Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study

Onyut LP, Neuner F, Ertl V, Schauer E, Odenwald M, Elbert T. Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study. Conflict and Health. 2009;3(1):6.Background: The aim of this study was to establish the prevalence of posttraumatic stress disorder (PTSD) and depression among Rwandese and Somali refugees resident in a Ugandan refugee settlement, as a measure of the mental health consequences of armed conflict, as well as to inform a subsequent mental health outreach program. The study population comprised a sample from 14400 (n = 519 Somali and n = 906 Rwandese) refugees resident in Nakivale refugee settlement in South Western Uganda during the year 2003. Methods: The Posttraumatic Diagnostic Scale (PDS) and the Hopkins Symptom Checklist 25 were used to screen for posttraumatic stress disorder and depression. Results: Thirty two percent of the Rwandese and 48.1% of the Somali refugees were found to suffer from PTSD. The Somalis refugees had a mean of 11.95 (SD = 6.17) separate traumatic event types while the Rwandese had 8.86 (SD = 5.05). The Somalis scored a mean sum score of 21.17 (SD = 16.19) on the PDS while the Rwandese had a mean sum score of 10.05 (SD = 9.7). Conclusion: Mental health consequences of conflict remain long after the events are over, and therefore mental health intervention is as urgent for post-conflict migrant populations as physical health and other emergency interventions. A mental health outreach program was initiated based on this study

Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement

BACKGROUND: Little data exists on the effectiveness of psychological interventions for children with posttraumatic stress disorder (PTSD) that has resulted from exposure to war or conflict-related violence, especially in non-industrialized countries. We created and evaluated the efficacy of KIDNET, a child-friendly version of Narrative Exposure Therapy (NET), as a short-term treatment for children. METHODS: Six Somali children suffering from PTSD aged 12–17 years resident in a refugee settlement in Uganda were treated with four to six individual sessions of KIDNET by expert clinicians. Symptoms of PTSD and depression were assessed pre-treatment, post-treatment and at nine months follow-up using the CIDI Sections K and E. RESULTS: Important symptom reduction was evident immediately after treatment and treatment outcomes were sustained at the 9-month follow-up. All patients completed therapy, reported functioning gains and could be helped to reconstruct their traumatic experiences into a narrative with the use of illustrative material. CONCLUSIONS: NET may be safe and effective to treat children with war related PTSD in the setting of refugee settlements in developing countries

Narrative Exposure Therapy: Does it prevent the development of PTSD in former child soldiers?

Ertl V, Schauer E, Onyut LP, Neuner F, Elbert T. Narrative Exposure Therapy: Does it prevent the development of PTSD in former child soldiers? Presented at the 10th European Conference on Traumatic Stress (ECOTS), Opatija, Croatia

Reliability and Validity of Instruments for the Assessment of Posttraumatic Stress Disorder in an Ugandan Refugee Camp

Ertl V, Onyut LP, Neuner F, Schauer E, Odenwald M, Elbert T. Reliability and Validity of Instruments for the Assessment of Posttraumatic Stress Disorder in an Ugandan Refugee Camp. Presented at the 9th European Conference on Traumatic Stress (ECOTS), Stockholm, Sweden

Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial

Neuner F, Onyut LP, Ertl V, Odenwald M, Schauer E, Elbert T. Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. Journal of Consulting and Clinical Psychology. 2008;76(4):686-694.Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether trained lay counselors can carry out effective treatment of posttraumatic stress disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277 Rwandan and Somalian refugees who were diagnosed with PTSD the authors investigated the effectiveness of psychotherapy administered by lay counselors. Strictly manualized narrative exposure therapy (NET) was compared with more flexible trauma counseling (TC) and a no-treatment monitoring group (MG). Fewer participants (4%) dropped out of NET treatment than TC (21%). Both active treatment groups were statistically and clinically superior to MG on PTSD symptoms and physical health but did not differ from each other. At follow-up, a PTSD diagnosis could not be established anymore in 70% of NET and 65% TC participants, whereas only 37% in MG did not meet PTSD criteria anymore. Short-term psychotherapy carried out by lay counselors with limited training can be effective to treat war-related PTSD in a refugee settlement

Prävalenz der posttraumatischen Belastungsstörung in einem ugandischen Flüchtlingslager

Ertl V, Onyut LP, Neuner F, Schauer E, Odenwald M, Elbert T. Prävalenz der posttraumatischen Belastungsstörung in einem ugandischen Flüchtlingslager. Presented at the 6. Jahrestagung der Deutschsprachigen Gesellschaft für Psychotraumatologie (DeGPT), Vienna, Austria

Narrative Exposure Therapy in Children: A Case Study

Schauer E, Neuner F, Elbert T, et al. Narrative Exposure Therapy in Children: A Case Study. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict. 2004;2(1):18-18.In this article a form of psychotherapy for traumatized children and adolescents (KIDNET) is described. This approach is based on Narrative Exposure Therapy (NET), a short-term treatment method for traumatized adults. The description of KIDNET is illustrated with a detailed report of the successful treatment of a severely traumatized 13-year old refugee child. (PsycINFO Database Record (c) 2006 APA, all rights reserved) (from the journal abstract

The Nakivale Camp Mental Health Project: Building local competency for psychological assistance to traumatised refugees

Onyut LP, Neuner F, Schauer E, et al. The Nakivale Camp Mental Health Project: Building local competency for psychological assistance to traumatised refugees. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict. 2004;2(2):90-90.Little is known about the usefulness of psychiatric concepts and psychotherapeutic approaches for refugees who have experienced severe traumatic events and continue to live in stressful and potentially dangerous conditions in refugee settlements. The central goal of the Nakivale Camp Mental Health Project is to establish the usefulness of short-term treatment approaches when applied by local paramedical personnel in a disaster region. In a randomized controlled clinical trial, the efficacy of Narrative Exposure Therapy (NET) vis-à-vis Supportive Counselling has been tested, when applied by trained paramedical personnel from within the same refugee community. Here we demonstrate the feasibility of such an approach and detail the methods and strategy for it. The project also included an epidemiological survey to ascertain the prevalence of PTSD among refugee adolescents and adults alike. Consistent with other investigations, the demographic survey revealed a high prevalence of chronic PTSD ranging from 31.1% in the Rwandan to 47% in the Somali population; even though traumatic events had on average taken place more than 9 and 11 years earlier in each case respectively. Diagnostic validity was assured using expert clinical interviews. The significant social and work-related dysfunction, a disabling consequence of PTSD, does not only impact on the life of the affected individual. Communities where a significant percentage of members, are psychologically affected by past human rights violations, atrocities and war, are held back in their recovery process at many levels. Therefore mental health programmes with workable guidelines on how to treat posttraumatic symptoms, based on solid scientific research with proven effectiveness and feasibility, in particular cultural settings, must become a humanitarian priority. (PsycINFO Database Record (c) 2006 APA, all rights reserved) (from the journal abstract

A deletion variant of the alpha2b-adrenoceptor is related to emotional memory in Europeans and Africans

Emotionally arousing events are recalled better than neutral events. This phenomenon, which helps us to remember important and potentially vital information, depends on the activation of noradrenergic transmission in the brain. Here we show that a deletion variant of ADRA2B, the gene encoding the alpha2b-adrenergic receptor, is related to enhanced emotional memory in healthy Swiss subjects and in survivors of the Rwandan civil war who experienced highly aversive emotional situations