .02). CONCLUSIONS Preventive efforts targeting maltreatment and interventions focusing on related psychopathology are needed to counter memory deficits and their potential negative implications for academic and socioeconomic outcomes.
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Affiliation(s)
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium; Department of Personality, Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
| | - Faustine Bwire Masath
- Department of Psychology, Bielefeld University, Germany; Department of Educational Psychology and Curriculum Studies, Dar es salaam University College of Education, Tanzania
| | - Mabula Nkuba
- Department of Educational Psychology and Curriculum Studies, Dar es salaam University College of Education, Tanzania
| | - Tobias Hecker
- Department of Psychology, Bielefeld University, Germany; Department of Psychology, University of Zurich, Switzerland
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14
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Affiliation(s)
- Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Theresa S Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Boston, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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15
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Abstract
Background Fragile states pose a global challenge. Assessing health research activity on people living in these states can help identify neglected health domains in fragile settings. The objective of the current study was to assess and describe health research activity on people living in fragile states in the alert zone. Method A bibliometric method was applied using SciVerse Scopus. Research articles published on people in fragile states in the alert zone were retrieved and analyzed. The Fragile State Index (FSI) score was used for selection of states in the alert zone. The analysis was limited to 1 year; 2018. Results The search query found 2299 research articles giving an average of 2 research articles per one million population per year in the selected fragile states. The number of research articles per one million population was not significantly correlated (p = 0.053; r = − 0.349) with FSI scores. However, it was significantly correlated with the extent of international research collaboration (p < 0.01, r = 065). Research on communicable diseases was the largest research domain (763 articles; 33.2%) followed by maternal/women’s health (430 articles; 18.7%), non-communicable diseases (291 articles; 12.7%), health system/policy (271 articles; 11.8%) and psychosocial and mental health (89; 3.9%). There were three research themes in the research domain of infectious diseases: HIV/AIDS; water-borne infectious diseases; and miscellaneous infectious diseases such as tuberculosis and malaria. The top ten cited articles were mainly on infectious diseases, particularly on malaria and Lassa fever. Of all the retrieved documents, 727 (31.6%) research articles appeared in national/regional journals while the remaining appeared in international journals. The World Health organization was the most active funding organization for research on fragile states. Top ten active institutions were mainly based in fragile states with the lowest FSI score, specifically Ethiopia, Uganda, Nigeria, and Pakistan. Conclusion Research on fragile states was relatively low. Research on mental health and health system/policy should be encouraged. Collaboration and funding might help academic institutions in fragile states to make health problems in these countries more visible.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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16
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Miller KE, Koppenol-Gonzalez GV, Arnous M, Tossyeh F, Chen A, Nahas N, Jordans MJD. Supporting Syrian families displaced by armed conflict: A pilot randomized controlled trial of the Caregiver Support Intervention. Child Abuse Negl 2020; 106:104512. [PMID: 32408022 DOI: 10.1016/j.chiabu.2020.104512] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The impact of armed conflict and displacement on children's mental health is strongly mediated by compromised parenting stemming from persistently high caregiver stress. Parenting interventions for refugees emphasize the acquisition of parenting knowledge and skills, while overlooking the deleterious effects of chronic stress on parenting. War Child Holland's Caregiver Support Intervention (CSI) aims to strengthen parenting by lowering stress and improving psychosocial wellbeing among refugee parents, while also increasing knowledge and skill related to positive parenting. The CSI is a nine-session group intervention delivered by non-specialist providers. OBJECTIVE We describe the findings of a two-arm pilot randomized controlled trial of the CSI with Syrian refugees in Lebanon. The primary aim was to test the feasibility of our study methodology prior to conducting a definitive RCT. METHODS We recruited 78 families (151 parents), who were randomized to the CSI or a waitlist control group. Data were collected at baseline and post-intervention. RESULTS Randomization was successful, retention was high (99 %), as was intervention completion (95 % among women, 86 % among men). Implementation fidelity was excellent. Blinding was largely, though not completely effective. The CSI group showed significantly increased parental warmth and responsiveness, decreased harsh parenting, lowered stress and distress, improved psychosocial wellbeing, and improved stress management. CSI parents reported increased child psychosocial wellbeing. Control families showed no significant change on any variable. CONCLUSIONS Findings demonstrate the feasibility of our methodology for a definitive RCT, and suggest that the CSI shows promise as a scalable approach to strengthening parenting in refugee communities. Trial registration # ISRCTN33665023.
