@article {270, title = {Psychosocial adjustment and mental health in former child soldiers--systematic review of the literature and recommendations for future research.}, journal = {J Child Psychol Psychiatry}, volume = {54}, year = {2013}, month = {2013 Jan}, pages = {17-36}, abstract = {

AIMS AND SCOPE: This article reviews the available quantitative research on psychosocial adjustment and mental health among children (age \<18\ years) associated with armed forces and armed groups (CAAFAG)--commonly referred to as child soldiers.

METHODS: PRISMA standards for systematic reviews were used to search PubMed, PsycInfo, JSTOR, and Sociological Abstracts in February 2012 for all articles on former child soldiers and CAAFAG. Twenty-one quantitative studies from 10 countries were analyzed for author, year of publication, journal, objectives, design, selection population, setting, instruments, prevalence estimates, and associations with war experiences. Opinion pieces, editorials, and qualitative studies were deemed beyond the scope of this study. Quality of evidence was rated according to the systematic assessment of quality in observational research (SAQOR).

FINDINGS: According to SAQOR criteria, among the available published studies, eight studies were of high quality, four were of moderate quality, and the remaining nine were of low quality. Common limitations were lack of validated mental health measures, unclear methodology including undefined sampling approaches, and failure to report missing data. Only five studies included a comparison group of youth not involved with armed forces/armed groups, and only five studies assessed mental health at more than one point in time. Across studies, a number of risk and protective factors were associated with postconflict psychosocial adjustment and social reintegration in CAAFAG. Abduction, age of conscription, exposure to violence, gender, and community stigma were associated with increased internalizing and externalizing mental health problems. Family acceptance, social support, and educational/economic opportunities were associated with improved psychosocial adjustment.

CONCLUSIONS: Research on the social reintegration and psychosocial adjustment of former child soldiers is nascent. A number of gaps in the available literature warrant future study. Recommendations to bolster the evidence base on psychosocial adjustment in former child soldiers and other war-affected youth include more studies comprising longitudinal study designs, and validated cross-cultural instruments for assessing mental health, as well as more integrated community-based approaches to study design and research monitoring.

}, keywords = {Adolescent, Child, Female, Humans, Male, Mental Health, Military Personnel, Prevalence, Resilience, Psychological, Risk Factors, Social Adjustment, Social Support, Stress Disorders, Post-Traumatic, Violence, War}, issn = {1469-7610}, doi = {10.1111/j.1469-7610.2012.02620.x}, author = {Betancourt, T. S. and Borisova, Ivelina and Williams, Timothy P and Meyers-Ohki, Sarah E and Rubin-Smith, Julia E and Annan, Jeannie and Kohrt, Brandon A} } @article {271, title = {Trajectories of internalizing problems in war-affected Sierra Leonean youth: examining conflict and postconflict factors.}, journal = {Child Dev}, volume = {84}, year = {2013}, month = {2013 Mar-Apr}, pages = {455-70}, abstract = {

Three waves of data from a prospective longitudinal study in Sierra Leone were used to examine internalizing trajectories in 529 war-affected youth (ages 10-17 at baseline; 25\% female). Latent class growth analyses identified 4 trajectories: A large majority of youth maintained lower levels of internalizing problems (41.4\%) or significantly improved over time (47.6\%) despite very limited access to care, but smaller proportions continued to report severe difficulties 6\ years postwar (4.5\%) or their symptoms worsened (6.4\%). Continued internalizing problems were associated with loss of a caregiver, family abuse and neglect, and community stigma. Despite the comparative resilience of most war-affected youth in the face of extreme adversity, there remains a compelling need for interventions that address family- and community-level stressors.

}, keywords = {Adaptation, Psychological, Adolescent, Child, Female, Humans, Internal-External Control, Male, Mental Disorders, Prospective Studies, Risk Factors, Sierra Leone, War}, issn = {1467-8624}, doi = {10.1111/j.1467-8624.2012.01861.x}, author = {Betancourt, T. S. and McBain, R. and Newnham, E. A. and Brennan, R. T.} } @article {272, title = {Interventions for children affected by war: an ecological perspective on psychosocial support and mental health care.}, journal = {Harv Rev Psychiatry}, volume = {21}, year = {2013}, month = {2013 Mar-Apr}, pages = {70-91}, abstract = {

BACKGROUND: Children and adolescents exposed to armed conflict are at high risk of developing mental health problems. To date, a range of psychosocial approaches and clinical/psychiatric interventions has been used to address mental health needs in these groups.

AIMS: To provide an overview of peer-reviewed psychosocial and mental health interventions designed to address mental health needs of conflict-affected children, and to highlight areas in which policy and research need strengthening.

METHODS: We used standard review methodology to identify interventions aimed at improving or treating mental health problems in conflict-affected youth. An ecological lens was used to organize studies according to the individual, family, peer/school, and community factors targeted by each intervention. Interventions were also evaluated for their orientation toward prevention, treatment, or maintenance, and for the strength of the scientific evidence of reported effects.

RESULTS: Of 2305 studies returned from online searches of the literature and 21 sources identified through bibliography mining, 58 qualified for full review, with 40 peer-reviewed studies included in the final narrative synthesis. Overall, the peer-reviewed literature focused largely on school-based interventions. Very few family and community-based interventions have been empirically evaluated. Only two studies assessed multilevel or stepped-care packages.

CONCLUSIONS: The evidence base on effective and efficacious interventions for conflict-affected youth requires strengthening. Postconflict development agendas must be retooled to target the vulnerabilities characterizing conflict-affected youth, and these approaches must be collaborative across bodies responsible for the care of youth and families.

}, keywords = {Adolescent, Child, Humans, Mental Disorders, Mental Health Services, Psychotherapy, War}, issn = {1465-7309}, doi = {10.1097/HRP.0b013e318283bf8f}, author = {Betancourt, T. S. and Meyers-Ohki, Sarah E and Charrow, Alexandra P and Tol, Wietse A} } @article {4681, title = {Commentary: Advancing an implementation science agenda on mental health and psychosocial responses in war-affected settings: comment on trials of a psychosocial intervention for youth affected by the Syrian crisis - by Panter-Brick et al. (2018)}, journal = {J Child Psychol Psychiatry}, volume = {59}, number = {5}, year = {2018}, note = {Betancourt, Theresa S
Fazel, Mina
eng
England
2018/04/19 06:00
J Child Psychol Psychiatry. 2018 May;59(5):542-544. doi: 10.1111/jcpp.12870.}, month = {May}, pages = {542-544}, abstract = {Syria{\textquoteright}s civil conflict has created the largest humanitarian disaster of our time, causing massive population displacement, tremendous exposure to trauma, and loss. Advancing the mental health and psychosocial responses of war-affected populations both during acute humanitarian emergencies and in post-conflict transition is imperative in forging a constructive implementation agenda. This study makes an important contribution in building evidence toward effective interventions to advance the mental health and well-being of those affected by the Syrian crisis. Using an innovative approach, this work demonstrates that a thoughtful, ethical, and scientifically valid trial can be carried out in the midst of mass displacement. Further research is urgently needed on the effectiveness of interventions for vulnerable populations, with a growing need to embed studies of evidence-based mental health interventions within humanitarian responses.}, isbn = {1469-7610 (Electronic)
0021-9630 (Linking)}, author = {Betancourt, T. S. and Fazel, M.} } @article {4696, title = {War-Related Traumas and Mental Health Across Generations}, journal = {JAMA Psychiatry}, volume = {75}, number = {1}, year = {2018}, note = {Betancourt, Theresa S
Thomson, Dana
VanderWeele, Tyler J
eng
2017/12/01 06:00
JAMA Psychiatry. 2018 Jan 1;75(1):5-6. doi: 10.1001/jamapsychiatry.2017.3530.}, month = {Jan 1}, pages = {5-6}, isbn = {2168-6238 (Electronic)
2168-622X (Linking)}, author = {Betancourt, T. S. and Thomson, D. and VanderWeele, T. J.} } @article {4706, title = {Comparing Trauma Exposure, Mental Health Needs, and Service Utilization Across Clinical Samples of Refugee, Immigrant, and U.S.-Origin Children}, journal = {J Trauma Stress}, volume = {30}, number = {3}, year = {2017}, note = {Betancourt, Theresa S
Newnham, Elizabeth A
Birman, Dina
Lee, Robert
Ellis, B Heidi
Layne, Christopher M
eng
K01 MH077246/MH/NIMH NIH HHS/
Comparative Study
2017/06/07 06:00
