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Adolescence is an important developmental period for social relationships, identity formation and future planning. Traumatic experiences, such as war and persecution, may interfere with optimal development, including the future orientation of adolescents. The present study examines how young adult war survivors construct, make sense of, and narrate their future goals, plans, and expectations. The participants were 13 Liberian 25-35-year old male and female refugees living in Ghana. This qualitative study is based on semi-structured interviews with prompting questions. By applying a phenomenological approach the interview transcripts were categorized into themes and subthemes about future orientations. Results revealed three main themes, two of them desired a positive future orientation, indicating optimism and determination to improve one's own life and to contribute to a flourishing nation and to peacebuilding. The third theme illustrated a failure to reconstruct war-shattered lives and involved pessimistic views of the future. The results are discussed in relation to peacebuilding and the developmental challenges of young adults as war survivors.

In the case of a mother with dysregulating attachment experiences and current enrolment in a parent-infant psychotherapy process, we explored which insecure, hostile/helpless, and prementalizing risk features were similar in her attachment and caregiving representations; which risk features were specific to her caregiving representations; and how these theory-defined features overlapped in detecting caregiving risks. Risk features in the attachment representations were assessed from the adult attachment interview and risk features in the caregiving representations from written psychotherapy notes. We found similar insecure (preoccupied and disorganized), prementalizing and hostile/helpless instances from both the attachment and the caregiving representations. However, confusion between self and child, greater variance in lapses into prementalizing, and specific and concrete fears and helplessness were unique to the caregiving representations. Hostile/helpless instances were found in tandem with almost all insecure and prementalizing instances, indicating this conceptualization captured risks in the caregiving representations most comprehensively. Fearful and helpless caregiving representations occurred somewhat independently from other risk conceptualizations, suggesting they need to be identified as independent phenomena. The results imply that detecting specific manifestations of intergenerational risks from caregiving representations is possible. peerReviewed

Objectives: The aims of the study were, first, to describe and analyze healthcare services utilization patterns of older immigrants in Finland, and particularly to compare the availability and accessibility of health services between older Somalis and Finns. The second aim was to examine the preferences for mental healthcare within the group of Somalis. The third aim was to test the existence of a service usage gap expected to be characteristic of the Somali group, in which high levels of mental health problems occur alongside simultaneous low levels of mental health service usage. Design: The participants were 256 men and women between the ages of 50–85; half were Somali migrants and the other half Finnish matched pairs. The participants were surveyed regarding their usage of somatic, mental, and preventive health services, as well as symptoms of depression, general distress, and somatization. The Somali participants were also surveyed regarding their usage of traditional healing methods and preferences for mental healthcare. Results: The Somali group had significantly lower access to personal/family doctors at healthcare centers as well as a lower availability of private doctors and occupational health services than the Finns. Instead, they used more nursing services than Finnish patients. The Somali participants attended fewer age-salient preventive check-ups than the Finns. The majority of the Somalis preferred traditional care, most commonly religious healing, for mental health problems. The hypothesized service gap was not substantiated, as a high level of depressive symptoms was not associated with a low usage of health services among the Somalis, but it was found unexpectedly among the Finns. Conclusion: Our findings call for culturally appropriate general and mental health services for older immigrants, which requires awareness of clients’ preferences, needs, and alternative healing practices. Somali participants encountered institutional barriers in accessing healthcare, and they preferred informal mental healthcare, especially religious healing instead of Western practices.

The contents of earliest memories (EM), as part of autobiographical memory, continue to fascinate scientists and therapists. However, research is scarce on the determinants of EM, especially among children. This study aims, first, to identify contents of EM of children living in war conditions, and, second, to analyse child gender, traumatic events and mental health as determinants of the contents of EM. The participants were 240 Palestinian schoolchildren from the Gaza Strip (10-12 years, M = 11.35, SD = 0.57; 49.4% girls). They responded to an open-ended EM question, and reported their trauma exposures (war trauma, losses and current traumatic events), posttraumatic stress, depressive symptoms and psychosocial well-being, indicating mental health. The EM coding involved nature, social orientation, emotional tone and specificity. Results showed, first, that 43% reported playing or visiting a nice place as EM, and about a third (30%) traumatic events or accidents (30%) or miscellaneous events (27%). The individual and social orientation were almost equally common, the emotional tone mainly neutral (45.5%), and 60% remembered a specific event. Second, boys remembered more EM involving traumatic events or accidents, and girls more social events. Third, war trauma was associated with less positive emotional tone and with more specific memories.

One of the most fundamental issues in psychiatric assessment across different sociocultural and linguistic groups is assuring test reliability and validity. We analyze the construct validity of the HSCL-25 depression and anxiety scales and the SCL-90-Somatization scale in a population-based study (Finnish Migrant Health and Wellbeing Study) among 1356 Russian, Somali and Kurdish origin migrants (aged 18–64 years old) in Finland using an Exploratory Structural Equation Modelling approach. The results revealed problems in establishing measurement invariance of the HSCL-25 depression and anxiety and SCL-90-Somatization scales. Two types of exploratory analysis (Exploratory Factor Analysis and Network Analysis) confirmed the mismatch between the theoretical structure and the data set. In addition, there were considerable group differences between the Russian, Somali and Kurdish groups, with the Somali group in particular showing differing results. The results are discussed in relation to sociocultural...