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Affiliation(s)
- Kenneth E Miller
- War Child Holland, Helmholtzstraat 61g, 1098LE Amsterdam, The Netherlands.
| | | | | | | | | | | | - Mark J D Jordans
- War Child Holland, Helmholtzstraat 61g, 1098LE Amsterdam, The Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, The Netherlands.
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17
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Harsha N, Lynch MA, Giacaman R. Child abuse in the West Bank of the occupied Palestinian territory (WB/oPt): social and political determinants. BMC Public Health 2020; 20:1130. [PMID: 32682404 PMCID: PMC7368693 DOI: 10.1186/s12889-020-09251-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Child maltreatment is a global epidemic. It affects morbidity, mortality, social behavior, wellbeing, and quality of life of children. This study aims to assess prevalence of child abuse in the West Bank (WB) of the occupied Palestinian territory (oPt) and to determine some of its social and political associated factors. METHODS We analyzed secondary data obtained from a cross sectional study conducted on a sample representing Palestinian children on the West Bank and using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) tool. The ISPCAN Child Abuse Screening Tool for parents (ICAST-P) questionnaire was completed by 1107 Palestinian mothers to estimate physical and emotional child abusive practices at home for children aged 0-12 years. Univariate, bivariate, and multivariate binary logistic regression analyses were performed using the SPSS® version 20 to assess prevalence and predictors of child abuse. RESULTS Overall, around 34% of the West Bank-children were abused by their mothers. Results of the logistic regression analysis indicated that male children, children of younger mothers, children whose fathers were with low levels of education, children whose mothers reported low levels of parental warmth, and children whose parents were exposed to political violence were at greater risk of being abused. CONCLUSIONS Child abuse is highly prevalent among children of the Palestinian society in the West Bank. Policy makers need to pay more attention to this epidemic. The association between child abuse and political violence found in this study makes a just solution for Palestinians essential for improving the welfare of children and families.
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Affiliation(s)
- Nouh Harsha
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary. .,Institute of Community and Public Health, Birzeit University- ICPH/BZU, Birzeit, Palestine.
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18
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Miller KE, Arnous M, Tossyeh F, Chen A, Bakolis I, Koppenol-Gonzalez GV, Nahas N, Jordans MJD. Protocol for a randomized control trial of the caregiver support intervention with Syrian refugees in Lebanon. Trials 2020; 21:277. [PMID: 32183862 PMCID: PMC7079443 DOI: 10.1186/s13063-020-4175-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background There is evidence that chronic stress negatively impacts parenting among refugees and other war-affected communities. Persistent parental stress and distress may lead to unresponsive, anxious, or overly harsh parenting and a corresponding increase in emotional and behavior problems among children. Most parenting interventions emphasize the acquisition of knowledge and skills; however, this overlooks the deleterious effects of chronic stress on parenting. The Caregiver Support Intervention (CSI) aims to strengthen quality of parenting skills by lowering stress and improving psychosocial wellbeing among refugee caregivers of children aged 3–12 years, while also increasing knowledge and skills related to positive parenting. The CSI is a nine-session psychosocial group intervention delivered by non-specialist providers. It is intended for all adult primary caregivers of children in high-adversity communities, rather than specifically targeting caregivers already showing signs of elevated distress. Methods/design The primary objective of this study is to assess the effectiveness of the CSI through a parallel group randomized controlled study with Syrian refugee families in North Lebanon. Participants will be primary caregivers of children aged 3–12 years, with one index child per family. Families will be randomized to the CSI or a waitlist control group. A total of 240 families (480 caregivers) will be recruited into the study. Randomization will be at the family level, and CSI groups will be held separately for women and men. The study will be implemented in two waves. Outcomes for both arms will be assessed at baseline, post-intervention, and at a 3-month follow-up. The primary outcome is quality of parenting skills. Secondary outcomes include parental warmth and sensitivity, harsh parenting, parenting knowledge, and child psychosocial wellbeing. Putative mediators of the CSI on parenting are caregiver stress, distress, psychosocial wellbeing, and stress management. Discussion This trial may establish the CSI as an effective intervention for strengthening parenting in families living in settings of high adversity, particularly refugee communities. Trial registration International Society for the Registration of Clinical Trials, ISRCTN22321773. Registered on 5 August 2019
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Affiliation(s)
- Kenneth E Miller
- Research and Development, War Child Holland, Amsterdam, The Netherlands.
