The rates and correlates of the exposure of Palestinian adolescents to family violence: toward an integrative-holistic approach

Co-Occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Influence of Early Life Experiences of Abuse

Little is known about co-occurring intimate partner violence (IPV) against women and child abuse within families in humanitarian settings. Baseline data from 203 couples in eastern Democratic Republic of Congo were analyzed to assess associations between childhood experiences of abuse with present co-occurring violence. Over half of women (56.1%) and men (50.5%) reported co-occurring violence. Adjusted models demonstrate experiencing physical abuse as a child was associated with greatest odds of recent co-occurring violence while witnessing parental IPV had mixed influence. Programmatic approaches focused on reducing early childhood violence may be promising to prevent both IPV and child abuse.

Parenting in a post-conflict region: Associations between observed maternal parenting practices and maternal, child, and contextual factors in northern Uganda

Studies show that war leads to an increase in harsh parenting and a decrease in parental warmth, which in turn has a devastating impact on children's development. However, there is insufficient research on the factors that affect parenting in post-conflict regions. In addition, most previous studies on the role of parenting in the context of war rely on self-reports, which are subject to a number of limitations. To complement existing research, the present cross-sectional study used behavioral observations of 101 mothers and their 6-12 year old children to assess parenting in post-conflict northern Uganda. The aim of the current study was to explore associations between observed maternal warmth and coercion and self-reported socioeconomic status (e.g., mother's educational level) as well as maternal (e.g., posttraumatic stress disorder), child (e.g., externalizing problems), and social contextual factors (e.g., family violence). Results show a link between observed parenting, child characteristics, and family violence. Higher levels of children's externalizing problems were associated with more severe maternal coercion. In addition, a negative association was found between family violence and maternal warmth. Findings are discussed in terms of their implications for prevention and intervention programs and the use of behavioral observations in post-conflict environments.

A systematic review and meta-analysis of the associations between interparental and sibling relationships: Positive or negative?

According to family systems theory, a family is regarded as an organized whole and relations within this system are interconnected. However, it is not clear to date whether the interparental and the sibling relationship are associated and, if such an association exists, whether it is positive or negative. Previous findings on the associations between the interparental and sibling relationships are inconsistent and there is as yet no pertinent review or meta-analysis. Therefore, this systematic review and meta-analysis set out (1) to aggregate previous studies investigating the links between the interparental and sibling relationships and (2) to examine potential moderators in this link. Based on 47 studies reporting 234 effect sizes (N = 29,746 from six nations; 6-12 years; 49% boys), meta-analytic results suggest a small positive correlation between interparental and sibling relationship quality (r = .14). Only the percentage of male children in the sample moderated this effect. Sex composition of sibling dyad and source of publication affected whether positive or negative associations were found. The findings support a growing consensus that family relations do not function in isolation, but are mutually interdependent, which should be considered in clinical practice.

Explaining the accumulation of victimization in vulnerable children: Interpersonal violence among children traumatized by war and disaster in a children's home in Sri Lanka

Research in postconflict settings indicated that children's exposure to war and natural disaster is a significant predictor of experiencing violence within their families. However, it is unclear if this effect is driven by characteristics of traumatized children or their parents. To disentangle these different factors we conducted a survey in a children's home in Sri Lanka. A total of 146 institutionalized children (aged 8 to 17) were interviewed using standardized questionnaires administered by local senior counselors in order to assess children's exposure to mass trauma, family violence, and violence in the institution as well as their mental health. Linear regression analyses revealed that, controlling for potential confounds, previous exposure to civil war was a significant predictor of violence by guardians in the children's home. In addition, previous exposure to family violence was a significant predictor of violence by peers in the institutions. A mediation analysis showed that children's internalizing and externalizing behavior problems partly mediated the relationship between violence prior to the admission to the children's home and violence in the children's home. The findings of our study provide evidence for the assumption that the transmission of mass trauma into interpersonal violence can occur independently from parents through children's psychopathology.

Adaptive work in the primary health care response to domestic violence in occupied Palestinian territory: a qualitative evaluation using Extended Normalisation Process Theory

BACKGROUND

A health system response to domestic violence against women is a global priority. However, little is known about how these health system interventions work in low-and-middle-income countries where there are greater structural barriers. Studies have failed to explore how context-intervention interactions affect implementation processes. Healthcare Responding to Violence and Abuse aimed to strengthen the primary healthcare response to domestic violence in occupied Palestinian territory. We explored the adaptive work that participants engaged in to negotiate contextual constraints.

METHODS

The qualitative study involved 18 participants at two primary health care clinics and included five women patients, seven primary health care providers, two clinic case managers, two Ministry of Health based gender-based violence focal points and two domestic violence trainers. Semi-structured interviews were used to elicit participants' experiences of engaging with HERA, challenges encountered and how these were negotiated. Data were analysed using thematic analysis drawing on Extended Normalisation Process Theory. We collected clinic data on identification and referral of domestic violence cases and training attendance.

RESULTS

HERA interacted with political, sociocultural and economic aspects of the context in Palestine. The political occupation restricted women's movement and access to support services, whilst the concomitant lack of police protection left providers and women feeling exposed to acts of family retaliation. This was interwoven with cultural values that influenced participants' choices as they negotiated normative structures that reinforce violence against women. Participants engaged in adaptive work to negotiate these challenges and ensure that implementation was safe and workable. Narratives highlight the use of subterfuge, hidden forms of agency, governing behaviours, controls over knowledge and discretionary actions. The care pathway did not work as anticipated, as most women chose not to access external support. An emergent feature of the intervention was the ability of the clinic case managers to improvise their role.