J Trauma Stress. 2017 Jun;30(3):209-218. doi: 10.1002/jts.22186. Epub 2017 Jun 6.}, month = {Jun}, pages = {209-218}, abstract = {Most mental health services for trauma-exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee-origin, immigrant-origin, and U.S.-origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee-origin youth (n = 60, 48.3\% female, mean age = 13.07 years) and propensity-matched samples of immigrant-origin youth (n = 143, 60.8\% female, mean age = 13.26 years), and U.S.-origin youth (n = 140, 56.1\% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.-origin youth (p < .001) or immigrant youth (p 0894-9867 (Linking)}, author = {Betancourt, T. S. and Newnham, E. A. and Birman, D. and Lee, R. and Ellis, B. H. and Layne, C. M.} } @article {4746, title = {Correction: Ethics in Community-Based Research with Vulnerable Children: Perspectives from Rwanda}, journal = {PLoS One}, volume = {11}, number = {9}, year = {2016}, note = {Betancourt, Theresa S
Smith Fawzi, Mary C
Stevenson, Anne
Kanyanganzi, Fredrick
Kirk, Catherine
Ng, Lauren
Mushashi, Christina
Bizimana, Justin
Beardslee, William
Raviola, Giuseppe
Smith, Stephanie
Kayiteshonga, Yvonne
Binagwaho, Agnes
eng
Published Erratum
2016/09/16 06:00
PLoS One. 2016 Sep 15;11(9):e0163384. doi: 10.1371/journal.pone.0163384. eCollection 2016.}, pages = {e0163384}, abstract = {[This corrects the article DOI: 10.1371/journal.pone.0157042.].}, isbn = {1932-6203 (Electronic)
1932-6203 (Linking)}, author = {Betancourt, T. S. and Smith Fawzi, M. C. and Stevenson, A. and Kanyanganzi, F. and Kirk, C. and Ng, L. and Mushashi, C. and Bizimana, J. and Beardslee, W. and Raviola, G. and Smith, S. and Kayiteshonga, Y. and Binagwaho, A.} } @article {4756, title = {Ethics in Community-Based Research with Vulnerable Children: Perspectives from Rwanda}, journal = {PLoS One}, volume = {11}, number = {6}, year = {2016}, note = {Betancourt, Theresa
Smith Fawzi, Mary C
Stevenson, Anne
Kanyanganzi, Fredrick
Kirk, Catherine
Ng, Lauren
Mushashi, Christina
Bizimana, Justin I
Beardslee, William
Raviola, Giuseppe
Smith, Stephanie
Kayiteshonga, Yvonne
Binagwaho, Agnes
eng
R34 MH084679/MH/NIMH NIH HHS/
T32 MH093310/MH/NIMH NIH HHS/
2016/06/29 06:00
PLoS One. 2016 Jun 28;11(6):e0157042. doi: 10.1371/journal.pone.0157042. eCollection 2016.}, pages = {e0157042}, abstract = {A "risk of harm" protocol to identify youth in need of immediate emergency assistance in a study on mental health and HIV in Rwanda among 680 youth ages 10-17 is described. Cases are presented that describe the experience in using this protocol to ensure safety of participants, with ethical and logistical challenges considered. Among the population of the study, 3.2\% were deemed "risk of harm." The most prevalent presenting problem was non-fatal suicidal behavior (91\% of risk of harm cases), with 36\% having a history of a reported previous attempt. Challenges included: acute food insecurity/significant poverty; lack of support/adequate supervision from family members; family violence; alcohol abuse; and HIV-related stigma. Development of a "risk of harm" protocol and collaboration between study staff, community leadership, health authorities, and health workers are critical to ensuring participants{\textquoteright} safety in research among vulnerable populations.}, keywords = {*Vulnerable Populations, Acquired Immunodeficiency Syndrome/diagnosis/*epidemiology, Adolescent, Child, Community-Based Participatory Research/*ethics/methods, Female, Humans, Male, Mental Health/statistics \& numerical data, Rwanda, Socioeconomic Factors, Suicide/statistics \& numerical data}, isbn = {1932-6203 (Electronic)
1932-6203 (Linking)}, author = {Betancourt, T. S. and Smith Fawzi, M. C. and Stevenson, A. and Kanyanganzi, F. and Kirk, C. and Ng, L. and Mushashi, C. and Bizimana, J. I. and Beardslee, W. and Raviola, G. and Smith, S. and Kayiteshonga, Y. and Binagwaho, A.} } @article {4761, title = {Optimizing an Era of Global Mental Health Implementation Science}, journal = {JAMA Psychiatry}, volume = {73}, number = {2}, year = {2016}, note = {Betancourt, Theresa S
Chambers, David A
eng
Review
2016/01/01 06:00
JAMA Psychiatry. 2016 Feb;73(2):99-100. doi: 10.1001/jamapsychiatry.2015.2705.}, month = {Feb}, pages = {99-100}, keywords = {*Global Health, *Health Services Research, *Mental Health Services, Humans}, isbn = {2168-6238 (Electronic)
2168-622X (Linking)}, author = {Betancourt, T. S. and Chambers, D. A.} } @article {4771, title = {Development of the SAFE Checklist Tool for Assessing Site-Level Threats to Child Protection: Use of Delphi Methods and Application to Two Sites in India}, journal = {PLoS One}, volume = {10}, number = {11}, year = {2015}, note = {Betancourt, Theresa S
Zuilkowski, Stephanie S
Ravichandran, Arathi
Einhorn, Honora
Arora, Nikita
Bhattacharya Chakravarty, Aruna
Brennan, Robert T
eng
Research Support, Non-U.S. Gov{\textquoteright}t
2015/11/06 06:00
PLoS One. 2015 Nov 5;10(11):e0141222. doi: 10.1371/journal.pone.0141222. eCollection 2015.}, pages = {e0141222}, abstract = {BACKGROUND: The child protection community is increasingly focused on developing tools to assess threats to child protection and the basic security needs and rights of children and families living in adverse circumstances. Although tremendous advances have been made to improve measurement of individual child health status or household functioning for use in low-resource settings, little attention has been paid to a more diverse array of settings in which many children in adversity spend time and how context contributes to threats to child protection. The SAFE model posits that insecurity in any of the following fundamental domains threatens security in the others: Safety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security. Site-level tools are needed in order to monitor the conditions that can dramatically undermine or support healthy child growth, development and emotional and behavioral health. From refugee camps and orphanages to schools and housing complexes, site-level threats exist that are not well captured by commonly used measures of child health and well-being or assessments of single households (e.g., SDQ, HOME). METHODS: The present study presents a methodology and the development of a scale for assessing site-level child protection threats in various settings of adversity. A modified Delphi panel process was enhanced with two stages of expert review in core content areas as well as review by experts in instrument development, and field pilot testing. RESULTS: Field testing in two diverse sites in India-a construction site and a railway station-revealed that the resulting SAFE instrument was sensitive to the differences between the sites from the standpoint of core child protection issues.}, keywords = {*Child Protective Services/methods/statistics \& numerical data, Checklist, Child, Construction Industry, Delphi Technique, Humans, India, Railroads, Safety/standards}, isbn = {1932-6203 (Electronic)
1932-6203 (Linking)}, author = {Betancourt, T. S. and Zuilkowski, S. S. and Ravichandran, A. and Einhorn, H. and Arora, N. and Bhattacharya Chakravarty, A. and Brennan, R. T.} } @article {4781, title = {Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study}, journal = {Pediatrics}, volume = {136}, number = {2}, year = {2015}, note = {Betancourt, Theresa S
Gilman, Stephen E
Brennan, Robert T
Zahn, Ista
VanderWeele, Tyler J
eng
1K01MH077246-01A2/MH/NIMH NIH HHS/
R01ES017876/ES/NIEHS NIH HHS/
R01HD073349-01/HD/NICHD NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
2015/07/08 06:00
Pediatrics. 2015 Aug;136(2):e344-50. doi: 10.1542/peds.2014-1521. Epub 2015 Jul 6.}, month = {Aug}, pages = {e344-50}, abstract = {BACKGROUND: War-affected youth often suffer from multiple co-occurring mental health problems. These youth often live in low-resource settings where it may be infeasible to provide mental health services that simultaneously address all of these co-occurring mental health issues. It is therefore important to identify the areas where targeted interventions would do the most good. METHODS: This analysis uses observational data from 3 waves of a longitudinal study on mental health in a sample of 529 war-affected youth (24.2\% female; ages 10-17 at T1, 2002) in Sierra Leone. We regressed 4 mental health outcomes at T3 (2008) on internalizing (depression/anxiety) and externalizing (hostility/aggression) problems and prosocial attitudes/behaviors and community variables at T2 (2004) controlling for demographics, war exposures, and previous mental health scores at T1, allowing us to assess the relative impact of potential mental health intervention targets in shaping mental health outcomes over time. RESULTS: Controlling for baseline covariates at T1 and all other exposures/potential intervention targets at T2, we observed a significant association between internalizing problems at T2 and 3 of the 4 outcomes at T3: internalizing (beta = 0.27, 95\% confidence interval [CI]: 0.11-0.42), prosocial attitudes (beta = -0.20, 95\% CI: -0.33 to -0.07) and posttraumatic stress symptoms (beta = 0.22, 95\% CI: 0.02-0.43). No other potential intervention target had similar substantial effects. CONCLUSIONS: Reductions in internalizing may have multiple benefits for other mental health outcomes at a later point in time, even after controlling for confounding variables.}, keywords = {*Health Priorities, *Mental Health Services, *Needs Assessment, *Warfare, Adolescent, Female, Humans, Longitudinal Studies, Male, Mental Disorders/*therapy, Sierra Leone}, isbn = {1098-4275 (Electronic)