| | - Maguy Arnous
- War Child Holland Lebanon Offices (Beirut and Tripoli), Beirut and Tripoli, Lebanon
| | - Fadila Tossyeh
- War Child Holland Lebanon Offices (Beirut and Tripoli), Beirut and Tripoli, Lebanon
| | - Alexandra Chen
- Psychology Department, Harvard University, Cambridge, MA, USA
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology, and Neuroscience at King's College London, London, UK
| | | | | | - Mark J D Jordans
- Research and Development, War Child Holland, Amsterdam, The Netherlands.,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
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Abstract
Although there has been increasing attention on the impact of risk and resilience factors on refugee children's mental health, there has been limited evidence on the role of parental factors to inform interventions, and this predominantly relies on adult reports. The aim was to investigate the relationship between perceived parenting styles and attachment relationships and child mental health, as reported by 322 Syrian refugee minors aged between 8 and 17 years in Turkey. Child-rated scales included the Children Revised Impact of Event Scale-8 (CRIES-8), Strengths and Difficulties Questionnaire (SDQ), Security Scale and Egna Minnen Betraffande Uppfostran for Children (EMBU-C), and were used as measures of post-traumatic stress disorder (PTSD), general mental health problems, attachment relationships and perceived parenting styles, respectively. Children with secure maternal and paternal attachment perceived their parents as less rejecting, while children with secure paternal attachment also reported their parents as emotionally warmer. Attachment relationships significantly contributed in predicting PTSD after controlling for age and gender, while conduct problems were predicted by lack of emotional warmth, rejection and over-protection by both parents, in addition to insecure attachment relationships. Refugee children's views are essential in establishing their needs and planning interventions. These should address both the impact of trauma and current family relationships.
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Affiliation(s)
- Seyda Eruyar
- Faculty of Social Sciences and Humanities, Necmettin Erbakan University, Turkey
| | - John Maltby
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Panos Vostanis
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
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20
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Jones L. Adversity and resilience: 10 lessons I have learnt from working with children in humanitarian emergencies. Arch Dis Child 2019; 104:833-836. [PMID: 30104391 DOI: 10.1136/archdischild-2017-314038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Lynne Jones
- Fellow, FXB Center for Health and Human Rights, Harvard University, Cambridge, Massachusetts, USA.,Honorary Consultant, South London and Maudsley NHS Foundation Trust, London, UK
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21
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Scharpf F, Kyaruzi E, Landolt MA, Hecker T. Prevalence and co-existence of morbidity of posttraumatic stress and functional impairment among Burundian refugee children and their parents. Eur J Psychotraumatol 2019; 10:1676005. [PMID: 31681466 PMCID: PMC6807941 DOI: 10.1080/20008198.2019.1676005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Although the family constitutes the prime source of risk and resilience for the well-being of children growing up in adverse conditions, the mental health of children living in refugee camps has rarely been investigated in conjunction with their parents' mental health. Objectives: To examine the prevalence of posttraumatic stress disorder (PTSD) and other mental health problems among Burundian refugee children and their parents living in Tanzanian refugee camps and to identify patterns of comorbidity among children and their parents based on PTSD symptom levels and functional impairment. Methods: We recruited a representative sample of 230 children aged 7-15 years and both of their parents (n = 690) and conducted separate structured clinical interviews. Latent Class Analysis was applied to identify patterns of comorbidity. Results: Children and parents were exposed to multiple traumatic event types. In total, 5.7% of children fulfilled DSM-5 criteria for PTSD in the past month and 10.9% reported enhanced levels of other mental health problems. 42.6% indicated clinically significant functional impairment due to PTSD symptoms. PTSD prevalence was higher among mothers (32.6%) and fathers (29.1%). Latent Class Analysis (LCA) revealed a familial accumulation of PTSD symptoms as children with high symptom levels and impairment were likely to live in families with two traumatized parents. Conclusions: Although the number of children who need support for trauma-related mental health problems was relatively low, taking into account parental trauma could aid to identify at-risk children with elevated PTSD symptom levels and impairment even in the face of existing barriers to mental health care access for children in refugee camp settings (e.g. lack of targeted services, prioritization of managing daily stressors).
