Mental Health

Outcomes and Moderators of a Preventive School-Based Mental Health Intervention for Children Affected by War in Sri Lanka: A Cluster Randomized Trial

Citation:

Tol, Wietse A., Ivan H. Komproe, Mark J.d. Jordans, Anavarathan Vallipuram, Heather Sipsma, Sambasivamoorthy Sivayokan, Robert D. Macy, and Joop T. De Jong. 2012. “Outcomes and Moderators of a Preventive School-Based Mental Health Intervention for Children Affected by War in Sri Lanka: A Cluster Randomized Trial.” World Psychiatry 11 (2): 114–22. doi:10.1016/j.wpsyc.2012.05.008.

Authors: Wietse A. Tol, Ivan H. Komproe, Mark J.d. Jordans, Anavarathan Vallipuram, Heather Sipsma, Sambasivamoorthy Sivayokan, Robert D. Macy, Joop T. De Jong

Abstract:

We aimed to examine outcomes, moderators and mediators of a preventive school-based mental health intervention implemented by paraprofessionals in a war-affected setting in northern Sri Lanka. A cluster randomized trial was employed. Subsequent to screening 1,370 children in randomly selected schools, 399 children were assigned to an intervention (n=199) or waitlist control condition (n=200). The intervention consisted of 15 manualized sessions over 5 weeks of cognitive behavioral techniques and creative expressive elements. As- sessments took place before, 1 week after, and 3 months after the intervention. Primary outcomes included post-traumatic stress disorder (PTSD), depressive, and anxiety symptoms. No main effects on primary outcomes were identified. A main effect in favor of intervention for conduct problems was observed. This effect was stronger for younger children. Furthermore, we found intervention benefits for spe- cific subgroups. Stronger effects were found for boys with regard to PTSD and anxiety symptoms, and for younger children on pro-social behavior. Moreover, we found stronger intervention effects on PTSD, anxiety, and function impairment for children experiencing lower levels of current war-related stressors. Girls in the intervention condition showed smaller reductions on PTSD symptoms than waitlisted girls. We conclude that preventive school-based psychosocial interventions in volatile areas characterized by ongoing war-related stress- ors may effectively improve indicators of psychological wellbeing and posttraumatic stress-related symptoms in some children. However, they may undermine natural recovery for others. Further research is necessary to examine how gender, age and current war-related expe- riences contribute to differential intervention effects.

Keywords: armed conflict, political violence, post-traumatic stress disorder, anxiety, depression, school-based intervention, prevention, Sri Lanka

Topics: Age, Youth, Armed Conflict, Gender, Girls, Boys, Health, Mental Health, PTSD, Violence Regions: Asia, South Asia Countries: Sri Lanka

Year: 2012

Moderators of Treatment Effectiveness for War-Affected Youth With Depression in Northern Uganda

Citation:

Betancourt, Theresa S., Elizabeth A. Newnham, Robert T. Brennan, Helen Verdeli, Ivelina Borisova, Richard Neugebauer, Judith Bass, and Paul Bolton. 2012. “Moderators of Treatment Effectiveness for War-Affected Youth With Depression in Northern Uganda.” Journal of Adolescent Health 51 (6): 544–50. doi:10.1016/j.jadohealth.2012.02.010.

Authors: Theresa S. Betancourt, Elizabeth A. Newnham, Robert T. Brennan, Helen Verdeli, Ivelina Borisova, Richard Neugebauer, Judith Bass, Paul Bolton

Abstract:

Purpose: As we build the evidence base of interventions for depression among war-affected youth, it is critical to understand factors moderating treatment outcomes. The current study investigated how gender and history of abduction by Lord’s Resistance Army rebels moderated treatment outcomes for war-affected youth.

Methods: The study—a three-armed, randomized, controlled trial—was conducted with internally displaced war-affected adolescents in northern Uganda. Participants with significant depression symptoms (N 304; 57% female; 14 –17 years of age) were randomly assigned to an interpersonal psychotherapy group (IPT-G), a creative play/recreation group, or a wait-list control condition. Secondary analyses were conducted on data from this randomized controlled trial.

Results: A history of abduction by Lord’s Resistance Army rebels was reported by 42% of the sample. Gender and abduction history interacted to moderate the effectiveness of IPT-G for the treatment of depression. In the IPT-G intervention arm, treatment effectiveness was greatest among female subjects without an abduction history, with effect size 1.06. IPT-G was effective for the treatment of depression for both male and female subjects with a history of abduction (effect size .92 and .50, respectively). Male subjects with no abduction history in IPT-G showed no significant improvement compared with those in the control conditions.

Conclusions: Abduction history and gender are potentially important moderators of treatment effects, suggesting that these factors need to be considered when providing interventions for war-affected youth. IPT-G may be an effective intervention for female subjects without an abduction history, as well as for both male and female former child soldiers, but less so for male subjects without an abduction history. 

