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Mental Health

Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military

Citation:

Millegan, Jeffrey, Lawrence Wang, Cynthia A. LeardMann, Derek Miletich, and Amy E. Street. 2016. “Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military.” Journal of Traumatic Stress 29 (2): 132–40. doi:10.1002/jts.22081.

Authors: Cynthia A. LeardMann, Derek Miletich, Jeffrey Millegan, Amy E. Street, Lawrence Wang

Annotation:

Although absolute counts of U.S. service men who experience sexual trauma are comparable to service women, little is known about the impact of sexual trauma on men. The association of recent sexual trauma (last 3 years) with health and occupational outcomes was investigated using longitudinal data (2004–2013) from the Millennium Cohort Study. Of 37,711 service men, 391 (1.0%) reported recent sexual harassment and 76 (0.2%) sexual assault. In multivariable models, sexual harassment or assault, respectively, was associated with poorer mental health: AOR = 1.60, 95% CI [1.22, 2.12], AOR = 4.39, 95% CI [2.40, 8.05]; posttraumatic stress disorder: AOR = 2.50, 95% CI [1.87, 3.33], AOR = 6.63, 95% CI [3.65, 12.06]; depression: AOR = 2.37, 95% CI [1.69, 3.33], AOR = 5.60, 95% CI [2.83, 11.09]; and multiple physical symptoms: AOR = 2.22, 95% CI [1.69, 2.92]; AOR = 3.57, 95% CI [1.98, 6.42], after adjustment for relevant covariates. Sexual harassment was also associated with poorer physical health: AOR = 1.68, 95% CI [1.27, 2.22]. Men who reported sexual trauma were more likely to have left military service: AOR = 1.60, 95% CI [1.14, 2.24], and be disabled/unemployed postservice: AOR = 1.76, 95% CI [1.02, 3.02]. Results suggest that sexual trauma was significantly associated with adverse health and functionality extending to postmilitary life. Findings support the need for developing better prevention strategies and services to reduce the burden of sexual trauma on service men.

Topics: Armed Conflict, Male Combatants, Men, Mental Health, PTSD, Trauma, Military Forces & Armed Groups, SV against men Regions: Americas, North America Countries: United States of America

Year: 2016

Developmental Trajectories and Predictors of Prosocial Behavior Among Adolescents Exposed to the 2008 Wenchuan Earthquake

Citation:

Qin, Yanyun, Ya Zhou, Fang Fan, Shijian Chen, Rong Huang, Rouna Cai, and Ting Peng. 2016. “Developmental Trajectories and Predictors of Prosocial Behavior Among Adolescents Exposed to the 2008 Wenchuan Earthquake.” Journal of Traumatic Stress 29 (1): 80–87. doi:10.1002/jts.22064.

Authors: Rouna Cai, Shijian Chen, Fang Fan, Rong Huang, Ting Peng, Yanyun Qin, Ya Zhou

Abstract:

This longitudinal study examined the developmental trajectories of prosocial behavior and related predictors among adolescents exposed to the 2008 Wenchuan earthquake. At 6-, 18-, and 30-months postearthquake, we followed a sample of 1,573 adolescents. Self-report measures were used to assess earthquake exposure, postearthquake negative life events, prosocial behavior, symptoms of posttraumatic stress disorder, depression, anxiety, social support, and coping style. Data were analyzed using growth mixture modeling and multinomial logistic regressions. Four trajectories of postearthquake prosocial behavior were identified in the sample: (a) high/enhancing (35.0%), (b) high/stable (29.4%), (c) low/declining (33.6%), and (d) low/steeply declining (2.0%). Female gender, more social support, and greater positive coping were significant factors related to a higher probability of developing the high/enhancing trajectory. These findings may be helpful for us to identify adolescents with poor prosocial behavior after exposure to earthquakes so as to provide them with appropriate intervention.

Topics: Environment, Environmental Disasters, Gender, Gender Analysis, Health, Mental Health, PTSD, Trauma Regions: Asia, East Asia Countries: China

Year: 2016

Questionable Associations: The Role of Forgiveness in Transitional Justice

Citation:

Saunders, Rebecca. 2011. “Questionable Associations: The Role of Forgiveness in Transitional Justice.” International Journal of Transitional Justice 5 (1): 119–41. doi:10.1093/ijtj/ijr003.