CONCLUSIONS

Flexible use of ENPT helped to surface practices the providers and women patients engaged in to make HERA workable. The findings have implications for the transferability of evidenced based interventions on health system response to violence against women in diverse contexts, and how HERA can be sustained in the long-term.

Assessment of parental nurturing and associated social, economic, and political factors among children in the West Bank of the occupied Palestinian territory (WB/oPt)

Background

Parental nurturing expressed through love and affection is a broad concept that entails caring for children and their activities, encouraging them and praising their achievements. Lack of love and affection makes children more susceptible to psychological problems such as stress, anxiety and depression across their life time. This study aims to evaluate parental nurturing and associated social, economic, and political factors among Palestinian children living in the West Bank (WB).

Methods

Secondary data representative of the Palestinian children living in the WB was used to estimate parental nurturing for children aged 0–12 years as reported by their mothers. Univariate and bivariate analyses were conducted, followed by multivariate analysis for all predictors found significant in the bivariate analysis using SPSS® version 20.

Results

19.90% (231/1162) of children experienced low levels of parental nurturing. No statistically significant differences were detected by the child’s gender. Children with high levels of parental nurturing were those aged 0–6 years, children who were last in the family index, children with no disability, children exposed to low to medium levels of disciplinary methods, children from urban areas, children living in North WB, and children whose families were not subjected to political violence.

Conclusions

Overall, Palestinian mothers reported high levels of parental nurturing towards their children. However, about one-fifth of Palestinian children are at risk of experiencing low levels of parental nurturing. Efforts should be placed in addressing the health and welfare needs of these high-risk children’s groups.

"Women hope the situation will change, and their husbands will change with it": narratives of intimate partner violence in Gaza

The authors' purpose in conducting this study was to identify barriers faced by survivors of intimate partner violence (IPV) in accessing services in Gaza. We collected data via in-depth interviews with women (ages 18-49; n = 25). Respondents were recruited through convenience sampling from women's organizations. Interviews were transcribed, translated, and coded using an inductive approach. Results indicate three main factors that influence help-seeking: perceived transgression of traditional gender roles; distrust of women's centers; and contextual acceptance of IPV. An understanding of emic perceptions of IPV can inform the design and delivery of support services and increase access to interventions for women in Gaza.

Behavioral Observations in Northern UGANDA: Development of a Coding System to Assess Mother-Child Interactions in a Post-war Society

There is growing interest in causes and consequences of disruptions in parent-child relationships in post-war environments. Recent studies mainly relied on self-reports to gain information about family dynamics following war exposure. Considering the limitations of self-report measures, we see the need for an in-depth examination of post-conflict parenting based on observational and quantitative data. The aim of the present study was the development of a coding system for a culturally bound description of parent-child interactions in northern Uganda, where virtually the entire population has been severely affected by 20 years of civil war. Interactions of 101 mothers and their 6- to 12-year-old children were observed during a structured interaction task (problem solving discussion). Foundation for the development of the coding system was the Family and Peer Process Code (FPP code). The cultural adaptation of the FPP code was based on in-depth qualitative analyses of the problem solving task, including a combination of inductive and deductive latent content analyses of textual data and videotapes, member checking and consultations of experts in the field of behavioral observations. The final coding system consists of 35 exhaustive and mutually exclusive content codes including codes for verbal, vocal, and compliance behavior as well as 14 affect codes. Findings indicate that the assessment of behavioral observations in post-conflict settings provides unique insights into culture- and context-specific interaction patterns and may be critical for the development and evaluation of parenting interventions.

Transmitting trauma: a systematic review of the risk of child abuse perpetrated by parents exposed to traumatic events

OBJECTIVES

To review the empirical evidence of a potential association between parental trauma and parental child abuse.

METHODS

Following PRISMA guidelines, 4645 publications were identified through a systematic search in PubMed, PsycINFO and Cochrane. The final number of publications included was 15.

RESULTS

The prevalence of child abuse was found to be consistently higher in populations exposed to traumatic events (prevalence range 36.0-97.5%) compared with non-exposed groups. Parents exposed to trauma were more likely to abuse their children in all studies, and trauma severity, including a PTSD diagnosis in parents, was associated with perpetration of child abuse in most studies. Such associations appeared to be independent of the type of traumatic event. The findings underscore that trauma does not only affect the individual, but also the family.

CONCLUSIONS

Parental trauma seems to be associated with perpetration of child abuse within the family. Abusive behavior against children could be a potential trauma reaction, which should be considered in preventive strategies aimed at reducing harm in traumatized families.

Comparing disciplinary methods used by mothers in Palestine and Qatar

This paper explores child disciplinary methods used by parents in Qatar and Palestine. In this study ICAST-P, an internationally recognized tool, was used with mothers reporting on one of their children up to their 12th birthday. It questions about disciplinary methods: nonviolent; physical: moderate and severe; and psychological methods that had been used in the previous year on the index child in the family. A comparative national cross-sectional household survey of mothers aged 25-50 years old was conducted in both Qatar and Palestine, both Arabic Muslim states, but with very different socio-economic and political contexts that place Qataris in a much more advantageous position. Our results show that the 1299 Palestinian mothers interviewed were younger, had more children and less education compared to the 1018 Qatari mothers. Fewer mothers from Palestine were working. The index child in Palestine tended to be younger with 60% being under 5 years, while 73.7% of Qatari children were over 5 years of age. Severe physical disciplinary methods were reported significantly more often, in Palestine, e.g. Kicking the child (P value < 0.001), using hand or pillow to prevent breathing (P value < 0.001) and hitting child with object or fist (P value < 0001). Moderate as well as psychological disciplinary methods were also significantly higher among Palestinian mothers (P value < 0.001). Our results suggest that challenging circumstances that Palestinian mothers experience, as compared to their Qatari peers, are associated with greater prevalence of the harsher forms of discipline. Our findings have policy implications and preventative strategies for child maltreatment in both countries.

