Authors: Kaplow JB, Layne CM, Pynoos RS, Cohen JA, Lieberman A.
Date: 2012
Abstract: Two bereavement-related disorders are proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V): Adjustment Disorder Related to Bereavement, to be located in the main body of the text as an official diagnostic entity; and Bereavement-Related Disorder, including a Traumatic Death Specifier, to be located in the Appendix as an invitation for further research. These diagnoses currently do not include developmentally informed criteria, despite the importance of developmental processes in the ways children and adolescents grieve. In this article, we draw upon a selective review of the empirical literature and expert clinical knowledge to recommend developmentally informed modifications and specifiers of the proposed criteria for both bereavement disorders and strategies to improve future research. This article is derived from an invited report submitted to the DSM-V Posttraumatic Stress Disorder, Trauma, and Dissociative Disorders Sub-Work Group, and suggested modifications have received preliminary approval to be incorporated into the DSM-V at the time of this writing. Adoption of these proposals will have far-reaching consequences, given that DSM-V criteria will influence both critical treatment choices for bereaved youth and the next generation of research studies.
[button link=”http://guilfordjournals.com/doi/abs/10.1521/psyc.2012.75.3.243″]Read More[/button]
Authors: Hallfors DD, Cho H, Mbai I, Milimo B, Itindi J.
Date: 2012
Abstract: We conducted a 2-year pilot randomized controlled trial (N = 105) in a high HIV-prevalence area in rural western Kenya to test whether providing young orphan adolescents with uniforms, school fees, and community visitors improves school retention and reduces HIV risk factors. The trial was a community intervention, limited to one community. In this paper, we examined intervention implementation and its association with outcomes using longitudinal data. We used both quantitative and qualitative methods to evaluate the community-based model for orphan HIV prevention, with recommendations for future studies. Despite promising effects after 1 year, GEE analyses showed null effects after 2 years. Volunteer community visitors, a key element of the intervention, showed little of the expected effect although qualitative reports documented active assistance to prevent orphans’ school absence. For future research, we recommend capturing the transition to high school, a larger sample size, and biomarker data to add strength to the research design. We also recommend a school-based intervention approach to improve implementation and reduce infrastructure costs. Finally, we recommend evaluating nurses as agents for improving school attendance and preventing dropout because of their unique ability to address critical biopsychosocial problems.
[button link=”http://dx.doi.org/10.1007/s10900-012-9548-x”]Read More[/button]
Authors: Bryant M, Beard J, Sabin L, Brooks MI, Scott N, Larson BA, Biemba G, Miller C, Simon J.
Date: 2012
Abstract: Sixteen million children in developing and middle-income countries have been orphaned by HIV/AIDS, and at least another million children per year are rendered vulnerable by parental HIV/AIDS-related illness. Since 2003 the US government has provided approximately $1.6 billion to give four million of these children care and support through the President’s Emergency Plan for AIDS Relief (PEPFAR). We conducted five studies to evaluate the effectiveness of PEPFAR’s interventions for such children in East Africa and southern Africa. We found evidence of beneficial changes in school enrollment rates and on the psychosocial well-being of children. However, we could not demonstrate empirically the impact of most of the PEPFAR initiatives that we examined, primarily because of a lack of baseline data and clear outcome and impact indicators. We also found that many programs were spread so thin across a vulnerable population that little in the way of services actually reached beneficiaries, which raises questions about whether PEPFAR funds are sufficient, or if the program is attempting to do much with too few resources. We offer several recommendations, including better measuring the effect of programs for orphans and vulnerable children by collecting baseline data and conducting well-designed, rigorous outcome and impact evaluations.
[button link=”http://content.healthaffairs.org/cgi/pmidlookup?view=long&pmid=22778340″]Read More[/button]
Authors: Williams TP, Binagwaho A, Betancourt TS
Date: 2012
Abstract:
OBJECTIVE:
To illuminate the different manifestations of transactional sexual exploitation and abuse among Rwanda’s children in order to inform effective responses by policies, programs, and communities.
METHOD:
Qualitative data was collected during April and May 2010. One-hundred and thirty-nine adults (56% female) and 52 children (60% female) participated in focus groups across three geographic locations in Rwanda. Eleven interviews were held with child protection stakeholders.