Author: Rebecca Saunders

Abstract:

Forgiveness has gained surprising prominence in transitional justice circles due, in part, to the impact of the South African Truth and Reconciliation Commission, advocacy of forgiveness by educational and social psychologists and critiques of retributive justice in critical legal studies. Drawing on philosophy, psychology, literature, legal theory and records of transitional justice in situ, this article argues that while advocates claim significant personal and social benefits derive from forgiveness, transitional justice should not consider forgiveness an a priori good or as commensurate with either reconciliation or peacebuilding. Before advocating forgiveness as a form of personal healing or social reconciliation, artisans of transitional justice mechanisms should consider that the repression of anger or resentment may be psychologically harmful and that perceived pressure to forgive may cause significant psychic distress. They should carefully consider the ways in which rhetoric or practices of forgiveness may facilitate perpetrators’ ability to do harm, teach victims to make peace with their oppression and reinforce structures of inequality.

Topics: Gender, Women, Health, Mental Health, Trauma, Justice, Transitional Justice, Post-Conflict Regions: Africa, Southern Africa Countries: South Africa

Year: 2011

War and Sexual Violence — Mental Health Care for Survivors

Citation:

Watts, Charlotte, Mazeda Hossain, and Cathy Zimmerman. 2013. “War and Sexual Violence — Mental Health Care for Survivors.” New England Journal of Medicine 368 (23): 2152–54. doi:10.1056/NEJMp1304712.

Authors: Charlotte Watts, Mazeda Hossain, Cathy Zimmerman

Topics: Armed Conflict, Health, Mental Health, Sexual Violence

Year: 2013

Mental Health of Female Survivors of Human Trafficking in Nepal

Citation:

Tsutsumi, Atsuro, Takashi Izutsu, Amod K. Poudyal, Seika Kato, and Eiji Marui. 2008. “Mental Health of Female Survivors of Human Trafficking in Nepal.” Social Science & Medicine 66 (8): 1841–47. doi:10.1016/j.socscimed.2007.12.025.

Authors: Atsuro Tsutsumi, Takashi Izutsu, Amod K. Poudyal, Seika Kato, Eiji Marui

Abstract:

Little is known about the mental health status of trafficked women, even though international conventions require that it be con- sidered. This study, therefore, aims at exploring the mental health status, including anxiety, depression and post-traumatic stress disorder (PTSD), of female survivors of human trafficking who are currently supported by local non-governmental organizations (NGOs) in Katmandu, the capital of Nepal, through comparison between those who were forced to work as sex workers and those who worked in other areas such as domestic and circus work (non-sex workers group). The Hopkins Symptoms Checklist-25 (HSCL-25) was administered to assess anxiety and depression, and the PTSD Checklist Civilian Version (PCL-C) was used to eval- uate PTSD. Both the sex workers’ and the non-sex workers’ groups had a high proportion of cases with anxiety, depression, and PTSD. The sex workers group tended to have more anxiety symptoms (97.7%) than the non-sex workers group (87.5%). Regarding depression, all the constituents of the sex workers group scored over the cut-off point (100%), and the group showed a significantly higher prevalence than the non-sex workers (80.8%). The proportion of those who are above the cut-off for PTSD was higher in the sex workers group (29.6%) than in the non-sex workers group (7.5%). There was a higher rate of HIV infection in the sex workers group (29.6%) than in the non-sex workers group (0%). The findings suggest that programs to address human trafficking should include interventions (such as psychosocial support) to improve survivors’ mental health status, paying attention to the category of work performed during the trafficking period. In particular, the current efforts of the United Nations and various NGOs that help survivors of human trafficking need to more explicitly focus on mental health and psychosocial support.

 

Keywords: human trafficking, women, Nepal, mental health, sex work, post-traumatic stress disorder, anxiety, depression

Topics: Gender, Women, Health, Mental Health, PTSD, Trafficking, Human Trafficking, Sex Trafficking Regions: Asia, South Asia Countries: Nepal

Year: 2008

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: 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: 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: 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

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