Child sexual abuse data from an Arabian Gulf country revisited

We revisit our previous work on child abuse in Kuwait, with a focus on the sexual abuse data, and discuss the findings in the context of the local culture. In 2006, a nationwide sample of 4467 senior high-school students (mean age 16.9; 48.6% boys) at government secondary schools was studied. Over their lifetime, 8.6% had been sexually attacked, 5.9% had experienced someone threatening to have sex with them, 15.3% had experienced unwanted sexual exposure, and 17.4% had had someone touch their sexual parts (boys 21.1%, girls 14.0%; P < 0.001). Most perpetrators were members of the extended family. The way to assist ‘dysfunctional families’, where ‘family honour’ and the need for peaceful relations with neighbours have priority over the mental health of female victims, is to propagate the finding that child sexual abuse has a wide-ranging deleterious impact on psychosocial functioning.

The impact of humanitarian emergencies on the prevalence of violence against children: an evidence-based ecological framework

Little is known about the patterns and mechanisms by which humanitarian emergencies may exacerbate violence against children. In this article, we propose using the ecological framework to examine the impact of humanitarian emergencies on interpersonal violence against children. We consider the literature that supports this framework and suggest future directions for research to fill identified gaps in the framework. The relationship between humanitarian emergencies and violence against children depends on risk factors at multiple levels, including a breakdown of child protection systems, displacement, threats to livelihoods, changing gender roles, changing household composition, overcrowded living conditions, early marriage, exposure to conflict or other emergency events, and alcohol abuse. The empirical evidence supporting the proposed emergency/violence framework is limited by cross-sectional study designs and a propensity to predominantly examine individual-level determinants of violence, especially exposure to conflict or emergency events. Thus, there is a pressing need to contextualize the relationship between conflict or emergency events and violence against children within the wider ecological and household dynamics that occur during humanitarian emergencies. Ultimately, this will require longitudinal observations of children, families and communities from before the emergency through recovery and improvements to ongoing global surveillance systems. More complete data will enable the humanitarian community to design effective, appropriate and well-targeted interventions.

Child discipline in Qatar and Palestine: A comparative study of ICAST-R

To compare the nature and determinants of child discipline in Qatar and Palestine among young adults through retrospective survey to develop legislation, policies and interventions for effective prevention of child maltreatment, and educational materials to promote positive discipline among parents and caregivers. Cross-sectional random household surveys were conducted in each country (Qataris N=697, Palestinians N=2064) using ISPCAN Child Abuse Screening Tool-Retrospective (ICAST-R) for young adults (18-24 years), to investigate child discipline methods into the maltreatment range. Qatari young adults were more educated (p<0.001) and had more full-time employment (p=0.004) than Palestinian young adults. Qatar reported lower physical and emotional abuse compared to their counterparts in Palestine, e.g. Hit/Punch, Kick (p<0.001) and Insult/Criticize, Threaten to be hurt/killed (p<0.001). Qatari participants found any harsh discipline they received in childhood was not reasonable and not justified compared to Palestinian participants. The more advantaged Qatari population was less likely to experience disciplinary methods that experts developing the ICAST-R defined as abuse compared to Palestinians where the higher incidence of child abuse could be attributed to lower economic advantage, lower level of education and greater exposure to violence. Suggestions are made for future studies in Qatar and Palestine to develop survey methodology with a more culturally appropriate level of intrusion, such as indirect yet meaningful child maltreatment questions.

Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and psychopathology in a post-conflict context

BACKGROUND

It is likely that alcohol use and abuse increase during and after violent conflicts. The most prominent explanation of this phenomenon has been referred to as self-medication hypothesis. It predicts that psychotropic substances are consumed to deal with conflict-related psychic strains and trauma. In northern Uganda, a region that has been affected by a devastating civil war and is characterized by high levels of alcohol abuse we examined the associations between war-trauma, childhood maltreatment and problems related to alcohol use. Deducing from the self-medication hypothesis we assumed alcohol consumption moderates the relationship between trauma-exposure and psychopathology.

METHODS

A cross-sectional epidemiological survey targeting war-affected families in post-conflict northern Uganda included data of male (n = 304) and female (n = 365) guardians. We used standardized questionnaires in an interview format to collect data on the guardians' socio-demography, trauma-exposure, alcohol consumption and symptoms of alcohol abuse, PTSD and depression.

RESULTS

Symptoms of current alcohol use disorders were present in 46 % of the male and 1 % of the female respondents. A multiple regression model revealed the unique contributions of emotional abuse in the families of origin and trauma experienced outside the family-context in the prediction of men's alcohol-related symptoms. We found that alcohol consumption moderated the dose-effect relationship between trauma-exposure and symptoms of depression and PTSD. Significant interactions indicated that men who reported more alcohol-related problems experienced less increase in symptoms of PTSD and depression with increasing trauma-exposure.