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Affiliation(s)
- Florian Scharpf
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Edna Kyaruzi
- Department of Educational Psychology and Curriculum Studies, Dar es salaam University College of Education, Dar es Salaam, Tanzania
| | - Markus A Landolt
- University Children's Hospital Zurich and Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Tobias Hecker
- Department of Psychology, Bielefeld University and Department of Psychology, University of Zurich, Bielefeld, Germany
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22
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Abstract
Ongoing research on the assessment of children's health has led to the development of a large number of quantitative tools. The Child Health Questionnaire-Parent Form (CHQ-PF) is a set of questionnaires aimed at measuring different facets of children's health as perceived by their parents. The present multi-trait multi-sample study tested the validity and the reliability of the 50-item version of the CHQ with families (N = 1095) living in contexts of low-intensity warfare. The validation procedures implemented (exploratory and confirmatory factor analysis, convergent validity, and reliability testing) yielded a new, shorter version of the questionnaire (CHQ-PF-25). We discuss the potential of using the CHQ-PF-25 in Arabic-speaking crisis contexts and the limitations of the present study.
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Affiliation(s)
- Guido Veronese
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Pepe
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milano, Italy
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Veronese G, Cavazzoni F, Antenucci S. Narrating hope and resistance: A critical analysis of sources of agency among Palestinian children living under military violence. Child Care Health Dev 2018; 44:863-870. [PMID: 30084134 DOI: 10.1111/cch.12608] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/12/2018] [Accepted: 07/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In light of critical and socioconstructionist theories, the aim of our research was to analyze source of agency, psychological adjustment to trauma as protective factors against political violence in children living in three different refugee camps in Palestine, as well as exploring the risks to which these children are exposed. METHODS Thematic content analysis was applied to children's written and drawn productions in order to extract the main categories and themes. RESULTS Four main domains of agency emerged from the analysis: personal growth, political well-being, social relationships, and geographical context. For each domain, specific dimensions are discussed. CONCLUSIONS The results of this preliminary exploration of children's agency suggest that the children's living environment plays a key role in shaping their suffering and reactions to war and ongoing violence. Furthermore, the social nature of the children affected by war-related suffering forces practitioners and policymakers to question the effectiveness of intervention programs that are predominantly focused on symptoms.
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Affiliation(s)
- Guido Veronese
- Department of Human Sciences "R. Massa", University of Milano-Bicocca, Milan, Italy
| | - Federica Cavazzoni
- Department of Human Sciences "R. Massa", University of Milano-Bicocca, Milan, Italy
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Massad S, Stryker R, Mansour S, Khammash U. Rethinking Resilience for Children and Youth in Conflict Zones: The Case of Palestine. Research in Human Development 2018. [DOI: 10.1080/15427609.2018.1502548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Brown FL, Carswell K, Augustinavicius J, Adaku A, Leku MR, White RG, Ventevogel P, Kogan CS, García-Moreno C, Bryant RA, Musci RJ, van Ommeren M, Tol WA. Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda. Glob Ment Health (Camb) 2018; 5:e27. [PMID: 30128163 PMCID: PMC6094406 DOI: 10.1017/gmh.2018.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/20/2018] [Accepted: 05/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Exposure to armed conflict and forced displacement constitute significant risks for mental health. Existing evidence-based psychological interventions have limitations for scaling-up in low-resource humanitarian settings. The WHO has developed a guided self-help intervention, Self Help Plus (SH+), which is brief, implemented by non-specialists, and designed to be delivered to people with and without specific mental disorders. This paper outlines the study protocol for an evaluation of the SH+ intervention in northern Uganda, with South Sudanese refugee women. METHODS A two-arm, single-blind cluster-randomised controlled trial will be conducted in 14 villages in Rhino Camp refugee settlement, with at least 588 women experiencing psychological distress. Villages will be randomly assigned to receive either SH+ with enhanced usual care (EUC), or EUC alone. SH+ is a five-session guided self-help intervention delivered in workshops with audio-recorded materials and accompanying pictorial guide. The primary outcome is reduction in overall psychological distress over time, with 3 months post-treatment as the primary end-point. Secondary outcomes are self-defined psychosocial concerns, depression and post-traumatic stress disorder symptoms, hazardous alcohol use, feelings of anger, interethnic relations, psychological flexibility, functional impairment and subjective wellbeing. Psychological flexibility is a hypothesised mediator, and past trauma history and intervention attendance will be explored as potential moderators. DISCUSSION This trial will provide important information on the effectiveness of a scalable, guided self-help intervention for improving psychological health and wellbeing among people affected by adversity. TRIAL REGISTRATION ISRCTN50148022; registered 13/03/2017.
