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PTSD

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

Year: 2012

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

The Gender-Specific Terror of El Salvador and Guatemala: Post-traumatic Stress Disorder in Central American Refugee Women

Citation:

Aron, Adrianne, Shawn Corne, Anthea Fursland, and Barbara Zelwer. 1991. “The Gender-Specific Terror of El Salvador and Guatemala: Post-traumatic Stress Disorder in Central American Refugee Women.” Women’s Studies International Forum 14 (1): 37–47. doi:10.1016/0277-5395(91)90082-S.

Authors: Adrianne Aron, Shawn Corne, Anthea Fursland, Barbara Zelwer

Abstract:

A taxonomy of three broad categories describes the forms of sexual abuse commonly found in El Salvador and Guatemala, where gender-specific political repression traumatizes people and gives rise to Post-Traumatic Stress Disorder (PSTD). If the psychological problems of Central American women refugees are to be addressed meaningfully, we must attend not only to the special characteristics of the assaults they have endured, but also to features of the pre-trauma environment in which they lived, and the post-trauma experience of exile. Of particular importance is the distinction between institutionalized and noninstitutionalized sexual assault; that is, assault sanctioned by the government as a normative act of social control versus assault which is considered deviant, criminal, and punishable by law. A case study of a Central American refugee woman suffering from PSTD is presented, to illustrate the psychological symptoms attendant to trauma and the use of sexual abuse as a form of political repression.

Topics: Displacement & Migration, Refugees, Gender, Women, Health, PTSD, Sexual Violence, SV against Women Regions: Americas, Central America Countries: El Salvador, Guatemala

Year: 1991

Waging Gendered Wars: U.S. Military Women in Afghanistan and Iraq

Citation:

Eager, Paige Whaley. 2014. Waging Gendered Wars: U.S. Military Women in Afghanistan and Iraq. New York: Routledge. https://www.routledge.com/Waging-Gendered-Wars-US-Military-Women-in-Afghanistan-and-Iraq/Eager/p/book/9781409448464.

Author: Paige Whaley Eager

Abstract:

Waging Gendered Wars examines, through the analytical lens of feminist international relations theory, how U.S. military women have impacted and been affected by the wars in Iraq and Afghanistan. Although women were barred from serving formally in ground combat positions within the U.S. armed forces during both wars, U.S. female soldiers are being killed in action. By examining how U.S. military women's agency as soldiers, veterans, and casualties of war affect the planning and execution of war, Whaley Eager assesses the ways in which the global world of international politics and warfare has become localized in the life and death narratives of female service personnel impacted by combat experience, homelessness, military sexual trauma, PTSD, and the deaths of fellow soldiers.
 
(Routledge)

Keywords: politics & international relations, gender politics, political philosophy, U.S. politics, security studies, war & conflict studies

Topics: Armed Conflict, Combatants, Female Combatants, Gender, Women, Health, PTSD, Trauma, Militarized Livelihoods, Military Forces & Armed Groups, Security

Year: 2014

The War Experiences and Psychosocial Development of Children in Lebanon

Citation:

Macksoud, Mona S., and J. Lawrence Aber. 1996. “The War Experiences and Psychosocial Development of Children in Lebanon.” Child Development 67 (1): 70–88.

Authors: Mona S. Macksoud, J. Lawrence Aber

Abstract:

This study examines the number and types of war traumas children face growing up in a war-torn country and the relation of such traumatic experiences to their psychosocial development. A sample of 224 Lebanese children (10-16 years old) were interviewed using measures of war exposure, mental health symptoms, adaptational outcomes, and Post-Traumatic Stress Disorder (PTSD). The number and type of children's war traumas varied meaningfully in number and type by their age, gender, father's occupational status, and mother's educational level. As predicted, the number of war traumas experienced by a child was positively related to PTSD symptoms; and various types of war traumas were differentially related to PTSD, mental health symptoms, and adaptational outcomes. For example, children who were exposed to multiple war traumas, were bereaved, became victims of violent acts, witnessed violent acts, and/or were exposed to shelling or combat exhibited more PTSD symptoms. Children who were separated from parents reported more depressive symptoms and children who experience bereavement and were not displaced reported more planful behavior. Lastly, children who were separated from parents and who witnessed violent acts reported more prosocial behavior. Implications for program interventions and directions for future research on the effects of war on the psychosocial development of children are explored.

Topics: Age, Youth, Armed Conflict, Girls, Boys, Health, PTSD, Trauma, Violence Regions: MENA, Asia, Middle East Countries: Lebanon

Year: 1996

The Legacy of Gender-Based Violence and HIV/AIDS in the Post-Genocide Era: Stories From Women in Rwanda

Citation:

Russell, Susan Garnett, Sanaya Lim, Paul Kim, and Sophie Morse. 2015. “The Legacy of Gender-Based Violence and HIV/AIDS in the Post-Genocide Era: Stories From Women in Rwanda.” Health Care for Women International, August, 1–43.

Author: Susan Garnett Russell, Sanaya Lim, Paul Kim, Sophie Morse

Abstract:

Drawing on qualitative interviews with 22 Rwandan women, we describe the lived experiences of women survivors of Gender-Based Violence (GBV) more than a decade and a half after the 1994 Genocide. We argue that the intersection between GBV and HIV/AIDS has long-term implications: the majority of women interviewed continue to endure trauma, stigma, social isolation, and economic hardship in the post-genocide era and are in need of expanded economic and mental health support. Our findings have implications for the importance of providing integrated psychosocial support to survivors of GBV post-conflict contexts. 