CONCLUSIONS

The gradual attenuation of the dose-effect the more alcohol-related problems were reported is consistent with the self-medication hypothesis. Hence, the functionality of alcohol consumption has to be considered when designing and implementing addiction treatment in post-conflict contexts.

Inadequate Sleep as a Mediating Variable between Exposure to Interparental Violence and Depression Severity in Adolescents

Exposure to violence, including interparental and peer dating violence, is a public health concern associated with negative outcomes, including depression. However, little is known about mechanisms by which exposure to violence influences depressive symptoms. One factor that may help explain this association is problematic sleep. This study sought to determine whether short sleep duration mediates the relationship between exposure to violence (interparental and peer dating violence) and depressive symptoms. Structural equation modeling was used to examine the mediating role of short sleep duration from a 3-year longitudinal study of 1,042 high school students. Results demonstrated interparental violence was negatively related to sleep duration (friends dating violence was not), and sleep duration negatively associated with depressive symptoms. Adolescents exposed to violence between their parents obtained less sleep on school nights. In turn, they reported more depressive symptoms. Short sleep duration mediated the relationship between exposure to interparental violence and depression severity.

Children of the postwar years: A two-generational multilevel risk assessment of child psychopathology in northern Uganda

In postconflict settings risk factors at multiple levels of the social ecology, including community, family, and relationship factors, potentially affect children's mental health. In addition, intergenerational risk factors such as guardians' history of childhood family violence, war exposure, and psychopathology may contribute to children's psychopathological symptoms. In this study, we aimed to identify risk constellations that predict child internalizing and externalizing behavior problems, depression, and posttraumatic stress symptoms in the postconflict setting of northern Uganda. In a cross-sectional epidemiological study, 513 second-grade students and their female guardians were interviewed using standardized clinical questionnaires. A higher exposure to traumatic events, more witnessed or experienced violence within the family, and lower child-reported care from female guardians independently predicted psychopathological symptoms in children. While controlling for intergenerational risk factors in female guardians, serial mediation modeling revealed that the effect of trauma exposure on children's psychopathological symptoms was partially mediated by higher exposure to family violence and lower child-perceived care from female guardians. The mediation appeared to be stronger for children's depression symptoms and internalizing and externalizing behavior problems than for posttraumatic stress symptoms. The current findings support the need for targeted interventions at the individual and family system levels that are matched to children's psychopathological symptoms.

Predictors of violence against children in Tamil families in northern Sri Lanka

Children living in post-conflict settings are not only at high risk of developing war-related psychopathology but also of experiencing maltreatment within their families. However, little is known about the mechanisms of the relationship between war and family violence. In order to investigate the variables associated with the experience and perpetration of child maltreatment, we conducted a two-generational study with Tamil families in the North of Sri Lanka, a region affected by war and Tsunami. We interviewed children and the corresponding family dyads and triads with 359 children, 122 mothers, and 88 fathers on the basis of standardized questionnaires to assess their exposure to adverse life experiences and mental health symptoms. Using multivariate regression analyses, we found that the strongest predictors for children's report of victimization were children's exposure to mass trauma and child psychopathology. Mothers' experiences of mass trauma, family violence and partner violence were each significantly related to mother-reported maternal perpetration as well as child-reported victimization. Likewise, all types of traumatic events reported by fathers were significantly related to child-reported victimization and father-reported perpetration. Fathers' alcohol use was the strongest predictor of father-reported paternal perpetration. These findings provide further support for the transmission of mass trauma into family violence, and emphasize the role of child psychopathology as well as alcohol consumption in this relationship.

Parental care protects traumatized Sri Lankan children from internalizing behavior problems

BACKGROUND

Research in war-torn regions has mainly focused on the impact of traumatic experiences on individual mental health and has found high prevalence rates of psychiatric disorders in affected adults and children. However, little is known about the possible protective factors occurring in children's environments in the aftermath of mass trauma. Therefore, we conducted a cross-sectional study with families in Northern Sri Lanka, a region that had been shattered by a long-lasting civil war and devastated by the Asian tsunami in 2004.

METHODS

Schoolchildren aged 7 to 11 (N = 359) were interviewed on the basis of standardized measures to assess children's exposure to traumatic events, mental health symptoms, and parenting behavior as perceived by children. All interviews were carried out by local senior counselors.

RESULTS

Linear regression analyses identified exposure to mass trauma and family violence as significant risk factors of child mental health whereas parental care emerged as a significant factor associated with fewer behavior problems. In addition, parental care significantly moderated the relationship between mass trauma and internalizing behavior problems.

CONCLUSIONS

Family characteristics seem to be strongly associated with children's mental health even in regions severely affected by mass trauma. This finding is particularly relevant for the development of targeted psychosocial interventions for children and families living in war torn areas.