Stigma and marginalization are one of the major challenges orphans face in their daily lives, particularly in developing countries, but little is known about their impacts on mental health. This study examines how orphan-related characteristics, stigma and marginalization are associated with psychosocial well-being. It further analyses the role of social support in mediating between stigma and marginalization and mental health, indicated by emotional well-being and mental distress. The participants in this study were 430 Rwandan orphans who were 10-25 years of age, and of whom 179 were females and 251 were males. Results showed that high levels of stigma and marginalization were associated with a lower level of emotional well-being and higher levels of mental distress. A mediation analysis indicated that low level of social support due to stigma and marginalization contributed significantly to low level of emotional well-being. Once stigma, marginalization and social support were fully accounted for, AIDS orphans exhibited higher levels of mental distress than those who were orphaned by genocide or other causes. Future interventions designed to reduce stigma and marginalization for orphans and actions that facilitate social support can significantly improve emotional well-being and reduce mental distress among orphans.

Objectives: First, to compare multilevel emotion processing (EP) of pregnancy between substance-abusing and non-using women, and, second, to analyse whether different types of interventions can increase positive and functional EP and decrease negative and dysfunctional EP among substance-abusing mothers. EP was conceptualised according to the multifocal theory of emotions proposed by Frijda in 1986, comprising feeling states, behavioural urges to act, cognitive appraisals, and meta-emotions. Method: Participants were 101 women, 51 with substance abuse disorder and 50 comparisons. The substance-abusing women were provided with either intensive psychodynamic mother–infant group therapy (PGT; n = 25) or individually tailored psychosocial support (PSS; n = 26). All women reported their EP once during pregnancy (T1; N = 94), and twice postpartum, when the child was four (T2; N = 84) and twelve (T3; N = 76) months. Results: As hypothesised, the results indicated that the pregnancy-related EP of substance-abusin...

This paper presents a brief history of Palestinian mental health care, a discussion of the current status of mental health and health services in the occupied Palestinian territory, and a critique of the biomedical Western-led discourse as it relates to the mental health needs of Palestinians. Medicalising distress and providing psychological therapies for Palestinians offer little in the way of alleviating the underlying causes of ongoing collective trauma. This paper emphasises the importance of separating clinical responses to mental illness from the public health response to mass political violation and distress. Palestinian academic research reframes the mental health paradigm utilising an approach based on the broader framework of social justice, quality of life, human rights and human security. Recognising social suffering as a public mental health issue requires a shift in the emphasis from narrow medical indicators, injury and illness to the lack of human security and human rights violations experienced by ordinary Palestinians. Such a change in perspective requires a parallel change in mental health policies from short-term emergency humanitarian aid to the development of a sustainable system of public mental health services, in combination with advocacy for human rights and the restoration of political, historical and moral justice.

The effectiveness of group psychotherapy in decreasing PTSD symptoms and psychiatric distress (e.g., depression, anxiety, and hostility) and increasing adequate coping strategies was examined among women exposed to severe violence and multiple trauma. The gender- and culture-sensitive group therapy was tailored to increase self-awareness, violence protection, empowerment, and coping capacity and to create support networks. Participants were 33 women from the Southeast Anatolian region diagnosed with PTSD. Women completed the Post Traumatic Stress Scale, the Impact of Event Scale Revised, the Brief Symptom Inventory, and the Scale of Coping With Stress at pretherapy, posttherapy, and at 3 and 6 months' follow-up. The group psychotherapy sessions involved a 2-day meeting once a month for 5 months. Results showed significant decreases in PTSD symptoms and depressiveness, anxiety, hostility, interpersonal problems, and paranoid ideation during the group therapy, and the improvement sustained across the follow...

In this article we present a novel method of outpatient care: brief, dynamic mother – infant group psychotherapy with mothers who have substance use problems. In this therapy, substance abuse treatment is part of mental health and parenting interventions. The focus is on preventing disturbance in the mother – infant relationship in this high-risk group. The clinical material is taken from 16 mother – infant dyads from six psychotherapy groups, which met weekly over six months from pregnancy to post-partum. The therapy process consists of 20 – 24 three-hour sessions. The basis of the therapy is to offer mothers experience of care, which they, in turn, can give to their infants. In this paper we analyse the core therapeutic elements that may contribute to better mothering and child development. They involve: the group providing a symbolic maternal lap, and the meeting of the mothers' and the infants' needs. It is hoped that this may offer the mothers a new experience within which to reappraise thei...

