Trauma-related psychological disorders among Palestinian children and adults in Gaza and West Bank, 2005-2008

BACKGROUND: Trauma from war and violence has led to psychological disorders in individuals living in the Gaza strip and West Bank. Few reports are available on the psychiatric disorders seen in children and adolescents or the treatment of affected populations. This study was conducted in order to describe the occurrence and treatment of psychiatric disorders in the Palestinian populations of the Gaza strip and Nablus district in the West Bank. METHODS: From 2005 to 2008, 1369 patients aged more than 1 year were identified through a local mental health and counseling health network. All were clinically assessed using a semi-structured interview based on the DSM-IV-TR criteria. RESULTS: Among 1254 patients, 23.2% reported post-traumatic stress disorder [PTSD], 17.3% anxiety disorder (other than PTSD or acute stress disorder), and 15.3% depression. PTSD was more frequently identified in children < or = 15 years old, while depression was the main symptom observed in adults. Among children < or = 15 years old, factors significantly associated with PTSD included being witness to murder or physical abuse, receiving threats, and property destruction or loss (p < 0.03). Psychological care, primarily in the form of individual, short-term psychotherapy, was provided to 65.1% of patients, with about 30.6% required psychotropic medication. Duration of therapy sessions was higher for children < or = 15 years old compared with adults (p = 0.05). Following psychotherapy, 79.0% had improved symptoms, and this improvement was significantly higher in children < or = 15 years old (82.8%) compared with adults (75.3%; p = 0.001). CONCLUSION: These observations suggest that short-term psychotherapy could be an effective treatment for specific psychiatric disorders occurring in vulnerable populations, including children, living in violent conflict zones, such as in Gaza strip and the West Bank

A rapid screening tool for psychological distress in children 3--6years old: results of a validation study.

International audienceABSTRACT: BACKGROUND: The mental health needs of young children in humanitarian contexts often remain unaddressed. The lack of a validated, rapid and simple tool for screening combined with few mental health professionals able to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of the principle cross-cultural validation of the "Psychological Screening for Young Children aged 3 to 6" (PSYCAa3-6). The PSYCa 3--6 is a simple scale for children 3 to 6 years old administered by non-specialists, to screen young children in crises and thereby refer them to care if needed. METHODS: This study was conducted in Maradi, Niger. The scale was translated into Hausa, using corroboration of independent translations. A cross-cultural validation was implemented using quantitative and qualitative methods. A random sample of 580 mothers or caregivers of children 3 to 6 years old were included. The tool was psychometrically examined and diagnostic properties were assessed comparing the PSYCa 3--6 against a clinical interview as the gold standard. RESULTS: The PSYCa 3--6 Hausa version demonstrated good concurrent validity, as scores correlated with the gold standard and the Clinical Global Impression Severity Scale (CGI-S) [rho = 0.41, p-value = 0.00]. A reduction procedure was used to reduce the scale from 40 to 22 items. The test-retest reliability of the PSYCa 3--6 was found to be high (ICC 0.81, CI95% [0.68; 0.89]). In our sample, although not the purpose of this study, approximately 54 of 580 children required subsequent follow-up with a psychologist. CONCLUSIONS: To our knowledge, this is the first validation of a screening scale for children 3 to 6 years old with a cross-cultural validation component, for use in humanitarian contexts. The Hausa version of the PSYCa 3--6 is a reliable and a valuable screening tool for psychological distress. Further studies to replicate our findings and additional validations of the PSYCa 3--6 in other populations may help improve the delivery of mental health care to children

Silence et reconnaissance sociale dans le processus de reconstruction d’anciens enfants juifs cachés = Silence and social acknowledgement in the healing process of former hidden Jewish children