Does war contribute to family violence against children? Findings from a two-generational multi-informant study in Northern Uganda

After 20 years of civil war in Northern Uganda, the continuity of violence within the family constitutes a major challenge to children's healthy development in the post-conflict era. Previous exposure to trauma and ongoing psychopathology in guardians potentially contribute to parental perpetration against children and dysfunctional interactions in the child's family ecology that increase children's risk of maltreatment. In order to investigate distal and proximal risk factors of child victimization, we first aimed to identify factors leading to more self-reported perpetration in guardians. Second, we examined factors in the child's family environment that promote child-reported experiences of maltreatment. Using a two-generational design we interviewed 368 children, 365 female guardians, and 304 male guardians from seven war-affected rural communities in Northern Uganda on the basis of standardized questionnaires. We found that the strongest predictors of self-reported aggressive parenting behaviors toward the child were guardians' own experiences of childhood maltreatment, followed by female guardians' victimization experiences in their intimate relationship and male guardians' posttrautmatic stress disorder (PTSD) symptoms and alcohol-related problems. Regarding children's self-report of victimization in the family, proximal factors including violence between adults in the household and male guardians' PTSD symptom severity level predicted higher levels of maltreatment. Distal variables such as female guardians' history of childhood victimization and female guardians' exposure to traumatic war events also increased children's report of maltreatment. The current findings suggest that in the context of organized violence, an intergenerational cycle of violence persists that is exacerbated by female guardians' re-victimization experiences and male guardians' psychopathological symptoms.

Intergenerational effects of war trauma among Palestinian families mediated via psychological maltreatment

We tested the hypothesis that intergenerational effects of parents' war trauma on offspring's attachment and mental health are mediated by psychological maltreatment. Two hundred and forty children and their parents were sampled from a war-prone area, Gaza, Palestine. The parents reported the number and type of traumatic experiences of war they had had during their lifetime before the child's birth and during a current war when the child was 10-12 years old. The children reported their war traumas, experiences of psychological maltreatment, attachment security, and symptoms of posttraumatic stress (PTSS), depression, and aggression. The direct and indirect intergenerational effects of war trauma were tested in structural equation models. The hypotheses were confirmed for father's past war exposure, and disconfirmed for mother's war exposure. The father's past war trauma had a negative association with attachment security and positive association with the child's mental health problems mediated by increased psychological maltreatment. In contrast, the mother's past war trauma had a negative association with the child's depression via decreased psychological maltreatment. The mother's current war trauma had a negative association with the child's depression and aggression via decreased psychological maltreatment. Among fathers, past war exposure should be considered as a risk factor for psychological maltreatment of children and the associated attachment insecurity and mental health problems. Among mothers, war exposure as such could be given less clinical attention than PTSS in the prevention of psychological maltreatment of children.

The rates and characteristics of the exposure of Palestinian youth to community violence

The article presents the results of a study that explored the rates and characteristics of exposure to community violence (CV) and its relevance to several sociodemographic factors among a sample of 1,930 Palestinian youth (1,018 girls and 912 boys), aged 12 to 19 years residing in diverse residential areas in the West Bank and East Jerusalem. Data were collected using a self-report questionnaire. The frequency of boys' exposure to CV during the previous 12 months was significantly higher than among girls. The frequency of witnessing CV during that period was higher than the frequency of personally experiencing CV, and exposure to mild CV incidents during that period was higher than the frequency of exposure to severe CV incidents during the same period, with no significant relationship to sociodemographic factors. Participants reported higher rates of witnessing most CV incidents outside of the neighborhood. Nonetheless, they reported higher rates of experiencing most incidents of CV inside the participants' neighborhood. The implications of the results for theory development and future research are discussed.

Intimate partner violence in Rwanda: the mental health of victims and perpetrators

Exposure to intimate partner violence (IPV) is a common feature of women living in low- and middle-income countries. Several studies have shown a significant association between IPV against women and mental health in both developed and in low- and middle-income countries. In postconflict settings, the relationship between IPV and mental health is likely more complex, given the high levels of violence experienced by the population as a whole. In this cross-sectional study the authors explore the association between IPV and common mental health disorders (CMD), and more specifically, suicidal ideation, among inhabitants of postgenocide Rwanda. The authors use the concept of "mutual partner violence," thereby exploring the association between IPV and CMD in victims, perpetrators, and those who state they are both. Data of 241 married men and women were used. Symptoms suggestive of CMD were established by use of the Self-Reporting Questionnaire (SRQ-20), and physical intimate partner violence was measured using the Conflict Tactics Scale, Short Version (CTS2S). The authors applied multivariate logistic regressions with total SRQ-20 scores (above/below cutoff) and suicidal ideation as the outcome measures and corrected for age and gender. The study findings suggest that reported IPV is associated with CMD (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 0.92-3.15) and suicidal ideation (OR = 1.6, 95% CI = 0.70-3.53). Those who state to be both victim and perpetrator (OR = 1.75, 95% CI = 0.82-3.72), or only perpetrator (OR = 3.13, 95% CI = 0.49-20.0), are more likely to report mental health problems than victims and people who do not report IPV. In a postconflict situation, perpetrators of IPV may suffer from mental health problems as much as, or even more than, victims. Longitudinal data are needed to clarify the complex relationship between CMD and IPV, especially if outcomes may also be related to other forms of violence experienced in the past.

Child maltreatment: the Lebanese children's experiences

BACKGROUND

This study examined the prevalence, risk factors and consequences associated with child maltreatment in the home.

METHODS

The sample was 1028 (556 boys; 472 girls) Lebanese children aged 8-17 years (M = 11.89; SD = 1.67). Children were administered an interview questionnaire that included the International Child Abuse Screening Tool, the Trauma Symptom Checklist and the Family Functioning in Adolescence Questionnaire.

RESULTS

Approximately 30% of the children reported at least one incident of witnessing violence, 65% reported at least one incident of psychological abuse and 54% reported at least one incident of physical abuse over a 1-year period. The results showed an overlap between children's reports of witnessing violence in their homes and physical and psychological abuse that were associated with adolescents' trauma symptoms. Family-related variables significantly predicted three forms of child maltreatment.