0031-4005 (Linking)}, author = {Betancourt, T. S. and Gilman, S. E. and Brennan, R. T. and Zahn, I. and VanderWeele, T. J.} } @article {4796, title = {Addressing health disparities in the mental health of refugee children and adolescents through community-based participatory research: a study in 2 communities}, journal = {Am J Public Health}, volume = {105 Suppl 3}, year = {2015}, note = {Betancourt, Theresa S
Frounfelker, Rochelle
Mishra, Tej
Hussein, Aweis
Falzarano, Rita
eng
R24 MD008057/MD/NIMHD NIH HHS/
5R24MD008057-02/MD/NIMHD NIH HHS/
Multicenter Study
Research Support, N.I.H., Extramural
2015/04/24 06:00
Am J Public Health. 2015 Jul;105 Suppl 3:S475-82. doi: 10.2105/AJPH.2014.302504. Epub 2015 Apr 23.}, month = {Jul}, pages = {S475-82}, abstract = {OBJECTIVES: We sought to understand the problems, strengths, and help-seeking behaviors of Somali Bantu and Bhutanese refugees and determine local expressions of mental health problems among youths in both communities. METHODS: We used qualitative research methods to develop community needs assessments and identify local terms for child mental health problems among Somali Bantu and Bhutanese refugees in Greater Boston and Springfield, Massachusetts, between 2011 and 2014. A total of 56 Somali Bantu and 93 Bhutanese refugees participated in free list and key informant interviews. RESULTS: Financial and language barriers impeded the abilities of families to assist youths who were struggling academically and socially. Participants identified resources both within and outside the refugee community to help with these problems. Both communities identified areas of distress corresponding to Western concepts of conduct disorders, depression, and anxiety. CONCLUSIONS: There are numerous challenges faced by Somali Bantu and Bhutanese youths, as well as strengths and resources that promote resilience. Future steps include using culturally informed methods for identifying those in need of services and developing community-based prevention programs.}, keywords = {*Community-Based Participatory Research, *Health Services Needs and Demand, *Health Status Disparities, *Healthcare Disparities, Adolescent, Bhutan/ethnology, Child, Female, Humans, Male, Massachusetts/epidemiology, Mental Disorders/*epidemiology/*ethnology, Refugees/*psychology, Somalia/ethnology}, isbn = {1541-0048 (Electronic)
0090-0036 (Linking)}, author = {Betancourt, T. S. and Frounfelker, R. and Mishra, T. and Hussein, A. and Falzarano, R.} } @article {4801, title = {The intergenerational impact of war: longitudinal relationships between caregiver and child mental health in postconflict Sierra Leone}, journal = {J Child Psychol Psychiatry}, volume = {56}, number = {10}, year = {2015}, note = {Betancourt, Theresa S
McBain, Ryan K
Newnham, Elizabeth A
Brennan, Robert T
eng
1K01MH077246-01A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
England
2015/02/11 06:00
J Child Psychol Psychiatry. 2015 Oct;56(10):1101-7. doi: 10.1111/jcpp.12389. Epub 2015 Feb 9.}, month = {Oct}, pages = {1101-7}, abstract = {BACKGROUND: Trauma from witnessing events such as bombings and killings as well as direct victimization or participation in violence has been associated with psychosocial distress and poor mental health among war-exposed children and adolescents. This study examines the relationship between caregiver mental health and child internalizing (anxiety and depression) symptoms over a 4-year period in postconflict Sierra Leone. METHODS: The sample included 118 adolescent Sierra Leonean youth (73\% male; mean age = 16.5 years at Time 1) and their caregivers (40\% male; mean age = 39.0 at Time 1). To measure depression and anxiety symptoms, the Hopkins Symptom Checklist-25 was used with adults and the Oxford Measure of Psychosocial Adjustment - previously validated for use with children and adolescents in the region - was used to assess youth. A multivariate hierarchical linear model (HLM) for studying change within dyads was implemented to study covariation in internalizing symptoms among caregivers and youth over time; these models also included covariates at the individual, family and community levels. The relationship of caregiver mental health to child{\textquoteright}s internalizing was tested in a latent variable extension of the HLM. RESULTS: The latent variable extension estimated that a one standard deviation (SD) change in caregiver anxiety/depression was associated with a .43 SD change in youth internalizing (p < .01) over the 4-year period. Family acceptance was negatively related to youth internalizing (p < .001), while community stigma was positively associated (p < .001). CONCLUSIONS: The findings highlight an important interplay between caregiver and child mental health within the postconflict setting and the need for psychosocial interventions to extend beyond the individual to account for family dynamics.}, keywords = {Adolescent, Adult, Anxiety, Anxiety/*psychology, Caregivers/psychology, Child, Depression, Depression/*psychology, dyadic analysis, Family Relations/psychology, Family/*psychology, Female, Humans, intergenerational, Longitudinal Studies, Male, Military Personnel/*psychology, Psychological Trauma/*psychology, Sierra Leone, Social Stigma, War, Warfare and Armed Conflicts/*psychology}, isbn = {1469-7610 (Electronic)
0021-9630 (Linking)}, author = {Betancourt, T. S. and McBain, R. K. and Newnham, E. A. and Brennan, R. T.} } @article {4811, title = {The intergenerational effect of war}, journal = {JAMA Psychiatry}, volume = {72}, number = {3}, year = {2015}, note = {Betancourt, Theresa S
eng
2015/01/08 06:00
JAMA Psychiatry. 2015 Mar;72(3):199-200. doi: 10.1001/jamapsychiatry.2014.2669.}, month = {Mar}, pages = {199-200}, keywords = {*Intergenerational Relations, *Warfare, Child, Child Development/*physiology, Humans, Violence/*psychology}, isbn = {2168-6238 (Electronic)
2168-622X (Linking)}, author = {Betancourt, T. S.} } @article {4821, title = {A behavioral intervention for war-affected youth in Sierra Leone: a randomized controlled trial}, journal = {J Am Acad Child Adolesc PsychiatryJ Am Acad Child Adolesc Psychiatry}, volume = {53}, number = {12}, year = {2014}, note = {Betancourt, Theresa S
McBain, Ryan
Newnham, Elizabeth A
Akinsulure-Smith, Adeyinka M
Brennan, Robert T
Weisz, John R
Hansen, Nathan B
eng
K01 MH077246/MH/NIMH NIH HHS/
5K01MH077246-05/MH/NIMH NIH HHS/
P30 AG024409/AG/NIA NIH HHS/
5P30AG024409-08/AG/NIA NIH HHS/
1F31MH097333-01A1/MH/NIMH NIH HHS/
F31 MH097333/MH/NIMH NIH HHS/
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
2014/12/03 06:00
J Am Acad Child Adolesc Psychiatry. 2014 Dec;53(12):1288-97. doi: 10.1016/j.jaac.2014.09.011. Epub 2014 Oct 2.}, month = {Dec}, pages = {1288-97}, abstract = {OBJECTIVE: Youth in war-affected regions are at risk for poor psychological, social, and educational outcomes. Effective interventions are needed to improve mental health, social behavior, and school functioning. This randomized controlled trial tested the effectiveness of a 10-session cognitive-behavioral therapy (CBT)-based group mental health intervention for multisymptomatic war-affected youth (aged 15-24 years) in Sierra Leone. METHOD: War-affected youth identified by elevated distress and impairment via community screening were randomized (stratified by sex and age) to the Youth Readiness Intervention (YRI) (n = 222) or to a control condition (n = 214). After treatment, youth were again randomized and offered an education subsidy immediately (n = 220) or waitlisted (n = 216). Emotion regulation, psychological distress, prosocial attitudes/behaviors, social support, functional impairment, and posttraumatic stress disorder (PTSD) symptoms were assessed at pre- and postintervention and at 6-month follow-up. For youth in school, enrollment, attendance, and classroom performance were assessed after 8 months. Linear mixed-effects regressions evaluated outcomes. RESULTS: The YRI showed significant postintervention effects on emotion regulation, prosocial attitudes/behaviors, social support, and reduced functional impairment, and significant follow-up effects on school enrollment, school attendance, and classroom behavior. In contrast, education subsidy was associated with better attendance but had no effect on mental health or functioning, school retention, or classroom behavior. Interactions between education subsidy and YRI were not significant. CONCLUSION: YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement and behavior, suggesting potential to prepare war-affected youth for educational and other opportunities. Clinical trial registration information-Trial of the Youth Readiness Intervention (YRI); http://clinicaltrials.gov; NCT01684488.}, keywords = {*Warfare, Adolescent, Adult, Cognitive Therapy/*methods, Female, Humans, intervention, Male, Mental Disorders/etiology/*therapy, Mental Health, randomized controlled trial, report no biomedical interests or potential conflicts of interest., Sierra Leone, Treatment Outcome, War-affected, Young Adult, youth}, isbn = {1527-5418 (Electronic)
0890-8567 (Linking)}, author = {Betancourt, T. S. and McBain, R. and Newnham, E. A. and Akinsulure-Smith, A. M. and Brennan, R. T. and Weisz, J. R. and Hansen, N. B.} } @article {4831, title = {We left one war and came to another: resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families}, journal = {Cultur Divers Ethnic Minor Psychol}, volume = {21}, number = {1}, year = {2015}, note = {Betancourt, Theresa S
Abdi, Saida
Ito, Brandon S
Lilienthal, Grace M
Agalab, Naima
Ellis, Heidi
eng
K01 MH077246/MH/NIMH NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
2U79SM060444/SM/CMHS SAMHSA HHS/
5U79SM058141/SM/CMHS SAMHSA HHS/
Research Support, N.I.H., Extramural
Research Support, U.S. Gov{\textquoteright}t, P.H.S.