RESULTS:
Interview and focus group participants reported how children, primarily girls, engaged in transactional sex as a survival strategy in response to situations of adversity including economic deprivation, difficulty accessing school, and social pressure.
CONCLUSIONS:
Policy and programs should work to address the underlying social and economic determinants of transactional sexual exploitation through structural interventions that reduce gender inequalities to accessing school and securing basic needs. Further quantitative and qualitative research to better understand the complexities of this issue is warranted.
[button link=”http://linkinghub.elsevier.com/retrieve/pii/S0145-2134(12)00032-4″]Read More[/button]
Authors: Betancourt TS, Williams TP, Kellner SE, Gebre-Medhin J, Hann K, Kayiteshonga Y.
Date: 2012
Abstract: This study examines the core components of children’s basic security and well-being in order to examine issues central to improving child protection in Rwanda. Sources of data included 15 focus groups with adults, 7 focus groups with children ages 10-17, and 11 key informant interviews with child protection stakeholders, including representatives from international NGOs, community-based groups, and the Rwandan Government, all of which took place in April and May of 2010. Participants painted a complex picture of threats to children’s basic security in Rwanda. Three key themes were pervasive across all interviews: (1) deterioration of social and community cohesion in post-genocide Rwanda; (2) the cascading effects of poverty; and (3) the impact of caregiver illness and death on the caregiving environment. Consistent with the SAFE (Safety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security) model of child protection, participants rarely elaborated on a child protection threat independent of other basic security needs and rights. Findings suggest a need for integrated approaches to child protection that recognize this interrelatedness and extend beyond issue-specific child protection responses. This study contributes to a growing body of work highlighting the interrelated nature of child protection threats and the implications of adaptive and dangerous survival strategies that children and families engage in to meet their basic security needs. Analysis of this interrelatedness provides a roadmap for improving policies and implementing integrated and robust child protection strategies in Rwanda and other settings.
[button link=”http://www.sciencedirect.com/science/article/pii/S0277953612001505]Read More[/button]
Authors: Betancourt TS, Salhi C, Buka S, Leaning J, Dunn G, Earls F.
Date: 2012
Abstract: The study investigated factors associated with internalising emotional and behavioural problems among adolescents displaced during the most recent Chechen conflict. A cross-sectional survey (N=183) examined relationships between social support and connectedness with family, peers and community in relation to internalising problems. Levels of internalising were higher in displaced Chechen youth compared to published norms among non-referred youth in the United States and among Russian children not affected by conflict. Girls demonstrated higher problem scores compared to boys. Significant inverse correlations were observed between family, peer and community connectedness and internalising problems. In multivariate analyses, family connectedness was indicated as a significant predictor of internalising problems, independent of age, gender, housing status and other forms of support evaluated. Sub-analyses by gender indicated stronger protective relationships between family connectedness and internalising problems in boys. Results indicate that family connectedness is an important protective factor requiring further exploration by gender in war-affected adolescents.
[button link=”http://onlinelibrary.wiley.com/doi/10.1111/j.1467-7717.2012.01280.x/abstract;jsessionid=3ACE955FF3471855B8D5C858B027507D.d01t02?systemMessage=Wiley+Online+Library+will+be+disrupted+on+23+February+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance”]Read More[/button]
Authors: Betancourt TS, Yudron M, Wheaton W, Smith-Fawzi MC.
Date: 2012
Abstract:
PURPOSE:
To examine the role of caregiver mental health and risk and protective factors in influencing levels of internalizing and externalizing emotional and behavioral symptoms over time among a sample of refugee adolescents.
METHODS:
Prospective study of 153 Kunama refugee adolescents receiving an emergency education intervention while living in a camp in Ethiopia. Surveys were collected in 2001 (T1) and 2002 (T2). Adolescent and caregiver mental health were assessed using a Kunamenga adaptation of the Youth Self Report; caregiver mental health was assessed using the Hopkins Symptom Checklist-25. Attitudes toward education, satisfaction with education programming, socioeconomic status, and perceptions of access to services were also explored as variables potentially influencing adolescent mental health at follow-up.
RESULTS:
Caregiver distress was significantly associated with youth externalizing behavior symptoms (β = 8.34, p < .001) and internalizing symptoms (β = 4.02, p < .05). Caregiver perceived access to services had a protective effect on externalizing behaviors (β = -7.54, p < .05) and internalizing behaviors (β = -13.67, p < .001). Higher socioeconomic status (β = -1.47, p < .05) had a protective effect on internalizing symptoms. In terms of modifying effects, among youth with distressed caregivers, those who were satisfied with the International Rescue Committee education intervention had a lower internalizing score (β = -6.34, p < .001) compared with those who were not satisfied with the program.