CONCLUSION

These results highlight the importance of examining children's multiple experiences of violence in their homes in research designs, prevention efforts and policy mandates. However, it should be noted that estimates of prevalence (as opposed to estimates of the relation between variables which is relatively more robust to selection bias) are open to error because of the nature of our sample.

The relationship between organized violence, family violence and mental health: findings from a community-based survey in Muhanga, Southern Rwanda

BACKGROUND

The relationship between organized violence and family violence, and their cumulative effect on mental health in post-conflict regions remains poorly understood.

OBJECTIVE

The aim of the present study was to establish prevalence rates and predictors of family violence in post-conflict Rwanda. And to examine whether higher levels of war-related violence and its socio-economic consequences would result in higher levels of violence within families and whether this would be related to an increase of psychological distress in descendants.

METHOD

One hundred and eighty-eight parent-child pairs from four sectors of the district Muhanga, Southern Province of Rwanda, were randomly selected for participation in the study. Trained local psychologists administered structured diagnostic interviews. A posttraumatic stress disorder (PTSD) diagnosis was established using the PTSD Symptom Scale Interview (PSS-I) and child maltreatment was assessed by means of the Childhood Trauma Questionnaire (CTQ). Additionally, the Hopkins Symptom Checklist (HSCL-25) assessed symptoms of depression and anxiety in descendants.

RESULTS

Prevalence rates of child abuse and neglect among descendants were below 10%. Ordinal regression analyses revealed that the level of child maltreatment in descendants was predicted by female sex, poverty, loss of the mother, exposure to war and genocide as well as parents' level of PTSD and reported child maltreatment. Poor physical health, exposure to war and genocide, parental PTSD symptoms, and reported childhood trauma were significantly associated with depressive and anxious symptoms, while only exposure to war and genocide and poor physical health predicted the level of PTSD.

CONCLUSION

The results indicate that cumulative stress such as exposure to organized violence and family violence in Rwandan descendants poses a risk factor for the development of depressive and anxious symptoms. Besides the support for families to cope with stress, awareness-raising initiatives challenging the current discourse of discipline toward children in schools or at home need to be fostered.

Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: association with family characteristics, anxiety, depression, self-esteem, and quality of life

OBJECTIVES

The objectives were first, to assess the lifetime and 12-month prevalence of physical, psychological, and sexual abuse among a stratified random sample of Kuwaiti high school students and second, to explore the association of child abuse with parental characteristics, subjective quality of life (QOL), self-esteem, anxiety, and depression.

METHOD

We assessed the students for experience of abuse by their mothers, fathers, and others, using standard scales on psychological, physical and sexual abuse. They also completed the short version of the World Health Organization's QOL Instrument; the Rosenberg self-esteem scale, and a scale for anxiety and depression.

RESULTS

We obtained responses from 4,467 students (49% boys), mean age 16.9 years. About 18, 15, and 18%, indicated that for at least six times in the past 12 months, they experienced psychological abuse by their mothers, fathers and others, respectively. The corresponding figures for lifetime experience were similar. The respective figures for experience of physical abuse during the past 12 months were 4.3, 5.8, and 6.4%. For lifetime experience, the corresponding figures were 3.4, 5.3, and 5.8%. The girls had significantly higher physical/psychological abuse scores. There were no significant gender differences in the prevalence of sexual attacks (8.6%) and someone threatening the subjects with sex (5.9%). The prevalence of someone sexually exposing themselves to the students (15.3%) and unwanted touching of sexual parts (17.4%) was significantly higher among the boys. Over one-third of those abused had experienced multiple abuses. Child abuse was significantly associated with parental divorce, diminished QOL and self-esteem, high scores on anxiety/depression, and difficulty with studies, and social relationships. In the regression analysis involving only the abuse indices, psychological abuse by mothers was the most important predictor of depression, anxiety, and self-esteem (11.5-19.7% of variance). Good quality of parental relationship seemed protective.

CONCLUSION

The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

Witnessing violence toward siblings: an understudied but potent form of early adversity

Research on the consequences of witnessing domestic violence has focused on inter-adult violence and most specifically on violence toward mothers. The potential consequences of witnessing violence to siblings have been almost entirely overlooked. Based on clinical experience we sought to test the hypothesis that witnessing violence toward siblings would be as consequential as witnessing violence toward mothers. The community sample consisted of unmedicated, right-handed, young adults who had siblings (n = 1,412; 62.7% female; 21.8±2.1 years of age). History of witnessing threats or assaults to mothers, fathers and siblings, exposure to parental and sibling verbal abuse and physical abuse, sexual abuse and sociodemographic factors were assessed by self-report. Symptoms of depression, anxiety, somatization, anger-hostility, dissociation and ‘limbic irritability’ were assessed by rating scales. Data were analyzed by multiple regression, with techniques to gauge relative importance; logistic regression to assess adjusted odds ratios for clinically-significant ratings; and random forest regression using conditional trees. Subjects reported witnessing violence to siblings slightly more often than witnessing violence to mothers (22% vs 21%), which overlapped by 51–54%. Witnessing violence toward siblings was associated with significant effects on all ratings. Witnessing violence toward mother was not associated with significant effects on any scale in these models. Measures of the relative importance of witnessing violence to siblings were many fold greater than measures of importance for witnessing violence towards mothers or fathers. Mediation and structural equation models showed that effects of witnessing violence toward mothers or fathers were predominantly indirect and mediated by changes in maternal behavior. The effects of witnessing violence toward siblings were more direct. These findings suggest that greater attention be given to the effects of witnessing aggression toward siblings in studies of domestic violence, abuse and early adversity.