2014/08/05 06:00
Cultur Divers Ethnic Minor Psychol. 2015 Jan;21(1):114-25. doi: 10.1037/a0037538. Epub 2014 Aug 4.}, month = {Jan}, pages = {114-25}, abstract = {Refugee families often encounter a number of acculturative and resettlement stressors as they make lives for themselves in host countries. These difficulties may be compounded by past trauma and violence exposure, posing increased risk for mental health problems. Greater knowledge is needed about protective processes contributing to positive development and adjustment in refugee families despite risk (e.g., resilience). The aims of this research were to identify and examine strengths and resources utilized by Somali refugee children and families in the Boston area to overcome resettlement and acculturative stressors. We used maximum variation sampling to conduct a total of 9 focus groups: 5 focus groups (total participants N = 30) among Somali refugee adolescents and youth, capturing gender and a range of ages (15 to 25 years), as well as 4 focus groups of Somali refugee mothers and fathers in groups (total participants N = 32) stratified by gender. Drawing from conservation of resources theory (COR), we identified 5 forms of resources comprising individual, family, and collective/community strengths: religious faith, healthy family communication, support networks, and peer support. "Community talk" was identified as a community dynamic having both negative and positive implications for family functioning. Protective resources among Somali refugee children and families can help to offset acculturative and resettlement stressors. Many of these locally occurring protective resources have the potential to be leveraged by family and community-based interventions. These findings are being used to design preventative interventions that build on local strengths among Somali refugees in the Boston area.}, keywords = {*Acculturation, Adolescent, Adult, Boston, Caregivers/*psychology, Family/ethnology/*psychology, Female, Focus Groups, Humans, Male, Refugees/*psychology, Somalia/ethnology, Stress, Psychological/ethnology/*etiology, Warfare, Young Adult}, isbn = {1099-9809 (Print)
1077-341X (Linking)}, author = {Betancourt, T. S. and Abdi, S. and Ito, B. S. and Lilienthal, G. M. and Agalab, N. and Ellis, H.} } @article {4846, title = {Developing an African youth psychosocial assessment: an application of item response theory}, journal = {Int J Methods Psychiatr Res}, volume = {23}, number = {2}, year = {2014}, note = {Betancourt, Theresa S
Yang, Frances
Bolton, Paul
Normand, Sharon-Lise
eng
K01 MH077246/MH/NIMH NIH HHS/
P60 MD002261/MD/NIMHD NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
2014/01/31 06:00
Int J Methods Psychiatr Res. 2014 Jun;23(2):142-60. doi: 10.1002/mpr.1420. Epub 2014 Jan 30.}, month = {Jun}, pages = {142-60}, abstract = {This study aimed to refine a dimensional scale for measuring psychosocial adjustment in African youth using item response theory (IRT). A 60-item scale derived from qualitative data was administered to 667 war-affected adolescents (55\% female). Exploratory factor analysis (EFA) determined the dimensionality of items based on goodness-of-fit indices. Items with loadings less than 0.4 were dropped. Confirmatory factor analysis (CFA) was used to confirm the scale{\textquoteright}s dimensionality found under the EFA. Item discrimination and difficulty were estimated using a graded response model for each subscale using weighted least squares means and variances. Predictive validity was examined through correlations between IRT scores (theta) for each subscale and ratings of functional impairment. All models were assessed using goodness-of-fit and comparative fit indices. Fisher{\textquoteright}s Information curves examined item precision at different underlying ranges of each trait. Original scale items were optimized and reconfigured into an empirically-robust 41-item scale, the African Youth Psychosocial Assessment (AYPA). Refined subscales assess internalizing and externalizing problems, prosocial attitudes/behaviors and somatic complaints without medical cause. The AYPA is a refined dimensional assessment of emotional and behavioral problems in African youth with good psychometric properties. Validation studies in other cultures are recommended.}, keywords = {*Models, Theoretical, Adolescent, Adolescent Behavior/*psychology, Adolescent Development/*physiology, Africa, children and adolescents, Factor Analysis, Statistical, Female, Humans, item response theory (IRT), Male, mental health assessment, psychometric measurement, Psychometrics/*methods, Surveys and Questionnaires, Uganda}, isbn = {1557-0657 (Electronic)
1049-8931 (Linking)}, author = {Betancourt, T. S. and Yang, F. and Bolton, P. and Normand, S. L.} } @article {4851, title = {Context matters: community characteristics and mental health among war-affected youth in Sierra Leone}, journal = {J Child Psychol Psychiatry}, volume = {55}, number = {3}, year = {2014}, note = {Betancourt, Theresa S
McBain, Ryan
Newnham, Elizabeth A
Brennan, Robert T
eng
K01 MH077246/MH/NIMH NIH HHS/
R01 HD073349/HD/NICHD NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
R01HD073349-01/HD/NICHD NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S.
England
2013/10/10 06:00
J Child Psychol Psychiatry. 2014 Mar;55(3):217-26. doi: 10.1111/jcpp.12131. Epub 2013 Sep 14.}, month = {Mar}, pages = {217-26}, abstract = {BACKGROUND: Worldwide, over one billion children and adolescents live in war-affected settings. At present, only limited research has investigated linkages between disrupted social ecology and adverse mental health outcomes among war-affected youth. In this study, we examine three community-level characteristics - social disorder and collective efficacy within the community, as reported by caregivers, and perceived stigma as reported by youth - in relation to externalizing behaviors and internalizing symptoms among male and female former child soldiers in postconflict Sierra Leone. METHODS: A total of 243 former child soldiers (30\% female, mean age at baseline: 16.6 years) and their primary caregivers participated in interviews in 2004 and 2008, as part of a larger prospective cohort study of war-affected youth in Sierra Leone. Two-point growth models were estimated to examine the relationship between community-level characteristics and externalizing and internalizing outcomes across the time points. RESULTS: Both social disorder within the community, reported by caregivers, and perceived stigma, reported by youth, positively covaried with youths{\textquoteright} externalizing and internalizing scores - indicating that higher levels of each at baseline and follow-up were associated with higher levels of mental health problems at both time points (p < .05). The relationship between collective efficacy and mental health outcomes was nonsignificant (p > .05). CONCLUSIONS: This study offers a rare glimpse into the role that the postconflict social context plays in shaping the mental health among former child soldiers. Results indicate that both social disorder and perceived stigma within the community demonstrate an important relationship to externalizing and internalizing problems among adolescent ex-combatants. Moreover, these relationships persisted over a 4-year period of follow-up. These results underscore the importance of the postconflict social environment and the need to develop postconflict interventions that address community-level processes in addition to the needs of families and individuals.}, keywords = {*Social Environment, *Social Stigma, *Warfare, Adolescent, Adult, child soldiers, Combat Disorders/complications, externalizing, Female, Follow-Up Studies, Humans, internalizing, Male, Mental Disorders/etiology/*psychology, Mental Health, Military Personnel/psychology, Post-conflict, Residence Characteristics, Sierra Leone, Social ecology, War, Young Adult}, isbn = {1469-7610 (Electronic)
0021-9630 (Linking)}, author = {Betancourt, T. S. and McBain, R. and Newnham, E. A. and Brennan, R. T.} } @article {4856, title = {A qualitative case study of child protection issues in the Indian construction industry: investigating the security, health, and interrelated rights of migrant families}, journal = {BMC Public Health}, volume = {13}, year = {2013}, note = {Betancourt, Theresa S
Shaahinfar, Ashkon
Kellner, Sarah E
Dhavan, Nayana
Williams, Timothy P
eng
Research Support, Non-U.S. Gov{\textquoteright}t
England
2013/09/21 06:00
BMC Public Health. 2013 Sep 17;13:858. doi: 10.1186/1471-2458-13-858.}, month = {Sep 17}, pages = {858}, abstract = {BACKGROUND: Many of India{\textquoteright}s estimated 40 million migrant workers in the construction industry migrate with their children. Though India is undergoing rapid economic growth, numerous child protection issues remain. Migrant workers and their children face serious threats to their health, safety, and well-being. We examined risk and protective factors influencing the basic rights and protections of children and families living and working at a construction site outside Delhi. METHODS: Using case study methods and a rights-based model of child protection, the SAFE model, we triangulated data from in-depth interviews with stakeholders on and near the site (including employees, middlemen, and managers); 14 participants, interviews with child protection and corporate policy experts in greater Delhi (8 participants), and focus group discussions (FGD) with workers (4 FGDs, 25 members) and their children (2 FGDs, 9 members). RESULTS: Analyses illuminated complex and interrelated stressors characterizing the health and well-being of migrant workers and their children in urban settings. These included limited access to healthcare, few educational opportunities, piecemeal wages, and unsafe or unsanitary living and working conditions. Analyses also identified both protective and potentially dangerous survival strategies, such as child labor, undertaken by migrant families in the face of these challenges. CONCLUSIONS: By exploring the risks faced by migrant workers and their children in the urban construction industry in India, we illustrate the alarming implications for their health, safety, livelihoods, and development. Our findings, illuminated through the SAFE model, call attention to the need for enhanced systems of corporate and government accountability as well as the implementation of holistic child-focused and child-friendly policies and programs in order to ensure the rights and protection of this hyper-mobile, and often invisible, population.}, keywords = {*Child Welfare, *Construction Industry, Adult, Child, Child, Preschool, Female, Focus Groups, Health Services Needs and Demand, Humans, India, Infant, Infant, Newborn, Male, Transients and Migrants/*statistics \& numerical data}, isbn = {1471-2458 (Electronic)
1471-2458 (Linking)}, author = {Betancourt, T. S. and Shaahinfar, A. and Kellner, S. E. and Dhavan, N. and Williams, T. P.} } @article {4861, title = {Post-traumatic stress symptoms among former child soldiers in Sierra Leone: follow-up study}, journal = {Br J Psychiatry}, volume = {203}, number = {3}, year = {2013}, note = {Betancourt, Theresa S
Newnham, Elizabeth A
McBain, Ryan
Brennan, Robert T
eng
P60 MD002261/MD/NIMHD NIH HHS/
1K01MH07724601A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S.