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Affiliation(s)
- F. L. Brown
- War Child Holland, Amsterdam, The Netherlands
- Department of Global Health and Population, Research Program for Children and Global Adversity, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - K. Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - J. Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. Adaku
- HealthRight International, New York, NY
- Arua Regional Referral Hospital, Arua, Uganda
| | | | - R. G. White
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - P. Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - C. S. Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - C. García-Moreno
- Department of Reproductive Health & Research, World Health Organization, Geneva, Switzerland
| | - R. A. Bryant
- University of New South Wales, Sydney, Australia
| | - R. J. Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M. van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - W. A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- HealthRight International, New York, NY
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26
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Ponnamperuma T, Nicolson NA. The Relative Impact of Traumatic Experiences and Daily Stressors on Mental Health Outcomes in Sri Lankan Adolescents. J Trauma Stress 2018; 31:487-498. [PMID: 30058730 PMCID: PMC6174989 DOI: 10.1002/jts.22311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/10/2017] [Revised: 03/30/2018] [Accepted: 04/27/2018] [Indexed: 11/25/2022]
Abstract
Prior trauma, current stress, and poor social support contribute to youth mental health problems. As daily stressors often increase in the aftermath of traumatic events, trauma could plausibly impact psychopathology not only directly but also indirectly via ongoing stress. In this study, we examined the relative roles of trauma and daily stressors in mental health outcomes in 753 Sri Lankan adolescents residing in areas impacted by the 2004 tsunami. In 2008, participants completed measures of trauma exposure, daily stressors, social support, posttraumatic stress symptoms (PTSS), emotional and behavioral problems (EBP), and functional impairment; a subsample (n = 89) repeated these assessments 16 months later. Regression models revealed positive associations between cumulative trauma and all three mental health measures. Significant variance in these associations could be explained indirectly, via daily stressors. For PTSS, the indirect effect accounted for 26.1% of the total effect of trauma, unstandardized coefficient ab = 0. 739, 95% CI [0.459, 1.122]. For EBP this percentage was 42.4%, ab = 0.287, 95% CI [0.189, 0. 404], and for functional impairment 70.0%, ab = 0.072, 95% CI [0.049, 0.121]. Indirect effects on impairment were strongest when perceived social support was low. Although we also present evidence that pathways between stressors and psychopathology may have been bidirectional, findings support the notion that adolescents' daily stressors are important transmitters of the impact of traumatic events and highlight the need for interventions focused not only on trauma processing but also on reducing current stress and improving social support.
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Affiliation(s)
- Thyagi Ponnamperuma
- Department of Community MedicineUniversity of RuhunaRuhunaSri Lanka
- Department of Psychiatry & NeuropsychologySchool for Mental Health and Neuroscience, Maastricht UniversityMaastrichtThe Netherlands
| | - Nancy A. Nicolson
- Department of Psychiatry & NeuropsychologySchool for Mental Health and Neuroscience, Maastricht UniversityMaastrichtThe Netherlands
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Çeri V, Nasiroğlu S. The number of war-related traumatic events is associated with increased behavioural but not emotional problems among Syrian refugee children years after resettlement. ARCH CLIN PSYCHIAT 2018. [DOI: 10.1590/0101-60830000000167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Veronese G, Barola G. Healing stories: An expressive-narrative intervention for strengthening resilience and survival skills in school-aged child victims of war and political violence in the Gaza Strip. Clin Child Psychol Psychiatry 2018; 23:311-332. [PMID: 29451002 DOI: 10.1177/1359104518755220] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Within a preventive framework, we outline a school-based intervention aimed at strengthening skills of survival and psychological functioning in children who have experienced war and political violence in the Gaza Strip. In accordance with a socio-ecological perspective on wellbeing and resilience, the pilot study aimed at evaluating the outcomes of a psychosocial narrative school-based intervention with a group of school-aged children in the aftermath of war. The intervention was oriented at empowering positive emotions, life satisfaction, and optimism in children as protective factors in preventing posttraumatic reactions after war. Findings showed the efficacy of the intervention in favoring life satisfaction in different ecological domains. Children in the intervention group showed greater appreciation for friends, school, family, themselves, and their living environment. At the end of the activity, children were increased the level of positive emotions, but negative feelings were stronger than before the narrative intervention. Clinical implications and future direction or community work are, then, discussed.