 

Keywords: war, depression, Treatment moderators, Interpersonal therapy, child soldiers

Topics: Age, Youth, Armed Conflict, Combatants, Child Soldiers, Gender, Health, Mental Health Regions: Africa, East Africa Countries: Uganda

Year: 2012

Past Horrors, Present Struggles: The Role of Stigma in the Association between War Experiences and Psychosocial Adjustment among Former Child Soldiers in Sierra Leone

Citation:

Betancourt, Theresa S., Jessica Agnew-Blais, Stephen E. Gilman, David R. Williams, and B. Heidi Ellis. 2010. “Past Horrors, Present Struggles: The Role of Stigma in the Association between War Experiences and Psychosocial Adjustment among Former Child Soldiers in Sierra Leone.” Social Science & Medicine 70 (1): 17–26. doi:10.1016/j.socscimed.2009.09.038.

Authors: Theresa S. Betancourt, Jessica Agnew-Blais, Stephen E. Gilman, David R. Williams, B. Heidi Ellis

Abstract:

Upon returning to their communities, children formerly associated with armed forces and armed groups–commonly referred to as child soldiers–often confront significant community stigma. Much research on the reintegration and rehabilitation of child soldiers has focused on exposure to past war-related violence and mental health outcomes, yet no empirical work has yet examined the role that post-conflict stigma plays in shaping long-term psychosocial adjustment. Two waves of data are used in this paper from the first prospective study of male and female former child soldiers in Sierra Leone. We examined the role of stigma (manifest in discrimination as well as lower levels of community and family acceptance) in the relationship between war-related experiences and psychosocial adjustment (depression, anxiety, hostility and adaptive behaviors). Former child soldiers differ from one another with regard to their post-war experiences, and these differences profoundly shape their psychosocial adjustment over time. Consistent with social stress theory, we observed that post-conflict factors such as stigma can play an important role in shaping psychosocial adjustment in former child soldiers. We found that discrimination was inversely associated with family and community acceptance. Additionally, higher levels of family acceptance were associated with decreased hostility, while improvements in community acceptance were associated with adaptive attitudes and behaviors. We found that post-conflict experi- ences of discrimination largely explained the relationship between past involvement in wounding/killing others and subsequent increases in hostility. Stigma similarly mediated the relationship between surviving rape and depression. However, surviving rape continued to demonstrate independent effects on increases in anxiety, hostility and adaptive/prosocial behaviors after adjusting for other variables. These findings point to the complexity of psychosocial adjustment and community reintegration in these youth and have a number of programmatic and policy implications. 

 

Keywords: war, mental health, children, adolescents, child soldiers, trauma, Stigma, Sierra Leone

Topics: Age, Youth, Armed Conflict, Combatants, Child Soldiers, Health, Mental Health, Trauma, Post-Conflict Regions: Africa, West Africa Countries: Sierra Leone

Year: 2010

Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence

Citation:

Bass, Judith K., Jeannie Annan, Sarah McIvor Murray, Debra Kaysen, Shelly Griffiths, Talita Cetinoglu, Karin Wachter, Laura K. Murray, and Paul A. Bolton. 2013. “Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence.” New England Journal of Medicine 368 (23): 2182–91. doi:10.1056/NEJMoa1211853.

Authors: Judith K. Bass, Jeannie Annan, Sarah McIvor Murray, Debra Kaysen, Shelly Griffiths, Talita Cetinoglu, Karin Wachter, Laura K. Murray, Paul A. Bolton

Abstract:

Background Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries.

Methods In this trial in the Democratic Republic of Congo, we randomly assigned 16 villages to provide cognitive processing therapy (1 individual session and 11 group sessions) or in- dividual support to female sexual-violence survivors with high levels of PTSD symptoms and combined depression and anxiety symptoms. One village was excluded owing to concern about the competency of the psychosocial assistant, resulting in 7 villages that provided therapy (157 women) and 8 villages that provided individual support (248 wom- en). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symp- toms]), PTSD symptoms (average score on the PTSD Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), and functional impairment (average score across 20 tasks [range, 0 to 4, with higher scores indicating greater impairment]) were performed at baseline, at the end of treatment, and 6 months after treatment ended.

Results A total of 65% of participants in the therapy group and 52% of participants in the indi- vidual-support group completed all three assessments. Mean scores for combined de- pression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were signifi- cantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) (P<0.001 for all comparisons). Similar patterns were ob- served for PTSD and functional impairment. At 6 months after treatment, 9% of par- ticipants in the therapy group and 42% of participants in the individual-support group met criteria for probable depression or anxiety (P<0.001), with similar results for PTSD.

Conclusions In this study of sexual-violence survivors in a low-income, conflict-affected country, group psychotherapy reduced PTSD symptoms and combined depression and anxi- ety symptoms and improved functioning. 