England
2013/07/28 06:00
Br J Psychiatry. 2013 Sep;203(3):196-202. doi: 10.1192/bjp.bp.112.113514. Epub 2013 Jul 25.}, month = {Sep}, pages = {196-202}, abstract = {BACKGROUND: Former child soldiers are at risk of developing post-traumatic stress disorder (PTSD); however, the trajectory of symptoms has yet to be examined. AIMS: The risk and protective factors associated with PTSD symptom change among former child soldiers in Sierra Leone were investigated. METHOD: Data from 243 former child soldiers (mean age 16.6 years, 30\% female) were analysed. RESULTS: Self-reported rates of possible PTSD using standard cut-off points declined from 32\% to 16\% 4 years later (P<0.05). Symptoms of PTSD at baseline were significantly associated with war experiences (P<0.01) and post-conflict family abuse (P<0.001). Reliable improvement in symptoms was reported by 30\%. In growth models examining symptom change, worsening of symptoms was associated with death of a parent (P<0.05) and post-conflict stigma (P<0.001). Protective effects were observed for increases in family acceptance (P<0.001). CONCLUSIONS: The findings indicated improvement in PTSD symptoms among former child soldiers despite limited access to care. Family and community support played a vital part in promoting psychological adjustment.}, keywords = {*Warfare, Adolescent, Combat Disorders/*epidemiology/rehabilitation, Family Relations, Female, Follow-Up Studies, Humans, Male, Military Personnel/*psychology/statistics \& numerical data, Prospective Studies, Sierra Leone/epidemiology, Stereotyping, Violence/statistics \& numerical data}, isbn = {1472-1465 (Electronic)
0007-1250 (Linking)}, author = {Betancourt, T. S. and Newnham, E. A. and McBain, R. and Brennan, R. T.} } @article {4866, title = {Interventions for children affected by war: an ecological perspective on psychosocial support and mental health care}, journal = {Harv Rev PsychiatryHarv Rev Psychiatry}, volume = {21}, number = {2}, year = {2013}, note = {Betancourt, Theresa S
Meyers-Ohki, Sarah E
Charrow, Alexandra P
Tol, Wietse A
eng
K01 MH077246/MH/NIMH NIH HHS/
R01 HD073349/HD/NICHD NIH HHS/
Review
2013/05/10 06:00
Harv Rev Psychiatry. 2013 Mar-Apr;21(2):70-91. doi: 10.1097/HRP.0b013e318283bf8f.}, month = {Mar-Apr}, pages = {70-91}, abstract = {BACKGROUND: Children and adolescents exposed to armed conflict are at high risk of developing mental health problems. To date, a range of psychosocial approaches and clinical/psychiatric interventions has been used to address mental health needs in these groups. AIMS: To provide an overview of peer-reviewed psychosocial and mental health interventions designed to address mental health needs of conflict-affected children, and to highlight areas in which policy and research need strengthening. METHODS: We used standard review methodology to identify interventions aimed at improving or treating mental health problems in conflict-affected youth. An ecological lens was used to organize studies according to the individual, family, peer/school, and community factors targeted by each intervention. Interventions were also evaluated for their orientation toward prevention, treatment, or maintenance, and for the strength of the scientific evidence of reported effects. RESULTS: Of 2305 studies returned from online searches of the literature and 21 sources identified through bibliography mining, 58 qualified for full review, with 40 peer-reviewed studies included in the final narrative synthesis. Overall, the peer-reviewed literature focused largely on school-based interventions. Very few family and community-based interventions have been empirically evaluated. Only two studies assessed multilevel or stepped-care packages. CONCLUSIONS: The evidence base on effective and efficacious interventions for conflict-affected youth requires strengthening. Postconflict development agendas must be retooled to target the vulnerabilities characterizing conflict-affected youth, and these approaches must be collaborative across bodies responsible for the care of youth and families.}, keywords = {*Warfare, Adolescent, Child, Humans, Mental Disorders/etiology/prevention \& control/*therapy, Mental Health Services/*standards, Psychotherapy/methods/*standards}, isbn = {1465-7309 (Electronic)
1067-3229 (Linking)}, author = {Betancourt, T. S. and Meyers-Ohki, S. E. and Charrow, A. P. and Tol, W. A.} } @article {4881, title = {Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States}, journal = {J Trauma Stress}, volume = {25}, number = {6}, year = {2012}, note = {Betancourt, Theresa S
Newnham, Elizabeth A
Layne, Christopher M
Kim, Soeun
Steinberg, Alan M
Ellis, Heidi
Birman, Dina
eng
1K01MH077246-01A2/MH/NIMH NIH HHS/
3U79SM054284-10S/SM/CMHS SAMHSA HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
Research Support, U.S. Gov{\textquoteright}t, P.H.S.
2012/12/12 06:00
J Trauma Stress. 2012 Dec;25(6):682-90. doi: 10.1002/jts.21749.}, month = {Dec}, pages = {682-90}, 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{\textquoteright}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.}, keywords = {*Warfare, Adolescent, Child, Child, Preschool, Humans, Male, Mental Disorders/*epidemiology/etiology/psychology, Mental Health Services, Refugees/*psychology, Stress Disorders, Post-Traumatic/*epidemiology, United States}, isbn = {1573-6598 (Electronic)
0894-9867 (Linking)}, author = {Betancourt, T. S. and Newnham, E. A. and Layne, C. M. and Kim, S. and Steinberg, A. M. and Ellis, H. and Birman, D.} } @article {4886, title = {Validating the Center for Epidemiological Studies Depression Scale for Children in Rwanda}, journal = {J Am Acad Child Adolesc Psychiatry}, volume = {51}, number = {12}, year = {2012}, note = {Betancourt, Theresa
Scorza, Pamela
Meyers-Ohki, Sarah
Mushashi, Christina
Kayiteshonga, Yvonne
Binagwaho, Agnes
Stulac, Sara
Beardslee, William R
eng
K01 MH077246/MH/NIMH NIH HHS/
R34MH084679-02/MH/NIMH NIH HHS/
K01MH077246-05/MH/NIMH NIH HHS/
T32 MH096724/MH/NIMH NIH HHS/
R34 MH084679/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
2012/12/04 06:00
J Am Acad Child Adolesc Psychiatry. 2012 Dec;51(12):1284-92. doi: 10.1016/j.jaac.2012.09.003. Epub 2012 Nov 8.}, month = {Dec}, pages = {1284-92}, 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 (alpha = .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.}, keywords = {*Depression/diagnosis/epidemiology/psychology, *Mass Screening/methods/standards, Adolescent, Behavioral Symptoms/*diagnosis, Child, Female, Humans, Male, Predictive Value of Tests, Psychiatric Status Rating Scales/*standards, Reproducibility of Results, ROC Curve, Rwanda/epidemiology, Translations}, isbn = {1527-5418 (Electronic)
0890-8567 (Linking)}, author = {Betancourt, T. S. and Scorza, P. and Meyers-Ohki, S. and Mushashi, C. and Kayiteshonga, Y. and Binagwaho, A. and Stulac, S. and Beardslee, W. R.} } @article {4891, title = {Moderators of treatment effectiveness for war-affected youth with depression in northern Uganda}, journal = {J Adolesc Health}, volume = {51}, number = {6}, year = {2012}, note = {Betancourt, Theresa S
Newnham, Elizabeth A
Brennan, Robert T
Verdeli, Helen
Borisova, Ivelina
Neugebauer, Richard
Bass, Judith
Bolton, Paul
eng
1K01MH077246-01A2/MH/NIMH NIH HHS/
P60 MD002261/MD/NIMHD NIH HHS/
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
2012/11/24 06:00
J Adolesc Health. 2012 Dec;51(6):544-50. doi: 10.1016/j.jadohealth.2012.02.010. Epub 2012 Apr 5.}, month = {Dec}, pages = {544-50}, 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{\textquoteright}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{\textquoteright}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.}, keywords = {*Psychology, Adolescent, *Warfare, Adolescent, Depressive Disorder/diagnosis/etiology/*therapy, Female, Humans, Male, Military Personnel/*psychology, Psychotherapy/*methods, Refugees/*psychology, Sex Distribution, Stress Disorders, Post-Traumatic/diagnosis/etiology/*therapy, Treatment Outcome, Uganda}, isbn = {1879-1972 (Electronic)
1054-139X (Linking)}, author = {Betancourt, T. S. and Newnham, E. A. and Brennan, R. T. and Verdeli, H. and Borisova, I. and Neugebauer, R. and Bass, J. and Bolton, P.} } @article {4901, title = {Psychosocial adjustment and mental health in former child soldiers--systematic review of the literature and recommendations for future research}, journal = {J Child Psychol Psychiatry}, volume = {54}, number = {1}, year = {2013}, note = {Betancourt, Theresa S
Borisova, Ivelina
Williams, Timothy P
Meyers-Ohki, Sarah E
Rubin-Smith, Julia E
Annan, Jeannie
Kohrt, Brandon A
eng
K01 MH077246/MH/NIMH NIH HHS/
P60 MD002261/MD/NIMHD NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Review
England
2012/10/16 06:00