Background: There is an increasing amount of research indicating that patient's attachment style is related to the development of working alliance. The earlier research is based mainly on outpatients or therapy clients.Aims: In this study, we studied the association between adult attachment styles and early working alliance among psychiatric inpatients.Method: The information was gathered using self-report questionnaires (Relationship Questionnaire and Working Alliance Inventory). The participants were 100 inpatients and their 21 case managers from a unit of acute psychiatry.Results: The results showed that adult attachment style was associated with working alliance, but the association was different in men and women. As hypothesized, securely attached women formed stronger emotional and relational alliance (bond) than women with fearful and dismissing attachment styles. Among men, however, not only secure but also fearful attachment was related to strong cognitive aspects of working alliance (task).Concl...

Although traumatic events are generally associated with negative psychosocial consequences, trauma survivors also report positive changes in themselves, human relationships and spirituality. Our aims are, first to study associations between exposure to torture and ill-treatment and posttraumatic growth and negative emotions, and second, to examine the role of adult attachment in moderating the association between exposure and positive growth. The participants were 275 Palestinian men imprisoned in a political context. They completed the Posttraumatic Growth Inventory (PTGI), adult attachment questionnaire (AAQ) and reported exposure to traumatic events. The results show that a high level of torture and ill-treatment was associated with a low level of posttraumatic growth and a high level of negative emotions. However, adult attachment style moderated that association, among men with secure attachment exposure to torture and ill-treatment was associated with a high level of posttraumatic growth, w...

The content and structure of self and other representations and their association with posttraumatic stress symptoms, somatic symptoms, and positive growth were studied among 117 Palestinian male political prisoners. Further, the associations between the representations and the severity of trauma and the post-detention conditions (such as education, place of residency and employment), and the role of representation patterns as a moderator between trauma exposure and symptoms was studied. Cluster analysis identified three representation patterns based on participants' descriptions of their spouse and themselves, and of childhood relationships with their mother and father. Representation patterns differed in negative vs. positive content and in the levels of differentiation and conceptual maturity: The Malevolent Others and Defeated Self representation pattern was characterized by very negative content, and poor differentiation and conceptual maturity in all descriptions; the Moderate Parents and Negative S...

Background : Survivors of life-endangering trauma use varying resources that help them to recover. Attachment system activates in the times of distress, and is expected to associate with stress responses, arousal regulation, and mental health. Objective : We examined the associations of attachment style with posttraumatic stress disorders (PTSD) symptoms and dissociative symptoms, and posttraumatic growth (PTG) among students exposed to a school shooting in Finland in a three-wave follow-up setting. Method : Participants were students ( M age =24.9 years; 95% female) who were followed 4 (T1, N =236), 16 (T2, N =180), and 28 months (T3, N =137) after the shooting. The assessments included the Attachment Style Questionnaire, the Impact of Event Scale, part of the Adolescent Dissociative Experiences Scale and the Posttraumatic Growth Inventory. Results : Securely attached survivors had lower levels of posttraumatic stress and dissociative symptoms than preoccupied at T1 and T2 as hypothesized. At T3 survivors with avoidant attachment style had higher levels of intrusive and hyperarousal symptoms than those with secure style. Concerning PTG, survivors with avoidant attachment style scored lower in PTG at T3 than survivors with both secure and preoccupied style. Conclusion : Secure attachment style was beneficial in trauma recovery. A challenge to the health care systems is to acknowledge that survivors with preoccupied and avoidant attachment styles react uniquely to trauma, and thus need help in different doses, modalities, and timings. Keywords: Attachment style; school violence; dissociation; posttraumatic stress symptoms; posttraumatic growth Responsible Editor: Grete Dyb, Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Norway. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Article Tools) This paper is part of the Special Issue: Understanding terror and violence in the lives of children and adolescents . More papers from this issue can be found at http://www.eurojnlofpsychotraumatol.net (Published: 2 July 2014) Citation: European Journal of Psychotraumatology 2014, 5 : 22728 - http://dx.doi.org/10.3402/ejpt.v5.22728 A Corrigendum has been published for this paper. Please see http://www.ejpt.net/index.php/ejpt/article/view/26871

Memory and metamemory functioning were studied among 30 adult patients suffering from major depression. The results indicate that, besides showing signs of cognitive slowing, the patients were especially vulnerable to visual memory impairment, whereas verbal, short-term memory, and recall by recognition were more often unaffected. The patients whose depression was characterized by physiological symptoms, such as loss of appetite and sleep disturbances, showed impairment in traditional short-term memory measures, whereas there was no firm connection between cognitive or behavioral depressive symptoms and memory functioning. The depressive patients' generalized view of their memory capability was strongly underestimated, whereas online metamemory accuracy by which one perceives and makes inferences about one's performance was adequate.

(1988). Experiences of Torture, Means of Coping, and Level of Symptoms among Palestinian Political Prisoners. Journal of Palestine Studies: Vol. 17, No. 4, pp. 81-96.

(1989). Factors Affecting the Mental Health of Palestinian Children Exposed to Political Violence. International Journal of Mental Health: Vol. 18, Mental Health Aspects of Political Repression and Violence—III, pp. 63-79.