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Affiliation(s)
- Guido Veronese
- Department of Human Sciences "R. Massa," University of Milano-Bicocca, Italy
| | - Gianpiero Barola
- Department of Human Sciences "R. Massa," University of Milano-Bicocca, Italy
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29
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O'Leary P, Cameron CM, Lakhani A, Osborne JM, de Souza L, Hope K, Naimi MS, Khan H, Jawad QS, Majidi S. Violence against children in Afghanistan: Concerns and opportunities for positive change. Child Abuse Negl 2018; 76:95-105. [PMID: 29096162 DOI: 10.1016/j.chiabu.2017.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 03/11/2017] [Revised: 09/18/2017] [Accepted: 10/14/2017] [Indexed: 06/07/2023]
Abstract
Violence against children (VAC) in Afghanistan is a serious issue in the context of many decades of conflict and poverty. To date, limited studies have explored the extent of VAC in Afghanistan and the settings where VAC takes place. To understand (i) the extent of VAC, (ii) settings where VAC takes place, (iii) parental forms of VAC and (iv) regional differences, an interview administered cross-sectional survey was employed among a community sample of 145 children and 104 parents living within Kabul, Torkham, and Jalalabad. Demographic information was collected as well as items from the International Child Abuse Screening Tool (ICAST-CH). In this study, 71% of children reported experiencing physical violence is some form in the past year. Home was the most likely location of violence. The overwhelming majority of parents reported using physical violence as a discipline method. Parents who attained higher levels of education and had more skilled occupations used violence less as a discipline method. However, consistent with international research, children cited their parents as their preferred source of support in situations of violence. Interestingly, parents did not see violent forms of discipline as more effective than non-violent strategies. The results offer a disturbing yet 'on the ground' insight into VAC in Afghanistan from the experience of children and parents. The results have important implications for programming design and provide a focus for stopping and preventing VAC in Afghanistan and similar contexts.
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Affiliation(s)
- Patrick O'Leary
- Menzies Health Institute Queensland, School of Human Services and Social Work, Griffith University, Meadowbrook, QLD 4131, Australia.
| | - Cate M Cameron
- Menzies Health Institute Queensland, School of Human Services and Social Work, Griffith University, Meadowbrook, QLD 4131, Australia.
| | - Ali Lakhani
- Menzies Health Institute Queensland, School of Human Services and Social Work, Griffith University, Meadowbrook, QLD 4131, Australia.
| | - Jodie M Osborne
- Menzies Health Institute Queensland, School of Human Services and Social Work, Griffith University, Meadowbrook, QLD 4131, Australia.
| | - Luana de Souza
- Terre des Hommes Foundation, Avenue de Montchoisi, 15-CH-1006 Lausanne, Switzerland; Terre des Hommes Foundation, Afghanistan Country Office, House No. 103, Quali-Fatullah, Kabul, Afghanistan.
| | - Kristen Hope
- Terre des Hommes Foundation, Avenue de Montchoisi, 15-CH-1006 Lausanne, Switzerland.
| | - Mohammad S Naimi
- Terre des Hommes Foundation, Avenue de Montchoisi, 15-CH-1006 Lausanne, Switzerland; Terre des Hommes Foundation, Afghanistan Country Office, House No. 103, Quali-Fatullah, Kabul, Afghanistan.
| | - Hassan Khan
- Terre des Hommes Foundation, Avenue de Montchoisi, 15-CH-1006 Lausanne, Switzerland; Terre des Hommes Foundation, Afghanistan Country Office, House No. 103, Quali-Fatullah, Kabul, Afghanistan.
| | - Qazi S Jawad
- Terre des Hommes Foundation, Avenue de Montchoisi, 15-CH-1006 Lausanne, Switzerland; Terre des Hommes Foundation, Afghanistan Country Office, House No. 103, Quali-Fatullah, Kabul, Afghanistan.
| | - Sabir Majidi
- Terre des Hommes Foundation, Avenue de Montchoisi, 15-CH-1006 Lausanne, Switzerland.