CONCLUSIONS:
This study presents a rare prospective investigation of caregiver-adolescent mental health during an active refugee displacement. Results suggest that programs targeting mental health in refugee children should consider children within the larger family system, including caregiver influence on child and adolescent mental health adjustment over time.
[button link=”http://linkinghub.elsevier.com/retrieve/pii/S1054-139X(12)00002-X”]Read More[/button]
Authors: Theresa Betancourt, Pamela Scorza, Sarah Meyers-Ohki,, Christina Mushashi, Yvonne Kayiteshonga, Agnes Binagwaho, Sara Stulac, William R. Beardslee
Date: December 2012
Abstract:
Objective
We assessed the validity of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) as a screen for depression in Rwandan children and adolescents. Although the CES-DC is widely used for depression screening in high-income countries, its validity in low-income and culturally diverse settings, including sub-Saharan Africa, is unknown.
Method
The CES-DC was selected based on alignment with local expressions of depression-like problems in Rwandan children and adolescents. To examine criterion validity, we compared CES-DC scores to depression diagnoses on a structured diagnostic interview, the Mini International Neuropsychiatric Interview for Children (MINI KID), in a sample of 367 Rwandan children and adolescents aged 10 through 17 years. Caregiver and child or adolescent self-reports endorsing the presence of local depression-like problems agahinda kenshi (persistent sorrow) and kwiheba (severe hopelessness) were also examined for agreement with MINI KID diagnosis.
Results
The CES-DC exhibited good internal reliability (α = .86) and test-retest reliability (r = .85). The area under the receiver operating characteristic curve for the CES-DC was 0.825 when compared to MINI KID diagnoses, indicating a strong ability to distinguish between depressed and nondepressed children and adolescents in Rwanda. A cut point of≥30 corresponded with a sensitivity of 81.9% and a specificity of 71.9% in this referred sample. MINI KID diagnosis was well aligned with local expressions of depression-like problems.
Conclusion
The CES-DC demonstrates good psychometric properties for clinical screening and evaluation in Rwanda, and should be considered for use in this and other low-resource settings. Population samples are needed to determine a generalizable cut point in nonreferred samples.
[button link=”http://www.jaacap.com/article/S0890-8567(12)00689-2/”]Read More[/button]
Authors: Betancourt TS, Newnham EA, Brennan RT, Verdeli H, Borisova I, Neugebauer R, Bass J, Bolton P.
Date: 2012
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.
[button link=”http://www.jahonline.org/article/S1054-139X(12)00073-0/abstract”]Read More[/button]
Authors: Betancourt TS, Newnham EA, Layne CM, Kim S, Steinberg AM, Ellis H, Birman D.
Date: 2012
Abstract: There is an increasing need to deliver effective mental health services to refugee children and adolescents across the United States; however, the evidence base needed to guide the design and delivery of services is nascent. We investigated the trauma history profiles, psychopathology, and associated behavioral and functional indicators among war-affected refugee children presenting for psychological treatment. From the National Child Traumatic Stress Network’s Core Data Set, 60 war-affected refugee children were identified (51.7% males, mean age = 13.1 years, SD = 4.13). Clinical assessments indicated high rates of probable posttraumatic stress disorder (30.4%), generalized anxiety (26.8%), somatization (26.8%), traumatic grief (21.4%), and general behavioral problems (21.4%). Exposure to war or political violence frequently co-occurred with forced displacement; traumatic loss; bereavement or separation; exposure to community violence; and exposure to domestic violence. Academic problems and behavioral difficulties were prevalent (53.6% and 44.6%, respectively); however, criminal activity, alcohol/drug use, and self-harm were rare (all < 5.45%). These findings highlight the complex trauma profiles, comorbid conditions, and functional problems that are important to consider in providing mental health interventions for refugee children and adolescents. Given the difficulties associated with access to mental health services for refugees, both preventive and community-based interventions within family, school, and peer systems hold particular promise.
[button link=”http://onlinelibrary.wiley.com/doi/10.1002/jts.21749/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+23+February+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance”] Read More[/button]