 

Topics: Armed Conflict, Gender, Women, Health, Mental Health, PTSD, Sexual Violence, SV against Women Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2013

‘When We Wanted to Talk About Rape’: Silencing Sexual Violence at the Special Court for Sierra Leone

Citation:

Kelsall, Michelle Staggs, and Shanee Stepakoff. 2007. “‘When We Wanted to Talk About Rape’: Silencing Sexual Violence at the Special Court for Sierra Leone.” International Journal of Transitional Justice 1 (3): 355–74. doi:10.1093/ijtj/ijm034.

Authors: Michelle Staggs Kelsall, Shanee Stepakoff

Abstract:

This article explores the legal and psychological ramifications arising from the exclusion of evidence of sexual violence during the Civil Defence Forces (CDF) case at the Special Court for Sierra Leone. Using empirical findings from post-trial interviews conducted with the ten victim-witnesses who were originally to testify, we juxtapose what the Special Court allowed the women to say, and what the women themselves wanted to say. From a legal perspective, we then critique the Trial Chamber's reasons for excluding the evidence and question the legal bases upon which the women were silenced, arguing that wider and wider circles of the women's experience were removed from the Court's records despite there being ample authority at an international level to support inclusion. We further look at the gendered biases in international criminal law and how expedience and efficiency usurped the significance of prosecuting crimes of sexual violence in this instance. From a psychological perspective, we discuss the consequences that the act of silencing had for the witnesses, and argue that a more emotionally sensitive understanding of the Court's notion of ‘protection’ is required.

Topics: Gender, Women, Health, Mental Health, International Law, International Criminal Law, Justice, International Tribunals & Special Courts, Post-Conflict, Sexual Violence Regions: Africa, West Africa Countries: Sierra Leone

Year: 2007

Violence Against Women in Northern Uganda: The Neglected Health Consequences of War

Citation:

Liebling-Kalifani, Helen, Ruth Ojiambo-Ochieng, Angela Marshall, Juliet Were-Oguttu, Seggane Musisi, and Eugene Kinyanda. 2008. “Violence against Women in Northern Uganda: The Neglected Health Consequences of War.” Journal of International Women’s Studies 9 (3): 174.

Authors: Helen Liebling-Kalifani, Ruth Ojiambo-Ochieng, Angela Marshall, Juliet Were-Oguttu, Seggane Musisi, Eugene Kinyanda

Abstract:

This article presents a summary of research intervention work carried out in waraffected Northern Uganda by Isis-WICCE, a women’s international non-government organisation, in conjunction with the Ugandan Medical Association and funded by Medica Mondiale, a German-based foundation. The findings of this research demonstrate the serious effects of sexual violence and torture experienced on women’s physical and psychological health. However, this paper also describes women’s key role in trying to bring peace to this region, as well as their resistance and survival strategies. It is recommended that funding is urgently required for the provision of sustainable, gender sensitive physical and psychological health services in this region. Women’s campaign for justice for the atrocities they have suffered should be heard by the International Criminal Court. Further recommendations are made with respect to policy changes in line with enhancing women’s roles and furthering the empowerment of these women war survivors.

Keywords: women, war, health, sexual violence, Northern Uganda

Topics: Gender, Women, Gender-Based Violence, Health, HIV/AIDS, Mental Health, Reproductive Health, Justice, Peacebuilding, Post-Conflict, Sexual Violence, Torture, Sexual Torture Regions: Africa, East Africa Countries: Uganda

Year: 2008

Natural Disaster and Women’s Mental Health

Citation:

Parida, Pradeep Kumar. “Natural Disaster and Women’s Mental Health.” Social Change 45, no. 2 (June 1, 2015): 256–75. doi:10.1177/0049085715574189.

Author: Pradeep Kumar Parida

Abstract:

Based on a case study in the Himalayan state of Uttarakhand, this article examines women’s vulnerability to the June 2013 floods in constructing mental health outcomes. By means of qualitative research and diverse vulnerability approaches such as entitlement, livelihood and political economy, the study draws attention to the initial well-being, livelihood resilience, self-protection, societal protection and social capital of women and underlines how their lack of capacity to avoid, cope with and recover from disasters increased mental health exposure to risk. To this point, women’s vulnerability and mental disorders are reciprocally related to each other. In conclusion, while physical exposure to the flood was a necessary element, it was women’s pre-existing symptoms and developmental processes that were most influential in generating mental health consequences after the disaster.

Keywords: vulnerability, mental health, natural disaster, gender inequality, Uttarakhand

Topics: Economies, Environment, Environmental Disasters, Gender, Women, Health, Mental Health, Livelihoods Regions: Asia, South Asia Countries: India

Year: 2015

Women and health consequences of natural disasters: Challenge or opportunity?