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Glass N, Kohli A, Surkan PJ, Remy MM, Perrin N. The relationship between parent mental health and intimate partner violence on adolescent behavior, stigma and school attendance in families in rural Democratic Republic of Congo. Glob Ment Health (Camb) 2018; 5:e20. [PMID: 29868240 DOI: 10.1017/gmh.2018.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 01/02/2018] [Accepted: 02/06/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Prolonged conflict and economic instability challenge the existing support networks in families and society places significant stress on both adults and adolescents. Exploring individual, family and social factors that increase the likelihood of or protect adolescents from negative outcomes are important to the development of evidence-based prevention and response programing in global settings. OBJECTIVE Examine the relationship between parent mental health and experience/perpetration of intimate partner violence (IPV) and adolescent behaviors, stigma, and school attendance. The relationship is further examined for differences by gender. METHODS Secondary analysis of data from an ongoing comparative effectiveness trial of a productive asset transfer program in eastern Democratic Republic of Congo (DRC). RESULTS Three hundred and eighty-eight adolescent and parent dyads were included in the analysis. The analysis demonstrated that parent mental health and IPV can have a negative impact their children's well-being and the impact is different for boys and girls, likely linked to gender roles and responsibilities in the home and community. Social relationships of adolescents, as reported through experienced stigma, were negatively impacted for both boys and girls. Parent report of symptoms of PTSD and depression had a stronger negative effect on girls' outcomes, including experienced stigma, externalizing behaviors, and missed days of school than boys. For adolescent boys, their parent's report of IPV victimization/perpetration was associated with more negative behaviors at the 8-month follow-up assessment. CONCLUSION The findings reinforce the critical importance of interventions that engage parents and their children in activities that advance health and improve relationships within the family.
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Key Words
- AYPA, African Youth Psychosocial Assessment
- CPT, cognitive processing therapy
- DRC, Democratic Republic of Congo
- HDDS, Household Dietary Diversity Scale
- HSCL, Hopkins Symptom Checklist
- HTQ, Harvard Trauma Questionnaire
- IPV, intimate partner violence
- IRB, Internal Review Board
- Intimate partner violence
- NICHD, National Institute of Child Health and Human Development
- NIH, National Institute of Health
- PFP, pigs for peace
- PTSD, post-traumatic stress disorder
- RA, research assistant
- RFR, rabbits for resilience
- mental health
- post-conflict
- stigma
- young adolescents
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Meyer SR, Steinhaus M, Bangirana C, Onyango-Mangen P, Stark L. The influence of caregiver depression on adolescent mental health outcomes: findings from refugee settlements in Uganda. BMC Psychiatry 2017; 17:405. [PMID: 29258471 PMCID: PMC5738231 DOI: 10.1186/s12888-017-1566-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/30/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Family-level predictors, including caregiver depression, are considered important influences on adolescent mental health. Adolescent depression and anxiety in refugee settings is known to be a significant public health concern, yet there is very limited literature from humanitarian settings focusing on the relationship between caregiver mental health and adolescent mental health. In the context of a larger study on child protection outcomes in refugee settings, researchers explored the relationship between caregiver depression and adolescent mental health in two refugee settlements, Kiryandongo and Adjumani, in Uganda. METHODS Adolescents between 13 and 17 and their caregivers participated in a household survey, which included measures of adolescent anxiety and depression, and caregiver depression. Analysis was conducted using multiple logistic regression models, and results were reported for the full sample and for each site separately. RESULTS In Kiryandongo, a one-unit increase in a caregiver's depression score tripled the odds that the adolescent would have high levels of anxiety symptoms (AOR: 3.0, 95% CI: 1.4, 6.1), while in Adjumani, caregiver depression did not remain significant in the final model. Caregiver depression, gender and exposure to violence were all associated with higher symptoms of adolescent depression in both sites and the full sample, for example, a one unit increase in caregiver depression more than tripled the odds of higher levels of symptoms of adolescent depression (AOR: 3.6, 95% CI: 2.0, 6.2). Caregiver depression is a consistently significantly associated with adverse mental health outcomes for adolescents in this study. CONCLUSIONS Adolescent well-being is significantly affected by caregiver mental health in this refugee context. Child protection interventions in humanitarian contexts do not adequately address the influence of caregivers' mental health, and there are opportunities to integrate child protection programming with prevention and treatment of caregivers' mental health symptoms.
