When combat prevents PTSD symptoms—results from a survey with former child soldiers in Northern Uganda

Weierstall R, Schalinski I, Crombach A, Hecker T, Elbert T. When combat prevents PTSD symptoms—results from a survey with former child soldiers in Northern Uganda. BMC Psychiatry. 2012;12(1): 41

Is the Implicit Association Test for Aggressive Attitudes a Measure for Attraction to Violence or Traumatization?

Traumatic exposure is particularly devastating for those who, at a young age, have become combatants or experienced massive adversity after abduction by armed movements. We investigated the impact of traumatic stressors on psychopathology among war-affected young men of Northern Uganda, including former child soldiers. Adaptation to violent environments and coping with trauma-related symptoms often result in an increasing appetite for violence. We analyze implicit attitudes toward violence, assessed by an Implicit Association Test (IAT), among 64 male participants. Implicit attitudes varied as a function of the number of experienced traumatic event types and committed offense types. As the number of traumatic experiences and violence exposure increased, more appetitive aggression was reported, whereas the IAT indicated increasingly negative implicit attitudes toward aggression. The IAT was also the strongest predictor of cortisol levels. Diffusion-model analysis was the best way to demonstrate IAT validity. Implicit measures revealed the trauma-related changes of cognitive structures

Screening for mental disorders in post-conflict regions using computer apps - a feasibility study from Burundi

A high level of psychosocial functioning is essential for survival in many resource-poor countries and is needed for development in these regions. Organized violence, often in combination with other stressors such as poverty and familial conflict, however, result in a range of mental disorders and damage socio-economic progress. An efficient assessment of mental health is a prerequisite for prevention and intervention measures. However, this may require considerable resources that are difficult to obtain in resource-poor countries. We present new methods for the efficient and effective assessment of mental, especially trauma- and stress-related disorders that can easily be administered by trained local paramedics. For decades, Burundi has been a staging ground for armed conflicts leaving behind many survivors with trauma-related illness. In a study with over 900 combatants and veterans from the military as well as former rebels in Burundi, we used a tablet-computer (ipad)-based survey for the assessment of trauma-related syndromes, especially PTSD, in need for treatment. All participants reported the experience of serious traumatic stressors and a substantial portion presented severe symptoms of the trauma-spectrum. Based on the PSS-I and other standardized screening instruments, an ipad app guided the semistructured clinical interviews. Psychologists from the University of Konstanz, the Burundian military as well as psychologist students from the University Lumie` re, Bujumbura, Burundi carried out the interviews. In this contribution, we use the Burundian example to portray the logistics and technology of data acquisition and present respective data. We demonstrate the feasibility of using a computerbased screening approach in the field and in clinical settings. We provide evidence, that the computerized assessment of clinical symptoms can be a useful tool for mental health assessment and screenings, both in research and practice

Associations between societal disapproval and changes in symptoms of PTSD and appetitive aggression following treatment among high-risk South African males

Background: In violent communities, social rejection as a person with victim-offender attributes is associated with more intense symptoms of posttraumatic stress disorder (PTSD) and a higher propensity towards violence, i.e. appetitive aggression. Successful community reintegration encompassing adequate social acknowledgment of individuals with both a history of violence exposure and perpetration may be necessary to enhance the treatment effects of interventions addressing PTSD and aggression. Objective: In this study, the effects of treatment and post-treatment traumatic events, violent offenses, and social acknowledgment (with sub-dimensions of general disapproval, family disapproval, and recognition as a person with both a history of violence exposure and commission) on changes in PTSD symptom severity and appetitive aggression from baseline to 8-month follow-up were investigated. Method: Data were collected from 54 males recruited through a Cape Town offender reintegration programme for an intervention study targeting trauma and aggression (n = 28 treatment; n = 26 wait-list). Changes in PTSD symptom severity after treatment were assessed with the PTSD Symptom Scale-Interview, changes in appetitive aggression with the Appetitive Aggression Scale (AAS), post-treatment traumatic events with an adapted version of the Child's Exposure to Violence Checklist, offenses with an adapted checklist from the AAS, and social acknowledgment with an adapted form of the Social Acknowledgment Questionnaire. Results: Path analyses revealed negative relationships between ongoing societal disapproval and changes in PTSD symptom severity and appetitive aggression at 8-months, controlling for age. All other variables were non-significant, except for treatment, which was associated with PTSD symptom reduction. Conclusions: As a complementary strategy to effective psychotherapeutic treatment, increased social acknowledgment may contribute significantly to the alleviation of PTSD symptoms and appetitive aggression. Psychological interventions should, therefore, not neglect the impact of societal factors on treatment effects

