Die Untersuchung von Zusammenhängen zwischen Kriegstrauma, Psychopathologie, Familiendynamiken und Anpassung der Kinder - eine Multi-Informanten Studie mit Schulkindern in Norduganda und Sri Lanka
Final Report Abstract
Our project aimed at understanding the interrelationships between war trauma affecting families, psychopathology, family violence and child adaptation in a post-conflict context. For this purpose, we conducted various studies based on multi-informant data and different methodological approaches (interview, self-report, behavioral observation) in two post-conflict countries, Northern Uganda and the North of Sri Lanka. In Uganda, we accomplished a cross-sectional epidemiological study that comprised of 1391 participants from 516 different families. Well-trained local trauma therapists used a standardized clinical interview to assess exposure to traumatic experiences, experiences of intra-familial violence, parenting behaviours and psychopathological symptoms. Due to political restraints in Sri Lanka, our study there was smaller and restricted to the Jaffna district in the extreme North of the country. 359 children, 122 female caretakers and 88 male guardians participated in the survey. Again, local counsellors carried out standardized interviews with school children and their female and (where possible) male primary caretaker. Taken together, the results of the two surveys underline how important it is to address the issue of family violence, its risk factors on various levels (the individual, the family and the community) as well as its consequences for children’s mental health and adaptation in post-conflict societies. We found a high prevalence of intimate partner violence that was associated with certain characteristics of women (increased amount of war experiences, trauma symptoms) and with specific risk factors of the male perpetrators, in particular alcohol abuse. In Sri Lanka, we learned that war-affected children with higher levels of psychopathology were more at risk to be abused in their families. In Uganda, traumatic experiences and mental health problems in parents were the strongest predictors for the perpetration of violence towards children. Most interestingly, we found evidence that parental education strategies and the amount of care experienced by a child can be both, a risk and a protective factor for mental health disorders associated with war trauma. Based on our findings with families in Sri Lanka, there is reason to assume that positive parenting can mitigate the adverse effects of past traumatic experiences related to war or natural disaster. These findings have important implications for clinical interventions focusing on post-war populations. In order to reduce mental health problems and prevent a cycle of violence in war affected children and adults, therapeutic and preventive programs should aim at different levels including the individual, the family as well as the community. On the individual level, there is a need of effective therapy programs that address each person’s history of past traumatization and trauma-related mental health problems including the problem of alcohol abuse in men. On the family level, we should develop and evaluate culturally sensitive family based approaches and parenting trainings that promote positive education strategies and a caring caretaker-child relationship thereby reducing the risk of child maltreatment. The results of our pilot study on behavioral observation of mother-child interactions in Northern Uganda underscore the importance of developing parenting interventions in order to reduce dysfunctional communication patterns between caretakers and their children thereby decreasing the risk of emotional or behavioral difficulties in children. In view of the current situation in Germany, where more than one million asylum seekers mostly from war-affected countries have arrived over the last two years, the findings and implications of the current project are particularly relevant. Adequate health care programs for traumatized refugees should include, next to individual therapies also approaches on the family level that assess and address potential problems in partners as well as in parent-child relationships in order to break a potential vicious circle of war trauma, psychopathology and dysfunctional family dynamics including maltreatment of women and children.
Publications
- (2017) Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda. Family process 56 (2) 376–392
Wieling, Elizabeth; Mehus, Christopher; Yumbul, Cigdem; Möllerherm, Julia; Ertl, Verena; Laura, Achan; Forgatch, Marion; Neuner, Frank; Catani, Claudia
(See online at https://doi.org/10.1111/famp.12189) - (2013). Prevalence and predictors of partner violence against women in the aftermath of war: A survey among couples in Northern Uganda, Social Science and Medicine, 86, 17-25
Saile, R., Neuner, F., Ertl, V., Catani, C.
(See online at https://doi.org/10.1016/j.socscimed.2013.02.046) - (2014). Does war contribute to family violence against children? Findings from a two-generational multi-informant study in Northern Uganda, Child Abuse & Neglect, 38(1):135-46
Saile, R., Ertl, V., Neuner , F. & Catani, C.
(See online at https://doi.org/10.1016/j.chiabu.2013.10.007) - (2015). Assessing the Feasibility of Providing a Parenting Intervention for War Affected Families in Northern Uganda, Family & Community Health, 38(3), 253-268
Wieling, E., Mehus, C., Möllerherm, C., Neuner, F., Achan, L., Catani, C.
(See online at https://doi.org/10.1097/FCH.0000000000000064) - (2015). Children of the post-war years: A two-generational multilevel risk assessment of child psychopathology in Northern Uganda, Development and Psychopathology, 28(2), 607-620
Saile, R., Ertl, V., Neuner, F., Catani, C.
(See online at https://doi.org/10.1017/S0954579415001066) - (2015). Parental care protects traumatized Sri Lankan children from internalizing behavior problems, BMC Psychiatry, 15:203
Sriskandarajah, V., Neuner, F., Catani, C.
(See online at https://doi.org/10.1186/s12888-015-0583-x) - (2015). Predictors of Violence Against Children in Tamil Families in Northern Sri Lanka, Social Science and Medicine, 146, 257-265
Sriskandarajah, V., Neuner, F., Catani, C.
(See online at https://doi.org/10.1016/j.socscimed.2015.10.010) - (2016). Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and psychopathology in a post-conflict context. BMC Psychiatry, 16:202
Ertl, V., Saile, R., Neuner, F., Catani, C.
(See online at https://doi.org/10.1186/s12888-016-0905-7)