J Child Psychol Psychiatry. 2013 Jan;54(1):17-36. doi: 10.1111/j.1469-7610.2012.02620.x. Epub 2012 Oct 12.}, month = {Jan}, pages = {17-36}, abstract = {AIMS AND SCOPE: This article reviews the available quantitative research on psychosocial adjustment and mental health among children (age <18 years) associated with armed forces and armed groups (CAAFAG)--commonly referred to as child soldiers. METHODS: PRISMA standards for systematic reviews were used to search PubMed, PsycInfo, JSTOR, and Sociological Abstracts in February 2012 for all articles on former child soldiers and CAAFAG. Twenty-one quantitative studies from 10 countries were analyzed for author, year of publication, journal, objectives, design, selection population, setting, instruments, prevalence estimates, and associations with war experiences. Opinion pieces, editorials, and qualitative studies were deemed beyond the scope of this study. Quality of evidence was rated according to the systematic assessment of quality in observational research (SAQOR). FINDINGS: According to SAQOR criteria, among the available published studies, eight studies were of high quality, four were of moderate quality, and the remaining nine were of low quality. Common limitations were lack of validated mental health measures, unclear methodology including undefined sampling approaches, and failure to report missing data. Only five studies included a comparison group of youth not involved with armed forces/armed groups, and only five studies assessed mental health at more than one point in time. Across studies, a number of risk and protective factors were associated with postconflict psychosocial adjustment and social reintegration in CAAFAG. Abduction, age of conscription, exposure to violence, gender, and community stigma were associated with increased internalizing and externalizing mental health problems. Family acceptance, social support, and educational/economic opportunities were associated with improved psychosocial adjustment. CONCLUSIONS: Research on the social reintegration and psychosocial adjustment of former child soldiers is nascent. A number of gaps in the available literature warrant future study. Recommendations to bolster the evidence base on psychosocial adjustment in former child soldiers and other war-affected youth include more studies comprising longitudinal study designs, and validated cross-cultural instruments for assessing mental health, as well as more integrated community-based approaches to study design and research monitoring.}, keywords = {*Mental Health, *Resilience, Psychological, *Social Adjustment, *Warfare, Adolescent, Child, Female, Humans, Male, Military Personnel/*psychology, Prevalence, Risk Factors, Social Support, Stress Disorders, Post-Traumatic/epidemiology/etiology/rehabilitation, Violence/*psychology}, isbn = {1469-7610 (Electronic)
0021-9630 (Linking)}, author = {Betancourt, T. S. and Borisova, I. and Williams, T. P. and Meyers-Ohki, S. E. and Rubin-Smith, J. E. and Annan, J. and Kohrt, B. A.} } @article {4906, title = {Trajectories of internalizing problems in war-affected Sierra Leonean youth: examining conflict and postconflict factors}, journal = {Child Dev}, volume = {84}, number = {2}, year = {2013}, note = {Betancourt, Theresa S
McBain, Ryan
Newnham, Elizabeth A
Brennan, Robert T
eng
K01 MH077246/MH/NIMH NIH HHS/
R01 HD073349/HD/NICHD NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
2012/09/26 06:00
Child Dev. 2013 Mar-Apr;84(2):455-70. doi: 10.1111/j.1467-8624.2012.01861.x. Epub 2012 Sep 24.}, month = {Mar-Apr}, pages = {455-70}, abstract = {Three waves of data from a prospective longitudinal study in Sierra Leone were used to examine internalizing trajectories in 529 war-affected youth (ages 10-17 at baseline; 25\% female). Latent class growth analyses identified 4 trajectories: A large majority of youth maintained lower levels of internalizing problems (41.4\%) or significantly improved over time (47.6\%) despite very limited access to care, but smaller proportions continued to report severe difficulties 6 years postwar (4.5\%) or their symptoms worsened (6.4\%). Continued internalizing problems were associated with loss of a caregiver, family abuse and neglect, and community stigma. Despite the comparative resilience of most war-affected youth in the face of extreme adversity, there remains a compelling need for interventions that address family- and community-level stressors.}, keywords = {*Adaptation, Psychological, *Internal-External Control, *Warfare, Adolescent, Child, Female, Humans, Male, Mental Disorders/*psychology, Prospective Studies, Risk Factors, Sierra Leone}, isbn = {1467-8624 (Electronic)
0009-3920 (Linking)}, author = {Betancourt, T. S. and McBain, R. and Newnham, E. A. and Brennan, R. T.} } @article {4926, title = {Interrelatedness of child health, protection and well-being: an application of the SAFE model in Rwanda}, journal = {Soc Sci Med}, volume = {74}, number = {10}, year = {2012}, note = {Betancourt, Theresa S
Williams, Timothy P
Kellner, Sarah E
Gebre-Medhin, Joy
Hann, Katrina
Kayiteshonga, Yvonne
eng
England
2012/03/31 06:00
Soc Sci Med. 2012 May;74(10):1504-11. doi: 10.1016/j.socscimed.2012.01.030. Epub 2012 Mar 9.}, month = {May}, pages = {1504-11}, abstract = {This study examines the core components of children{\textquoteright}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{\textquoteright}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.}, keywords = {*Caregivers, *Child Welfare, *Poverty, *Social Environment, *Social Problems, Adolescent, Adult, Child, Child, Orphaned, Critical Illness, Focus Groups, HIV Infections/complications/psychology, Homicide/psychology, Humans, Interviews as Topic, Rwanda, Safety}, isbn = {1873-5347 (Electronic)
0277-9536 (Linking)}, author = {Betancourt, T. S. and Williams, T. P. and Kellner, S. E. and Gebre-Medhin, J. and Hann, K. and Kayiteshonga, Y.} } @article {4936, title = {Sierra Leone{\textquoteright}s child soldiers: war exposures and mental health problems by gender}, journal = {J Adolesc HealthJ Adolesc Health}, volume = {49}, number = {1}, year = {2011}, note = {Betancourt, Theresa S
Borisova, Ivelina I
de la Soudiere, Marie
Williamson, John
eng
K01 MH077246/MH/NIMH NIH HHS/
K01 MH077246-01A2/MH/NIMH NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S.
2011/06/28 06:00
J Adolesc Health. 2011 Jul;49(1):21-8. doi: 10.1016/j.jadohealth.2010.09.021. Epub 2010 Dec 24.}, month = {Jul}, pages = {21-8}, abstract = {PURPOSE: To examine associations between war experiences, mental health, and gender in a sample of male and female Sierra Leonean former child soldiers. METHODS: A total of 273 former child soldiers (29\% females) were assessed for depression and anxiety by using the Hopkins Symptoms Checklist, and for hostility, confidence, and prosocial attitudes by using an instrument developed for use with Sierra Leonean child soldiers. RESULTS: The former child soldiers had witnessed and perpetrated violence at largely comparable rates, although females experienced higher rates of rape (p < .0001). More females scored within clinical ranges for depression (p = .008) and anxiety (p < .0001). In multiple regression analyses, female gender was a significant predictor of lower levels of confidence but not of mental health problems. Children who perpetrated injury or killing reported greater levels of depression (p < .0001), anxiety (p < .0001), and hostility (p < .0001). Surviving rape was associated with increased anxiety (p < .05) and hostility (p < .05), in males. Surviving rape was also related to higher confidence levels (p < .05) and prosocial attitudes (p < .05). Male former child soldiers who lost caregivers were also more vulnerable to depression (p < .05) and anxiety (p < .05), strong and significant effects noted among male child soldiers. CONCLUSIONS: In our sample, female and male child soldiers experienced comparable levels of most war exposures. Female soldiers reported higher rates of rape and lower levels of adaptive outcomes. Toxic forms of violence (killing or injuring; rape) were associated with particularly poor outcomes. Although all boys and girls who experience rape and loss of caregivers are generally at risk for mental health problems, boys in our sample demonstrated increased vulnerability; these findings indicate a need for more inclusive mental health services.}, keywords = {*Warfare, Adolescent, Cohort Studies, Cross-Sectional Studies, Female, Humans, Male, Mental Disorders/*epidemiology, Military Personnel/*psychology, Sex Factors, Sierra Leone/epidemiology, Young Adult}, isbn = {1879-1972 (Electronic)
1054-139X (Linking)}, author = {Betancourt, T. S. and Borisova,, II and de la Soudiere, M. and Williamson, J.} } @article {4941, title = {Using Mixed-Methods Research to Adapt and Evaluate a Family Strengthening Intervention in Rwanda}, journal = {Afr J Trauma Stress}, volume = {2}, number = {1}, year = {2011}, note = {Betancourt, Theresa S
Meyers-Ohki, Sarah E
Stevenson, Anne
Ingabire, Charles
Kanyanganzi, Fredrick
Munyana, Morris
Mushashi, Christina
Teta, Sharon
Fayida, Ildephonse
Cyamatare, Felix Rwabukwisi
Stulac, Sara
Beardslee, William R
eng
R34 MH084679/MH/NIMH NIH HHS/
Uganda
2011/06/01 00:00
