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BackgroundInternational humanitarian aid workers (iHAWs) are motivated strongly to travel abroad to help communities affected by war, famine, disaster and disease. They expose themselves to dangers and hardships during their field assignments. Despite working under such challenging circumstances, most workers remain healthy. The objective of the present study was to unravel the mechanism that enables workers to remain healthy under the same circumstances that affect these communities. We hypothesised that the different components of the Sense of Coherence (SOC) health mechanism mediate the relationship between field stressors and post-assignment health.Methods and findingsThe stress-health model was tested among 465 international aid workers using a longitudinal pre-post assignment study design and structural equation modelling for path analyses. The (health) outcome variables were PTSD, anxiety, depression, emotional exhaustion, and work engagement. Our findings highlight the importance of being healthy before aid assignment and the negative health impact of field stressors that were not potentially traumatic. The SOC components mediated the relationship between field stress and post-assignment health, with males and females using different SOC components to alleviate stress. Males are more likely trying to understand the nature of the stressor, whereas females mobilise their resources to manage stressors. In both groups, a high level of meaningfulness of the work was an important component in maintaining health. Regarding using the SOC concept for understanding the process of maintaining health, our findings indicated that SOC is best considered context-specific and multidimensional.ConclusionIn addition to good pre-mission health, the SOC components help prevent field assignment-related negative health effects in iHAWs. Our findings support the idea to compose gender-balanced teams of iHAWs to maintain and promote health. The findings can be used to develop or refine health conversation tools and SOC based health interventions to promote health and wellbeing and prevent ill-health among aid workers and other stress-exposed populations.

Antecedentes/Objetivo: El maltrato infantil (MI) se ha asociado con la revictimizaci n y con el trastorno de estr s postraum tico (TEPT). Sin embargo, esta relaci n es poco conocida en los pa ses del Sur de Europa y en muestras comunitarias. Estas asociaciones se analizaron en una muestra de conveniencia compuesta por 1.200 adultos portugueses. M todo: Los datos fueron obtenidos usando la Escala de Diagn stico Post Traum tico (PDS) y el Cuestionario de Trauma Infantil-Versi n corta (CTQ-SF), y analizados con odds ratios y regresiones log sticas y jer rquicas. Resultados: La exposici n a MI aument m s del doble el riesgo de percibir revictimizaci n y tres veces el diagn stico de TEPT. Los eventos traum ticos frecuentes, como accidentes, se asociaron con CM. M s del 30% de los adultos diagnosticados con TEPT indicaron haber sufrido abuso emocional. Tras ajustar por factores demogr ficos, el abuso emocional predijo significativamente la revictimizaci n y fue el predictor con mayor efecto en la gravedad del TEPT ( = 0,24). Conclusiones: Nuestros hallazgos confirman el potential nocivo del abuso emocional en la infancia para los adultos de la comunidad. Se necesita m s conocimiento sobre los mecanismos que relacional el MI con la exposici n traum tica y el TEPT para informar mejor sobre posibles acciones preventivas y terap uticas.

AimTo evaluate the feasibility and effect of a 10-session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event.DesignA multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites).Methods125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping.ResultsResults showed that both hyperarousal symptoms (d = 0.61) and avoidance symptoms (d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth.ConclusionIn spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context.

Existing tools for evaluating psychosocial interventions (un-validated self-reporting questionnaires) are not ideal for use in non-Western conflict settings. We implement a generic method of treatment evaluation, using client and counsellor feedback, in 18 projects in non-Western humanitarian settings. We discuss our findings from the perspective of validity and suggestions for future research. A retrospective analysis is executed using data gathered from psychosocial projects. Clients (n = 7,058) complete two (complaints and functioning) rating scales each session and counsellors rate the client's status at exit. The client-completed pre- and post-intervention rating scales show substantial changes. Counsellor evaluation of the clients' status shows a similar trend in improvement. All three multivariable models for each separate scale have similar associations between the scales and the investigated variables despite different cultural settings. The validity is good. Limitations are: ratings give only a general impression and clinical risk factors are not measured. Potential ceiling effects may influence change of scales. The intra and inter-rater reliability of the counsellors' rating is not assessed. The focus on client and counsellor perspectives to evaluate treatment outcome seems a strong alternative for evaluation instruments frequently used in psychosocial programming. The session client rated scales helps client and counsellor to set mutual treatment objectives and reduce drop-out risk. Further research should test the scales against a cross-cultural valid gold standard to obtain insight into their clinical relevance.