Appetitive aggression in offending youths: Contributions of callous unemotional traits and violent cognitive patterns

Appetitive aggression, marked by the derivation of positive affect from harming others has been observed mostly among youths in societies experiencing extreme violence. Perpetrators report craving violence, and find the process and actual infliction of harm relishing. Because this dimension of aggression is relatively new, studies have barely examined likely psychological correlates of this phenomenon. In this study, we considered the associations between callous-unemotional (CU) traits as well as violent cognition, with appetitive aggression in young offenders. Male youth offenders (n = 188) from 2 detention facilities in Northern and the Niger Delta regions of Nigeria completed measures of appetitive aggression, CU traits, and violent-supportive cognition. Demographic information regarding their offences were collected from official records and corroborated with self-reports. CU traits were related to the perpetration of appetitive aggression. Offenders who endorsed machismo beliefs that portrays aggression as a masculine characteristic and a fitting response to threats were more likely to report the enjoyment of aggression. There was a mediation effect of machismo thinking on the relationship between CU traits and appetitive aggression. The study finds that, like other known types of aggression, CU traits and machismo thinking are associated with appetitive aggression, and invites future studies to investigate other correlates of this pattern of aggression

A generic questionnaire framework supporting psychological studies with smartphone technologies

Many psychological studies are performed with specifically tailored ‘‘paper & pencil’’-questionnaires. Such a paper-based approach usually results in a massive workload for evaluating and analyzing the collected data afterwards, e.g., to transfer data to electronic worksheets or any statistics software. To relieve researchers from such manual tasks and to improve the efficiency of data collection processes, we realized smart device applications for existing psychological questionnaires (e.g., the KINDEX, PDS, or CAPS questionnaire). Based on these applications, we were able to demonstrate the usefulness of smart devices (e.g., smartphones or tablets) for mobile data collection in the context of psychological questionnaires. Although the implemented applications already have shown several advantages in respect to data collection and analysis, they have not been suitable for psychological studies in the large scale yet, e.g., due to the high maintenance efforts for the psychologists. More precisely, changes to a questionnaire or its structure still must be accomplished by computer scientists, since its implementation is hard-coded. What is needed instead is an easy-to-use and self-explaining framework for creating, running, and evolving the questionnaires of psychological studies on mobile and smart devices. In this context, supporting the complete questionnaire lifecycle is essential, i.e., IT support for creating, using, evaluating, and archiving questionnaires is required to assist end-users having no programming background. We present our generic questionnaire framework, which encompasses the following three parts: a questionnaire configurator to create the questions and questionnaires, a way of integrating mobile devices to deploy, run and log questionnaires, and a middleware enabling a secure data exchange. Finally, we discuss how smartphone technology and mobile devices can be used to suitably support psychologists in their daily work with questionnaires. As major benefit of the framework, better data quality, shorter evaluation cycles, and significant decreases in workload will result

Provision of mental health services in resource-poor settings: a randomised trial comparing counselling with routine medical treatment in North Afghanistan (Mazar-e-Sharif)

<p>Abstract</p> <p>Background</p> <p>Psychosocial stress caused by war, ongoing conflict, lack of security, and restricted access to resources promotes mental suffering and diseases in many resource-poor countries. In an exemplary setting, the present study compares the efficacy of psychosocial counselling with routine pharmacological treatment in a randomised trial in Mazar-e-Sharif (Afghanistan).</p> <p>Methods</p> <p>Help seeking Afghan women (N = 61), who were diagnosed with mental health symptoms by local physicians either received routine medical treatment<b/>(treatment as usual) or psychosocial counselling (5-8 sessions) following a specifically developed manualised treatment protocol. Primary outcome measures were symptoms of depression and anxiety assessed before treatment and at follow-up using the Hopkins Symptom Checklist and the Mini-International Neuropsychiatric Interview. Secondary outcome measures were psychosocial stressors and coping mechanisms.</p> <p>Results</p> <p>At 3-month follow-up, psychosocial counselling patients showed high improvements with respect to the severity of symptoms of depression and anxiety. In addition, they reported a reduction of psychosocial stressors and showed an enhancement of coping strategies. At the same time, the severity of symptoms, the quantity of psychosocial stressors and coping mechanisms did not improve in patients receiving routine medical treatment.</p> <p>Conclusion</p> <p>These results indicate that psychosocial counselling can be an effective treatment for mental illnesses even for those living in ongoing unsafe environments.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01155687">NCT01155687</a></p