Afr J Trauma Stress. 2011 Jun;2(1):32-45.}, month = {Jun}, pages = {32-45}, abstract = {INTRODUCTION: Research in several international settings indicates that children and adolescents affected by HIV and other compounded adversities are at increased risk for a range of mental health problems including depression, anxiety, and social withdrawal. More intervention research is needed to develop valid measurement and intervention tools to address child mental health in such settings. OBJECTIVE: This article presents a collaborative mixed-methods approach to designing and evaluating a mental health intervention to assist families facing multiple adversities in Rwanda. METHODS: Qualitative methods were used to gain knowledge of culturally-relevant mental health problems in children and adolescents, individual, family and community resources, and contextual dynamics among HIV-affected families. This data was used to guide the selection and adaptation of mental health measures to assess intervention outcomes. Measures were subjected to a quantitative validation exercise. Qualitative data and community advisory board input also informed the selection and adaptation of a family-based preventive intervention to reduce the risk for mental health problems among children in families affected by HIV.. Community-based participatory methods were used to ensure that the intervention targeted relevant problems manifest in Rwandan children and families and built on local strengths. RESULTS: Qualitative data on culturally-appropriate practices for building resilience in vulnerable families has enriched the development of a Family-Strengthening Intervention (FSI). Input from community partners has also contributed to creating a feasible and culturally-relevant intervention. Mental health measures demonstrate strong performance in this population. CONCLUSION: The mixed-methods model discussed represents a refined, multi-phase protocol for incorporating qualitative data and community input in the development and evaluation of feasible, culturally-sound quantitative assessments and intervention models. The mixed-methods approach may be applied to research in other parts of sub-Saharan Africa and beyond.}, author = {Betancourt, T. S. and Meyers-Ohki, S. E. and Stevenson, A. and Ingabire, C. and Kanyanganzi, F. and Munyana, M. and Mushashi, C. and Teta, S. and Fayida, I. and Cyamatare, F. R. and Stulac, S. and Beardslee, W. R.} } @article {4946, title = {Attending to the mental health of war-affected children: the need for longitudinal and developmental research perspectives}, journal = {J Am Acad Child Adolesc Psychiatry}, volume = {50}, number = {4}, year = {2011}, note = {Betancourt, Theresa S
eng
Comment
Editorial
2011/03/23 06:00
J Am Acad Child Adolesc Psychiatry. 2011 Apr;50(4):323-5. doi: 10.1016/j.jaac.2011.01.008.}, month = {Apr}, pages = {323-5}, keywords = {*Afghan Campaign 2001-, *Developing Countries, *Life Change Events, *Resilience, Psychological, *Social Environment, Female, Humans, Male, Stress Disorders, Post-Traumatic/*diagnosis}, isbn = {1527-5418 (Electronic)
0890-8567 (Linking)}, author = {Betancourt, T. S.} } @article {4951, title = {Sierra Leone{\textquoteright}s former child soldiers: a follow-up study of psychosocial adjustment and community reintegration}, journal = {Child Dev}, volume = {81}, number = {4}, year = {2010}, note = {Betancourt, Theresa Stichick
Borisova, Ivelina Ivanova
Williams, Timothy Philip
Brennan, Robert T
Whitfield, Theodore H
de la Soudiere, Marie
Williamson, John
Gilman, Stephen E
eng
K01 MH077246/MH/NIMH NIH HHS/
K01 MH077246-01A2/MH/NIMH NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
P60 MD002261/MD/NIMHD NIH HHS/
Research Support, N.I.H., Extramural
Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S.
2010/07/20 06:00
Child Dev. 2010 Jul-Aug;81(4):1077-95. doi: 10.1111/j.1467-8624.2010.01455.x.}, month = {Jul-Aug}, pages = {1077-95}, abstract = {This is the first prospective study to investigate psychosocial adjustment in male and female former child soldiers (ages 10-18; n = 156, 12\% female). The study began in Sierra Leone in 2002 and was designed to examine both risk and protective factors in psychosocial adjustment. Over the 2-year period of follow-up, youth who had wounded or killed others during the war demonstrated increases in hostility. Youth who survived rape not only had higher levels of anxiety and hostility but also demonstrated greater confidence and prosocial attitudes at follow-up. Of the potential protective resources examined, improved community acceptance was associated with reduced depression at follow-up and improved confidence and prosocial attitudes regardless of levels of violence exposure. Retention in school was also associated with greater prosocial attitudes.}, keywords = {*Adaptation, Psychological, *Social Adjustment, *Warfare, Adolescent, Child, Family, Female, Follow-Up Studies, Hostility, Humans, Interpersonal Relations, Male, Military Personnel/*psychology, Prospective Studies, Psychology, Adolescent, Psychology, Child, Residence Characteristics, Sierra Leone, Socioeconomic Factors, Violence}, isbn = {1467-8624 (Electronic)
0009-3920 (Linking)}, author = {Betancourt, T. S. and Borisova,, II and Williams, T. P. and Brennan, R. T. and Whitfield, T. H. and de la Soudiere, M. and Williamson, J. and Gilman, S. E.} } @article {4956, title = {A Longitudinal Study of Psychosocial Adjustment and Community Reintegration among Former Child Soldiers in Sierra Leone}, journal = {Int Psychiatry}, volume = {7}, number = {3}, year = {2010}, note = {Betancourt, Theresa S
eng
K01 MH077246/MH/NIMH NIH HHS/
England
2010/07/01 00:00
Int Psychiatry. 2010 Jul;7(3):60-62.}, month = {Jul}, pages = {60-62}, isbn = {1749-3676 (Print)
1749-3676 (Linking)}, author = {Betancourt, T. S.} } @article {4961, title = {Sierra Leone{\textquoteright}s former child soldiers: a longitudinal study of risk, protective factors, and mental health}, journal = {J Am Acad Child Adolesc Psychiatry}, volume = {49}, number = {6}, year = {2010}, note = {Betancourt, Theresa S
Brennan, Robert T
Rubin-Smith, Julia
Fitzmaurice, Garrett M
Gilman, Stephen E
eng
K01 MH077246/MH/NIMH NIH HHS/
K01 MH077246-01A2/MH/NIMH NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov{\textquoteright}t
Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S.
2010/05/25 06:00
J Am Acad Child Adolesc Psychiatry. 2010 Jun;49(6):606-15. doi: 10.1016/j.jaac.2010.03.008. Epub 2010 May 1.}, month = {Jun}, pages = {606-15}, abstract = {OBJECTIVE: To investigate the longitudinal course of internalizing and externalizing problems and adaptive/prosocial behaviors among Sierra Leonean former child soldiers and whether postconflict factors contribute to adverse or resilient mental health outcomes. METHOD: Male and female former child soldiers (N = 260, aged 10 to 17 years at baseline) were recruited from the roster of an non-governmental organization (NGO)-run Interim Care Center in Kono District and interviewed in 2002, 2004, and 2008. The retention rate was 69\%. Linear growth models were used to investigate trends related to war and postconflict experiences. RESULTS: The long-term mental health of former child soldiers was associated with war experiences and postconflict risk factors, which were partly mitigated by postconflict protective factors. Increases in externalizing behavior were associated with killing/injuring others during the war and postconflict stigma, whereas increased community acceptance was associated with decreases in externalizing problems (b = -1.09). High baseline levels of internalizing problems were associated with being raped, whereas increases were associated with younger involvement in armed groups and social and economic hardships. Improvements in internalizing problems were associated with higher levels of community acceptance and increases in community acceptance (b = -0.86). Decreases in adaptive/prosocial behaviors were associated with killing/injuring others during the war and postconflict stigma, but partially mitigated by social support, being in school and increased community acceptance (b = 1.93). CONCLUSIONS: Psychosocial interventions for former child soldiers may be more effective if they account for postconflict factors in addition to war exposures. Youth with accumulated risk factors, lack of protective factors, and persistent distress should be identified. Sustainable services to promote community acceptance, reduce stigma, and expand social supports and educational access are recommended.}, keywords = {*Adaptation, Psychological, *Civil Disorders, *Developing Countries, *Internal-External Control, *Resilience, Psychological, *Social Adjustment, *Social Behavior, Adolescent, Aggression/psychology, Anxiety Disorders/diagnosis/epidemiology/psychology, Child, Cross-Sectional Studies, Depressive Disorder/diagnosis/epidemiology/psychology, Female, Homicide/psychology, Humans, Longitudinal Studies, Male, Mental Disorders/diagnosis/epidemiology/*psychology, Military Personnel/*psychology, Prejudice, Rape/psychology, Sierra Leone, Social Identification, Social Support, Stress Disorders, Post-Traumatic/diagnosis/epidemiology/psychology, Violence/psychology/statistics \& numerical data, Wounds and Injuries/psychology, Young Adult}, isbn = {1527-5418 (Electronic)
0890-8567 (Linking)}, author = {Betancourt, T. S. and Brennan, R. T. and Rubin-Smith, J. and Fitzmaurice, G. M. and Gilman, S. E.} } @article {4971, title = {Past horrors, present struggles: the role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone}, journal = {Soc Sci Med}, volume = {70}, number = {1}, year = {2010}, note = {Betancourt, Theresa S
Agnew-Blais, Jessica
Gilman, Stephen E
Williams, David R
Ellis, B Heidi
eng
K01 MH077246/MH/NIMH NIH HHS/
P60 MD002261/MD/NIMHD NIH HHS/
1K01MH077246-01A2/MH/NIMH NIH HHS/
Research Support, N.I.H., Extramural
Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S.