Citation:

Sohrabizadeh, Sanaz, Sogand Tourani, and Hamid Reza Khankeh. 2016. “Women and Health Consequences of Natural Disasters: Challenge or Opportunity?” Women & Health (May 2, 2016): 1–17. doi:10.1080/03630242.2016.1176101.

Authors: Sanaz Sohrabizadeh, Sogand Tourani, Hamid Reza Khankeh

Abstract:

Disasters do not affect people equally; the impact of disasters on the lives of women is different from other groups of a community. Women’s fundamental rights to health and safety are violated after disasters. The authors of this study aimed to explore various factors of women’s health with reference to previous natural disasters in Iran. A qualitative approach using in-depth unstructured interviews and field observations was employed to explore women’s health factors in the affected regions. A total of 22 participants affected by disasters, as well as key informants, were interviewed applying the purposeful sampling method. Data were collected in 2014 in three provinces, including East Azerbaijan, Bushehr, and Mazandaran. A content analysis using the Graneheim approach was performed for analyzing the transcribed interviews. Two themes and four categories were extracted from the data. The themes that emerged included psycho-physical effects and women’s health status. Physical and psycho-emotional effects and reproductive and environmental health effects were the four emergent categories. The findings implied that managing women’s health challenges may result in reducing the distressing effects of disaster. These findings support identification and application of the mechanisms by which women’s well-being in physical, mental, reproductive, and environmental aspects can be protected after disasters.

Keywords: disasters, Gender, health, iran, women

Topics: Environment, Environmental Disasters, Gender, Women, Health, Mental Health, Reproductive Health Regions: MENA, Asia, Middle East Countries: Iran

Year: 2016

'Living in a Movie’ — Israeli Women Combatants in Conflict Zones

Citation:

Tekoah, Shir Daphna, and Ayelet Harel-Shalev. 2014. “‘Living in a Movie’ — Israeli Women Combatants in Conflict Zones.” Women’s Studies International Forum 44 (May): 26–34. doi:10.1016/j.wsif.2014.03.002.

 

Authors: Shir Daphna Tekoah, Ayelet Harel-Shalev

Abstract:

This study utilizes two different qualitative analysis techniques to explore the experiences of women who served as combatants or in combat support roles in conflict zones. By using data analysis techniques such as the “listening guide” and content theme analysis, the study uncovers the experiences that this specific group undergoes, while exposing their dilemmas and thoughts. This research investigates how military service in conflict zones impacts the psychological, physical, and emotional wellbeing of female combatants. Twenty female Israeli veterans between the ages of 21 and 30 who served in the Israeli Defense Forces in the Occupied Territories (the West Bank and Gaza) were interviewed for this study. The findings suggest that although the combatants actively served by choice in high-status positions, they applied a dissociation mechanism in order to survive the traumatic and complex reality of their service. This study offers a unique, multilayered analysis of these women combatants' voices.

Topics: Combatants, Female Combatants, Gender, Women, Health, Mental Health, Military Forces & Armed Groups, Militaries Regions: MENA, Asia, Middle East Countries: Israel, Palestine / Occupied Palestinian Territories

Year: 2014

Narratives and Testimonies of Women Detainees in the Anti-Apartheid Struggle

Citation:

Hiralal, Kalpana. 2015. “Narratives and Testimonies of Women Detainees in the Anti-Apartheid Struggle.” Agenda: Empowering Women for Gender Equity 29 (4): 34–44. doi:10.1080/10130950.2015.1104883.

Author: Kalpana Hiralal

Abstract:

South Africa's road to democracy was a product of the contributions of both men and women in the freedom struggle. Thousands of women risked their lives and sacrificed their families. In the post-apartheid era the narratives of the nationalist struggle have largely focused on popular and well known men and women, their experiences in exile and their role in the African National Congress (ANC) which led to the under-ground movement. This article seeks to document the lived experiences of women inmates and detainees in the liberation struggle, whose stories have remained in the shadows of dominant nationalist narratives. Thousands of women were arrested, subjected to naked body searches, torture, verbal abuse and sexual harassment. Women experienced both physical and psychological humiliation. This article argues that prison, despite being a "site of humiliation", repression, and subversion, also became a "site of female community and resistance" (Thapar-Bjorkert, 2006:12,25) and that women political prisoners were capable of challenging and negotiating their incarceration. This study challenges dominant narratives of the nationalist struggle by making women inmates and detainees crucial historical subjects and introduces the prison as another terrain of political struggle, resistance, confrontation, and negotiation in the telling of the liberation struggle.

Keywords: gender, prison, apartheid, Narratives, women detainees

Topics: Armed Conflict, Gender, Women, Health, Mental Health, Race, Sexual Violence, Sexual Exploitation and Abuse, Torture, Sexual Torture Regions: Africa, Southern Africa Countries: South Africa

Year: 2015

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