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Affiliation(s)
- Sarah R Meyer
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York City, NY, 10032, USA.
| | - Mara Steinhaus
- 0000 0004 0508 0388grid.419324.9International Center for Research on Women, New York City, USA
| | - Clare Bangirana
- TPO Uganda, Plot 3271 Kansanga, Opp. KIU, 21646 Kampala, Uganda
| | | | - Lindsay Stark
- 0000000419368729grid.21729.3fProgram on Forced Migration and Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York City, NY 10032 USA
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Veronese G, Pepe A. Life satisfaction and trauma in clinical and non-clinical children living in a war-torn environment: A discriminant analysis. J Health Psychol 2017; 25:459-471. [PMID: 28810496 DOI: 10.1177/1359105317720004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this work was to discriminate between healthy children and children at risk of developing mental impairments by evaluating the impact on contextual and individual factors of a context characterized by war. We tested the hypothesis that a linear discriminant function composed of trauma, life satisfaction, and affect balance has the power to classify the children as community or clinical referred. Membership of the clinical-referred group was associated with poorer life satisfaction and higher levels of trauma. Community-referred profiles were associated with lesser trauma. Perceived life satisfaction regarding family and school was the main contributor to the discriminant function.
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Doumit MAA, Farhood LF, Hamady C. Focus Groups Investigating Mental Health Attitudes and Beliefs of Parents and Teachers in South Lebanon: Are They Culturally Determined? J Transcult Nurs 2017; 29:240-248. [DOI: 10.1177/1043659617700958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: The wars that Lebanon had endured led to a devastating number of deaths, injuries, and displacements. Such tragedies have detrimentally affected its civilians psychologically. Purpose: To identify knowledge, attitudes, and practices of teachers and parents concerning child/adolescent mental health. Method: Using purposeful sampling, five focus groups were conducted with teachers and parents of students from elementary, middle, and secondary levels in two private hub schools in South Lebanon. Results: A total of 27 teachers and 18 parents participated separately in focus groups. Three themes emerged: (a) Mental health care is a priority for overall health, (b) Mental illness is a cultural taboo, and (c) There is a need for better education and cultural understanding about mental health. Discussion: This is the first study in Lebanon directly targeted at parents’ and teachers’ mental health concerns. Such findings will add to transcultural nursing knowledge about the importance of mental health care.
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Stark L, Asghar K, Meyer S, Yu G, Bakemore T, Poulton C, Falb K. The effect of gender norms on the association between violence and hope among girls in the Democratic Republic of the Congo. Glob Ment Health (Camb) 2017; 4:e1. [PMID: 28596902 DOI: 10.1017/gmh.2016.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/14/2016] [Accepted: 12/02/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Girls at early stages of adolescence are vulnerable to violence victimization in humanitarian contexts, but few studies examine factors that affect girls' hope in these settings. We assessed attitudes toward traditional gender norms as an effect modifier of the relationship between violence exposure and future orientation in displaced girls. METHODS Secondary analysis, using multivariable regression of cross-sectional data from girls ages 10-14 in South Kivu, Democratic Republic of the Congo. Key variables of interest were attitudes toward intimate partner violence (IPV), Children's Hope Scale (CHS) score, and exposure to physical, emotional, and sexual violence within the last 12 months. Additional covariates included age, educational status, and territory. RESULTS The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for physical violence (β = -0.09, p = 0.040) and unwanted sexual touching (β = -0.20, p = 0.003) among girls age 10-14, when adjusting for other covariates. The interaction of exposure to violence and attitudes toward IPV magnified the association between violence exposure and lower CHS score for forced sex (β = -0.22, p = 0.016) among girls age 13-14, when adjusting for covariates. Findings for emotional violence, any form of sexual violence, and coerced sex trended toward lower CHS scores for girls who reported higher acceptance of IPV, but did not reach significance. CONCLUSIONS Findings support the utility of gender norms-transformative programming in increasing resilience of girls who have experienced sexual violence in humanitarian contexts.
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