Beliefs about wife beating: an exploratory study with Lebanese students

In recent years, there has been a growing interest in understanding the sociocultural contexts and risk factors for domestic violence in the Arab world. This study provides an analysis of the religious, legal, and familial contexts of domestic violence in Lebanon and assesses contemporary attitudes toward women and wife beating in a sample of 206 Lebanese university students. Gender, patriarchal attitudes, religion, childhood experiences with family violence, and mother's employment status were investigated as predictors of attitudes toward wife beating. Consistent with feminist theories of wife abuse, gender and attitudes toward women's roles emerged as the strongest predictors of beliefs about wife beating.

Association between exposure to political violence and intimate-partner violence in the occupied Palestinian territory: a cross-sectional study

BACKGROUND

Intimate-partner violence might increase during and after exposure to collective violence. We assessed whether political violence was associated with male-to-female intimate-partner violence in the occupied Palestinian territory.

METHODS

A nationally representative, cross-sectional survey was done between Dec 18, 2005, and Jan 18, 2006, by the Palestinian Central Bureau of Statistics. 4156 households were randomly selected with a multistage random cluster design, from which 3815 ever-married women aged 15-64 years were identified. We restricted our analysis to presently married women (n=3510, 92% participation rate), who completed a short version of the revised conflict tactics scales and exposure to political violence inventory. Exposure to political violence was characterised as the husband's direct exposure, his indirect exposure via his family's experiences, and economic effects of exposure on the household. We used adjusted multinomial logistic regression models to estimate odds ratios (ORs) for association between political violence and intimate-partner violence.

FINDINGS

Political violence was significantly related to higher odds of intimate-partner violence. ORs were 1.89 (95% CI 1.29-2.76) for physical and 2.23 (1.49-3.35) for sexual intimate-partner violence in respondents whose husbands were directly exposed to political violence compared with those whose husbands were not directly exposed. For women whose husbands were indirectly exposed, ORs were 1.61 (1.25-2.07) for physical and 1.97 (1.49-2-60) for sexual violence, compared with those whose husbands were not indirectly exposed. Economic effects of exposure were associated with increased odds of intimate-partner violence in the Gaza Strip only.

INTERPRETATION

Because exposure to political violence is associated with increased odds of intimate-partner violence, and exposure to many traumas is associated with poor health, a range of violent exposures should be assessed when establishing the need for psychosocial interventions in conflict settings.

Exposure to conflict and violence across contexts: relations to adjustment among Palestinian children

Despite extensive literatures on the impact on children of exposure to violence in families, neighborhoods, and peer groups, there has been relatively little effort evaluating their cumulative impact. There also has been less attention to the effects of exposure to political conflict and violence. We collected data from a representative sample of 600 Palestinian youths (3 age cohorts: 8, 11, and 14 years old) to evaluate the relation of exposure to political conflict and violence, and violence in the family, community, and school, to posttraumatic stress (PTS) symptoms and aggressive behavior. Results highlight the additive effects of exposure to political conflict and violence, suggesting that interventionists should consider the full spectrum of sources of environmental risk for PTS symptoms and aggressive behavior.

Posttraumatic stress disorder among Sri Lankan University students as a consequence of their exposure to family violence

The article presents the results of a study on the association between exposure to family violence (i.e., witnessing interparental violence and experiencing parental violence) during childhood and adolescence and adult posttraumatic stress disorder (PTSD). The study was conducted among a self-selected convenience sample of 476 students from Sri Lanka, using a self-administered questionnaire. The findings indicate that the more participants witnessed interparental violence and the more they experienced parental violence, the more they exhibited PTSD symptoms. Moreover, the findings reveal that participants' exposure to family violence explains a significant amount of the variance in their PTSD over and above the variance that can be attributed to their sociodemographic characteristics (age, gender, number of siblings, and family's socioeconomic status) and to their perceptions of the environment and functioning of their families. The limitations of the study and recommendations for future research are discussed.

A social-cognitive-ecological framework for understanding the impact of exposure to persistent ethnic-political violence on children's psychosocial adjustment

In this article, we describe a theoretical framework for understanding how persistent and extreme exposure to ethnic-political conflict and violence interacts with cognitive, emotional, and self processes to influence children's psychosocial adjustment. Three recent strands of theorizing guide our approach. First, we focus on how observational and social learning processes combine to influence the development of social-cognitive structures and processes that affect behavior. Second, we focus on the role of developing self and identity processes in shaping the child's interactions with the world and the consequences of those interactions. Third, we build on the complex systems perspective on development and assume that human development can only be understood accurately by examining how the multiple contexts affecting children and the adults in their lives interact to moderate biosocial factors which predispose individuals to develop in certain directions. We review the recent empirical literature on children's exposure to ethnic-political violence and we apply the social-cognitive-ecological framework to the empirical findings in this literature. Finally, we propose future directions for research and clinical implications derived from this framework.

Rates and psychological effects of exposure to family violence among Sri Lankan university students

OBJECTIVES

The study had two objectives: to examine the rates of exposure to family violence among students in a non-Western society, with Sri Lanka as a case study and to examine the psychological effects of their exposure.