Topics: Armed Conflict, Gender, Women, Girls, Gender-Based Violence, Governance, Post-Conflict Governance, Health, HIV/AIDS, Mental Health, PTSD, Reproductive Health, Trauma, Justice, Crimes against Humanity, International Tribunals & Special Courts, Reparations, War Crimes, Rights, Sexual Violence, Rape Regions: Africa, Central Africa, East Africa Countries: Rwanda

Year: 2015

Twentieth Century Theories on Combat Motivation and Breakdown

Citation:

Wessley, Simon. 2006. “Twentieth Century Theories on Combat Motivation and Breakdown.” Journal of Contemporary History 41 (2): 269-286. 

Author: Simon Wessley

Abstract:

All the combatant nations of the first world war struggled to deal with the problem of large-scale casualties that could not be ascribed to simple physical injury. After a brief flirtation with medical explanations (‘shell-shock’) these were soon realized to be psychological in nature, but not until the end of the war was there much consensus on whether these represented a psychological response to the stressors of industrial warfare, or alternatively a failure of motivation or even masculinity. Simultaneously combat motivation was seen within a moral framework that emphasized duty, patriotism, leadership and character. It was these latter virtues, or lack of them, that gradually came to explain combat breakdown, and not the psychological theories, even if modern narratives tend to overlook this. If a person had sufficient character, leadership and training, breakdown was unlikely even under the harshest conditions. By the end of the second world war, new thinking and research, mainly from the American forces, now downplayed the importance of ideological and personal factors, and instead concluded that the most powerful motivation for combat (as opposed to enlistment) came from the role of the small group — ‘men fight for their buddies’. Breakdown was still seen as the reserve side of combat motivation, most likely when the small group disintegrated, although ultimately even the most robust could succumb after prolonged combat exposure. However, provided that the individual was previously of normal personality, this would be short lived. Long-term illness was still almost entirely attributed to vulnerabilities acquired by inheritance or during childhood. Combat breakdown could also be made chronic by the influence of secondary gain, and so medical labels for combat breakdown were avoided, treatment was by reassurance and return to duty, and compensation was discouraged where possible. It was not until the aftermath of the Vietnam war that views on combat motivation and breakdown began to diverge. As a result of the efforts of American psychiatrists opposed to the Vietnam war a new medical label, post-traumatic stress disorder (PTSD), was introduced in 1980. It was now believed that not just transient, but also chronic, mental disorders could be caused by combat, even in those previously of robust disposition, and that the necessity for a diagnosis and compensation overcame concerns about illness reinforcement and secondary gain. Social explanations for breakdown based on group psychology largely disappeared, to be replaced by a framework based almost entirely on individual responses to trauma, although the role of predisposition quickly needed to be rediscovered. In contrast, the military continue to insist on the importance of small group psychology in explaining motivation to fight, and are distrustful of either ideological or individual explanatory models.

Topics: Armed Conflict, Combatants, Male Combatants, Gender, Men, Masculinity/ies, Gendered Power Relations, Masculinism, Health, Mental Health, PTSD, Trauma, Military Forces & Armed Groups, Militaries, Post-Conflict

Year: 2006

A Narrative Study of Refugee Women Who Have Experienced Violence in the Context of War

Citation:

Berman, Helene, Estrella Rosa Irías Girón, and Antonia Ponce Marroquin. 2006. “A Narrative Study of Refugee Women Who Have Experienced Violence in the Context of War.” Canadian Journal of Nursing Research 38 (4): 32-53.

Authors: Helene Berman, Estrella Rosa Irías Girón, Antonia Ponce Marroquin

Abstract:

Although women are rarely on the frontlines of battle, as in many other realms of contemporary life they bear a disproportionate burden of the consequences of war. Many have experienced torture firsthand or been witnesses to the torture or killing of family, friends, and loved ones. The use of rape and other forms of sexual torture has been well documented. For those who are forced to flee their homes and countries, separation from spouses, children, and other family members is common. Because of the sheer magnitude of global conflict, the number of refugees and displaced persons throughout the world has risen exponentially. It has been estimated that women constitute more than half of the world’s refugee population. The purpose of this narrative study was to examine the experiences of refugee women who experienced violence in the context of war. Data analysis revealed 8 themes: lives forever changed, new notions of normality, a pervasive sense of fear, selves obscured, living among and between cultures, a woman’s place in Canada, bearing heavy burdens – the centrality of children, and an uncaring system of care. Implications for research and practice, including limitations associated with individualized Western approaches, are discussed.

Keywords: refugees, women, war, violence, trauma, narrative, health

Topics: Displacement & Migration, Refugees, Gender, Women, Gender-Based Violence, Health, Mental Health, PTSD, Trauma, Sexual Violence, Rape, Sexual Exploitation and Abuse, SV against Women, Torture, Sexual Torture, Violence Regions: Americas, Central America, North America, South America, Europe, Balkans, Eastern Europe Countries: Bosnia & Herzegovina, Canada, Chile, El Salvador, Guatemala

Year: 2006

Between Manliness and Masculinity: The “War Generation” and the Psychology of Fear in Britain, 1914-1950

Citation:

Roper, Michael. 2005. “Between Manliness and Masculinity: The “War Generation” and the Psychology of Fear in Britain, 1914-1950.” Journal of British Studies 44 (2): 343-62.

Author: Michael Roper

Topics: Gender, Masculinity/ies, Health, Mental Health, PTSD Regions: Europe, Northern Europe Countries: United Kingdom

Year: 2005

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