Introduction Durant la Seconde Guerre mondiale, de nombreux enfants juifs ont pu survivre à l’Occupation nazie en se cachant sous fausse identité et dans la plupart des cas séparés de leurs parents. N’ayant pas été considérés comme des survivants à la fin de la guerre, les voix des enfants juifs cachés ont été absentes des grandes narrations de la Shoah, et ceci jusqu’à la fin des années 1980. But de l’étude Cette étude vise à expliquer le silence extrêmement long des enfants cachés et de comprendre comment ils sont peu à peu sortis de ce silence. Patients et méthode L’analyse de 60 récits de vie d’anciens enfants juifs cachés ont été récoltés afin de comprendre ce phénomène. Résultats L’immaturité cognitive, la sidération psychique, la mise en doute des souvenirs, la sur-adaptation à l’environnement, la non-reconnaissance du traumatisme et les mécanismes de défense représentent des clés de compréhension de ce traumatisme particulier (précoce et non reconnu). Conclusion La reconnaissance sociale, le lien aux petits-enfants, le vieillissement ainsi que le concept d’après-coup permettent d’expliquer la sortie du silence et de la sidération psychique dans laquelle ils se trouvaient ainsi que la mise en place progressive d’une meilleure compréhension et d’un processus de symbolisation de leur vécu.Background During World War II, many hidden Jewish children survived the Nazi occupation by hiding under false identities, in most cases separated from their parents. After the war, these children were not considered as survivors of the Holocaust and their suffering was often not recognized. Consequently, their experiences were ignored in many narratives of the Holocaust, and this until the end of the 1980s. Objectives This study aims to explain the long lasting silence of former hidden Jewish children and to understand what later made them communicate about their experiences related to World War II. Methods We have collected and analyzed 60 life narratives of former hidden Jewish children in order to understand this phenomenon. These people were between 65 and 78 years old when they were interviewed. Results We highlight that cognitive immaturity, psychic sideration, the uncertainty of certain memories, the over-adaptation to the environment and other defensive mechanisms, as well as the absence of social acknowledgment, permit to understand this specific destiny of an early trauma. In the experience of hidden Jewish children trauma is associated with a lack of understanding and a lack of integration of traumatic events. Their young age and the fact of being considered as “lucky” in comparison to other Holocaust survivors reinforced an emotional and representative freezing in the psyche of these children and young adolescents. Psychic freezing is related to their inability to integrate their past and to share it on a collective level. Moreover, their uncertainties in regard to their childhood memories have discouraged them to speak about the past and they lacked backup from the environment to do so; a child though needs the help of an adult in order to understand traumatic events. The over-adaptation to the environment and the fact that often they continued to hide their Jewish identity in adulthood contributed to the maintenance of silence. Furthermore, the lack of social acknowledgement of their trauma and the maintenance of defensive mechanisms impeded the social sharing of their experiences. In the case of hidden children, the narration of a story – that can be told, shared and symbolized – has been impaired by these factors. Conclusion The experience of hidden Jewish children highlights the importance of social acknowledgement as a condition for sharing traumatic memories, emotions and the recovery of frozen psychic processes. Social acknowledgement has eventually led to a personal recognition of trauma and to the construction of a collective memory. Social acknowledgment of their trauma, projective identification with their grand-children, the desire to transmit their past, aging and the concept of deferred action can explain the resurgence of childhood memories and the sharing of their experiences after decades of silence. These factors often induced a better understanding and a process of symbolization of what had happened to them. If social sharing led to a revival of trauma, it also provided collective support to elaborate the past

Association between prenatal exposure to the Haiti 2010 earthquake, consequent maternal PTSD and autistic symptoms in offspring

The present work reports findings from a study that examined the association between pregnant women's exposure to the 2010 earthquake in Haiti and Autism Spectrum Disorders (ASD) symptoms/behaviors in their offspring at age three. A sample of 364 mother–offspring dyads who survived the 2010 earthquake in Haiti (mean (SD) age=27.31 (5.93)) participated in the study. Maternal data were elicited via the Earthquake Experience Questionnaire (EEQ), the Peritraumatic Distress Inventory (PDI), and the PTSD Checklist Specific (PCL-S). Child-related data were obtained from maternal completion of the Échelle d’Évaluation des Comportements Autistiques Révisée (ECAR) (Autistic Behaviors Scale Revised) and the Child Behavior Checklist (CBCL). Peritraumatic distress was significantly associated with maternal PTSD symptoms (r=.64, p=0.01). Moreover, when maternal PTSD symptoms were added to final models of predictors for offspring autistic behaviors and pervasive developmental disorder, the amount of variance explained increased respectively from 14 to 21% and 15 to 23%. Exposure to the 2010 earthquake in Haiti during pregnancy may be a risk factor for maternal PTSD, which may be associated with the presence of ASD symptoms/behaviors in the offspring at age three. This study underscores the effect of maternal exposure to disasters on the trajectory of child development, a critical factor in planning disaster preparedness programs

Traumatismes et résiliences chez les enfants de 3 à 6ans dans trois quartiers de Port-au-Prince après le séisme de 2010 en Haïti

International audienc

The destiny of an unacknowledged trauma : the deferred retroactive effect of apres-coup in the hidden Jewish children of wartime Belgium

For almost 45 years, the experience of Jewish children who were hidden during World War II was considered to be of little importance, particularly with respect to what had taken place in the concentration camps. Their very history was ignored in the many accounts of the Holocaust. It was only at the end of the 1980s that their experience began to be thought of as potentially traumatic. In this paper, the authors report on their psychoanalytical research project concerning the psychological outcomes of those experiences that had remained concealed for such an extraordinarily long latency period. The results are based on the analysis of 60 accounts and on psychoanalytically-oriented group work. The authors show that the trauma experienced by those hidden children was triggered by the retroactive effect of a deferred action [apres-coup]