METHOD

Four hundred seventy six medical students in Sri Lanka were surveyed. A self-administered questionnaire was utilized, which included two forms of the Conflict Tactics Scales (CTS) to measure the extent to which the students witnessed interparental violence and experienced parental violence in childhood and adolescence. Additional instruments included the Trauma Symptom Checklist (TSC-33), which measures dissociation, anxiety, depression, and sleep disturbance, and the Family Functioning in Adolescence Questionnaire (FFAQ), which measures the students' perceptions of the functioning and environment in their families.

RESULTS

Between 16% and 18% of the participants indicated that they had witnessed at least one act of interparental psychological aggression, and between 2% and 16% indicated that they had witnessed at least one act of interparental physical violence before the age of 18. Between 11% and 84% of the participants had experienced at least one act of parental psychological aggression, and between 2% and 22% had experienced at least one act of parental physical violence during childhood. Significant amounts of the variance in participants' dissociation, anxiety, depression, and sleep disturbance were explained by their witnessing interparental violence and experiencing parental violence.

CONCLUSIONS

The present study provides strong evidence that the rates of family violence in a non-Western society (i.e., Sri Lankan families) are within the range of violence found in Western societies. In addition, the psychological effects of exposure to family violence in non-Western societies are similar to those in Western societies, although the relevance of familial, cultural, and political contexts as well as socio-demographic characteristics to those effects in non-Western societies should be taken into consideration.

PRACTICE IMPLICATIONS

Counseling centers at universities should focus on developing better routine screening to reach students who are victims of family violence. The importance of sensitivity to risks associated with asking students about these problems should be taken into consideration. Interventions should aim to increase the students' safety, to alleviate the mental health consequences of their exposure to family violence, and to help those victims to develop productive help-seeking behaviors and coping resources to ensure their safety. Collaboration between the university and community and within the university for the benefit of those victims may help in facilitating the indentification of and intervention with students' victims of family violence.

Harsh corporal punishment of Yemeni children: occurrence, type and associations

OBJECTIVE

To examine the occurrence, type and associations of harsh corporal punishment in Yemen.

METHODS

Caregiver and teacher reports were obtained on 1,196 Yemeni 7-10-year olds obtained by systematic random sampling of children in the 1st to 4th grades of urban and rural schools. Caregivers (86% mothers) reported on disciplinary practices, socio-familial background, and child psychopathology. Teachers reported on school performance and child psychopathology.

RESULTS

More than half of the rural caregivers and about a quarter of the urban caregivers reported using harsh corporal punishment (hitting children with implements, tying them up, pinching them, or biting them). Harsh corporal punishment was significantly associated with poor school performance and both behavioral and emotional difficulties. The socio-familial factors that were independently associated with harsh corporal punishment were: rural area, male gender of the child, low maternal education, and large family size.

CONCLUSION

Harsh corporal punishment is very common in Yemen. International findings suggest that the association with school failure and psychological maladjustment may well be causal. Promoting parental use of effective and non-violent disciplinary methods should be a public health priority.

PRACTICE IMPLICATIONS

Yemen urgently needs to develop and evaluate programs that teach parents how to use culturally appropriate rewards and non-abusive sanctions to shape children's behavior without stunting their academic and emotional development. Persuading parents to adopt such approaches may need programs that focus not just on techniques but also on attitudes, e.g. challenging the commonly held belief that children will not develop properly unless they are beaten when they do wrong.

Political violence in retrospect: Its effect on the mental health of Palestinian adolescents

The aim of this study has been to examine the effect of retrospective report of political violence during the first Intifada (1987—1993) on psychological adjustment of 1185 Palestinian adolescents (10th to 12th graders) seven years after the first Intifada had ended. Analysis of the inter-relations was conducted between self-reported measures of political violence, socio-demographic characteristics, perceived parents' psychological adjustment problems and internalizing (i.e., somatization, withdrawal, anxiety, and depression) and externalizing (i.e., thought, attention and social problems, delinquent and aggressive behaviors) symptoms. It showed the significant net effect of retrospectively reported exposure to political violence on both internalizing symptoms and externalizing symptoms over and above the effect of socio-demographic characteristics and perceived parents' psychological adjustment problems. The discussion addresses the meaning of these results in light of the conceptual and methodological limitations of this study.

Does war beget child aggression? Military violence, gender, age and aggressive behavior in two Palestinian samples

We examined, first, the relations between children's exposure to military violence and their aggressive behavior and the role of age and gender in that relation in two Palestinian samples. Second, we tested parenting practices as a moderator of the relation between exposure to military violence and aggressive behavior, and third, whether exposure to military violence of different nature (direct victimization versus witnessing) has specific associations with different forms of aggression (reactive, proactive and aggression-enjoyment). Study I was conducted in a relatively calm military-political atmosphere in Palestine-Gaza, and included 640 children, aged 6-16 years whose parents (N=622) and teachers (N=457) provided reports. Older children (> or =12 years) provided self-reports (N=211). Study II included 225 Palestinian children aged 10-14-year, who participated during a high-violence period of the Al Aqsa Intifada characterized by air raids, killing and destruction. Results showed that witnessing severe military violence was associated with children's aggressive and antisocial behavior (parent-reported) in study I, and with proactive, reactive and aggression-enjoyment (child-reported) in the study II. As hypothesized, good and supporting parenting practices could moderate the link between exposure to military violence and aggressive behavior. Aggr.