England
2009/10/31 06:00
Soc Sci Med. 2010 Jan;70(1):17-26. doi: 10.1016/j.socscimed.2009.09.038. Epub 2009 Oct 28.}, month = {Jan}, pages = {17-26}, abstract = {Upon returning to their communities, children formerly associated with armed forces and armed groups--commonly referred to as child soldiers--often confront significant community stigma. Much research on the reintegration and rehabilitation of child soldiers has focused on exposure to past war-related violence and mental health outcomes, yet no empirical work has yet examined the role that post-conflict stigma plays in shaping long-term psychosocial adjustment. Two waves of data are used in this paper from the first prospective study of male and female former child soldiers in Sierra Leone. We examined the role of stigma (manifest in discrimination as well as lower levels of community and family acceptance) in the relationship between war-related experiences and psychosocial adjustment (depression, anxiety, hostility and adaptive behaviors). Former child soldiers differ from one another with regard to their post-war experiences, and these differences profoundly shape their psychosocial adjustment over time. Consistent with social stress theory, we observed that post-conflict factors such as stigma can play an important role in shaping psychosocial adjustment in former child soldiers. We found that discrimination was inversely associated with family and community acceptance. Additionally, higher levels of family acceptance were associated with decreased hostility, while improvements in community acceptance were associated with adaptive attitudes and behaviors. We found that post-conflict experiences of discrimination largely explained the relationship between past involvement in wounding/killing others and subsequent increases in hostility. Stigma similarly mediated the relationship between surviving rape and depression. However, surviving rape continued to demonstrate independent effects on increases in anxiety, hostility and adaptive/prosocial behaviors after adjusting for other variables. These findings point to the complexity of psychosocial adjustment and community reintegration in these youth and have a number of programmatic and policy implications.}, keywords = {*Adaptation, Psychological, *Psychology, Adolescent, *Psychology, Child, *Stereotyping, Adolescent, Child, Family/psychology, Female, Humans, Interpersonal Relations, Interviews as Topic, Life Change Events, Male, Mental Disorders/epidemiology, Military Personnel/*psychology, Prospective Studies, Regression Analysis, Residence Characteristics, Sierra Leone/epidemiology, Stress, Psychological/epidemiology, Warfare}, isbn = {1873-5347 (Electronic)
0277-9536 (Linking)}, author = {Betancourt, T. S. and Agnew-Blais, J. and Gilman, S. E. and Williams, D. R. and Ellis, B. H.} } @article {4981, title = {A qualitative study of mental health problems among children displaced by war in northern Uganda}, journal = {Transcult PsychiatryTranscult Psychiatry}, volume = {46}, number = {2}, year = {2009}, note = {Betancourt, Theresa Stichick
Speelman, Liesbeth
Onyango, Grace
Bolton, Paul
eng
K01 MH077246/MH/NIMH NIH HHS/
K01 MH077246-01A2/MH/NIMH NIH HHS/
Research Support, Non-U.S. Gov{\textquoteright}t
England
2009/06/23 09:00
Transcult Psychiatry. 2009 Jun;46(2):238-56. doi: 10.1177/1363461509105815.}, month = {Jun}, pages = {238-56}, abstract = {While multiple studies have found that children affected by war are at increased risk for a range of mental health problems, little research has investigated how mental health problems are perceived locally. In this study we used a previously developed rapid ethnographic assessment method to explore local perceptions of mental health problems among children and adults from the Acholi ethnic group displaced by the war in northern Uganda. We conducted 45 free list interviews and 57 key informant interviews. The rapid assessment approach appears to have worked well for interviewing caretakers and children aged 10-17 years. We describe several locally defined syndromes: two tam/par/kumu (depression and dysthymia-like syndromes), ma lwor (a mixed anxiety and depression-like syndrome), and a category of conduct problems referred to as kwo maraco/gin lugero. The descriptions of these local syndromes were similar to western mood, anxiety and conduct disorders, but included culture-specific elements.}, keywords = {*Cross-Cultural Comparison, *Developing Countries, Adolescent, Adult, Anxiety Disorders/diagnosis/*ethnology/psychology, Child, Cross-Sectional Studies, Depressive Disorder/diagnosis/*ethnology/psychology, Dysthymic Disorder/diagnosis/*ethnology/psychology, Female, Humans, Interview, Psychological, Male, Refugees/*psychology, Social Problems/psychology, Uganda}, isbn = {1363-4615 (Print)
1363-4615 (Linking)}, author = {Betancourt, T. S. and Speelman, L. and Onyango, G. and Bolton, P.} } @article {4986, title = {High Hopes, Grim Reality: Reintegration and the Education of Former Child Soldiers in Sierra Leone}, journal = {Comp Educ Rev}, volume = {52}, number = {4}, year = {2008}, note = {Betancourt, Theresa S
Simmons, Stephanie
Borisova, Ivelina
Brewer, Stephanie E
Iweala, Uzo
Soudiere, Marie de la
eng
K01 MH077246/MH/NIMH NIH HHS/
K01 MH077246-01A2/MH/NIMH NIH HHS/
2009/04/02 09:00
Comp Educ Rev. 2008 Nov 1;52(4):565-587. doi: 10.1086/591298.}, month = {Nov 1}, pages = {565-587}, isbn = {0010-4086 (Print)
0010-4086 (Linking)}, author = {Betancourt, T. S. and Simmons, S. and Borisova, I. and Brewer, S. E. and Iweala, U. and Soudiere, M. D.} } @article {4991, title = {The mental health of children affected by armed conflict: protective processes and pathways to resilience}, journal = {Int Rev Psychiatry}, volume = {20}, number = {3}, year = {2008}, note = {Betancourt, Theresa Stichick
Khan, Kashif Tanveer
eng
K01 MH077246/MH/NIMH NIH HHS/
K01 MH077246-01A2/MH/NIMH NIH HHS/
Review
England
2008/06/24 09:00
Int Rev Psychiatry. 2008 Jun;20(3):317-28. doi: 10.1080/09540260802090363.}, month = {Jun}, pages = {317-28}, abstract = {This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain {\textquoteright}invulnerable{\textquoteright} children. In contrast, this paper argues that a number of protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child{\textquoteright}s social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that further research on war-affected children should pay particular attention to coping and meaning making at the individual level; the role of attachment relationships, caregiver health, resources and connection in the family, and social support available in peer and extended social networks. Cultural and community influences such as attitudes towards mental health and healing as well as the meaning given to the experience of war itself are also important aspects of the larger social ecology.}, keywords = {*Adaptation, Psychological, *Warfare, Adolescent, Child, Child, Orphaned/psychology, Community Mental Health Services, Cultural Characteristics, culture, Family/psychology, Female, Humans, Male, Models, Psychological, Object Attachment, Refugees/psychology, Risk Factors, Social Environment, Social Support, Stress Disorders, Post-Traumatic/diagnosis/*psychology/therapy}, isbn = {1369-1627 (Electronic)
0954-0261 (Linking)}, author = {Betancourt, T. S. and Khan, K. T.} } @article {5001, title = {Child soldiers: reintegration, pathways to recovery, and reflections from the field}, journal = {J Dev Behav Pediatr}, volume = {29}, number = {2}, year = {2008}, note = {Betancourt, Theresa Stichick
eng
2008/04/15 09:00
J Dev Behav Pediatr. 2008 Apr;29(2):138-41. doi: 10.1097/DBP.0b013e31816be946.}, month = {Apr}, pages = {138-41}, keywords = {*Relief Work, *Warfare, Child, Child Abuse/*rehabilitation, Crime/*psychology, Female, Humans, Male, Military Personnel/*psychology, Sierra Leone, Uganda}, isbn = {0196-206X (Print)
0196-206X (Linking)}, author = {Betancourt, T. S.} } @article {5006, title = {Building an evidence base on mental health interventions for children affected by armed conflict}, journal = {Intervention (Amstelveen)}, volume = {6}, number = {1}, year = {2008}, note = {Betancourt, Theresa S
Williams, Timothy
eng
K01 MH077246/MH/NIMH NIH HHS/
K01 MH077246-01A2/MH/NIMH NIH HHS/
Netherlands
2008/01/01 00:00
Intervention (Amstelveen). 2008;6(1):39-56. doi: 10.1097/WTF.0b013e3282f761ff.}, pages = {39-56}, abstract = {This paper reviews what is currently known from research about the effectiveness of interventions to address mental health problems in children and adolescents affected by armed conflict. The focus will be on interventions delivered in conflict affected countries either during active humanitarian emergencies or during the post conflict period. The paper will discuss two main paradigms of intervention dominating the field: psychosocial approaches and clinical/psychiatric approaches. The paper reviews some of the basic literature, theories and issues involved in assessment, programme planning, monitoring and evaluation of both approaches. In order to explore these issues in depth, the paper will draw from the author{\textquoteright}s field experiences with research in the Russian Federation and in northern Uganda. The paper also presents a brief review of a handful of other published evaluations of mental health interventions for war affected children. We will close with a discussion of what future research is needed to build an evidence base regarding mental health interventions for children affected by armed conflict as well as the ethical and feasibility issues associated with carrying out this work.}, isbn = {1571-8883 (Print)
1571-8883 (Linking)}, author = {Betancourt, T. S. and Williams, T.} }