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BackgroundResearch on psychosocial interventions has been focused on the effectiveness of psychosocial interventions on mental health outcomes, without exploring how interventions achieve beneficial effects. Identifying the potential pathways through which interventions work would potentially allow further strengthening of interventions by emphasizing specific components connected with such pathways.MethodsWe conducted a preplanned mediation analysis using individual participant data from a dataset of 11 randomized controlled trials (RCTs) which compared focused psychosocial support interventions versus control conditions for children living in low‐ and middle‐income countries (LMICs) affected by humanitarian crises. Based on an ecological resilience framework, we hypothesized that (a) coping, (b) hope, (c) social support, and (d) functional impairment mediate the relationship between intervention and outcome PTSD symptoms. A systematic search on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, PyscARTICLES, Web of Science, and the main local LMICs databases was conducted up to August 2018. The hypotheses were tested by using individual participant data obtained from study authors of all the studies included in the systematic review.ResultsWe included 3,143 children from 11 studies (100% of data from included studies), of which 1,877 from six studies contributed to the mediation analysis. Functional impairment was the strongest mediator for focused psychosocial interventions on PTSD (mediation coefficient −0.087, standard error 0.040). The estimated proportion of effect mediated by functional impairment, and adjusted for confounders, was 31%.ConclusionsFindings did not support the proposed mediation hypotheses for coping, hope, and social support. The mediation through functional impairment may represent unmeasured proxy measures or point to a broader mechanism that impacts self‐efficacy and agency.

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

Aim:This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother–infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms.Background:Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities.Methods:The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n= 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby’s age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants’ 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs).Findings:The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.

Objective Women and their infants need special protection in war context, as traumatic events can risk maternal mental and obstetric health and compromise infant development. This prospective study examined, first, how exposure to war trauma is associated with maternal mental health in pregnancy and postpartum, obstetric and newborn health, and infant development. Second, it tested the role of maternal mental health and obstetric risks in mediating between war trauma and infant development. Method Palestinian women (N = 511) from the Gaza strip participated during pregnancy (T1) and at 4 (T2) and 12 (T3) months postpartum. They reported PTSD, depressive, anxiety, and dissociative symptoms, as well as pregnancy complications, newborn health risks such as prematurity, and infant sensorimotor and language development. Results First, exposure to war trauma was associated with high levels of maternal mental health and complications at pregnancy, and with increased postpartum mental health symptoms, but exposure was not directly associated with newborn health risks or problems in infant development. Second, maternal mental health both in pregnancy and postpartum, but not pregnancy complications or newborn health, mediated the negative impact of war trauma on infant sensorimotor and language development at 12 months. Conclusion Interventions to protect early child development in war conditions should be tailored to support maternal mental health. (PsycINFO Database Record

Multiple psychosocial factors influence help-seeking behavior among immigrants, but studies have focused on separate issues in single cultural groups. This study tested a model of help-seeking behavior among three ethnically different immigrant groups. Participants were 1356 Somali, Russian, and Kurdish immigrants (18-64 years). They reported past traumatic events, social network, acculturation indices, trust in services, and mental health as well as usage of mental and somatic health services. Structural equation modeling (SEM) with multigroup procedure was applied. First, past traumatic events were associated with seeking more mental health services, indirectly mediated through increased risk for mental health problems in all three ethnic groups. Second, acculturation played a significant role in the use of mental and somatic health services only in Kurds and social networks in Kurds and Russians. The unique culturally influenced dynamics in help-seeking behavior should be considered in the development of health services.

War survivors use multiple cognitive and emotional processes to protect their mental health from the negative impacts of trauma. Because mothers and infants may be especially vulnerable to trauma in conditions of war, it is urgent to determine which cognitive and emotional processes are effective for preventing negative trauma impacts." This study examined whether mothers' high posttraumatic growth (PTG) and positive posttraumatic cognitions (PTC) protected (a) their own mental health and (b) their infants' stress regulation and sensorimotor and language development from the effects of war trauma. The participants were 511 Palestinian mothers and their infants living in the Gaza strip. The mothers were interviewed in their second trimester of pregnancy (T1) as well as when the infant was four months (T2) and twelve months (T3). Mothers reported posttraumatic growth (PTG; Tedeschi & Calhoun, 1996) at T1 and posttraumatic cognitions (PTCI; Foa et al., 1999) at T2. They also reported their exposure to traumatic war events both at T1 and T3 and described their mental health conditions (e.g., PTSD and/or depressive and dissociation symptoms) at T3. The Infant Behaviour Questionnaire (IBQ) was used to measure infants' stress regulation at T2 and sensorimotor and language development at T3. The results, based on regression analyses with interaction terms between trauma and PTG, showed that high levels of traumatic war events were not associated with high levels of PTSD, depressive, or dissociation symptoms among mothers showing high levels of PTG. This suggests that PTG may protect maternal mental health from the effects of trauma. In turn, positive maternal PTCs appeared to protect the infants' stress regulation from the effects of war trauma. The study concludes by discussing ways to develop and implement preventive interventions for mother-infant dyads in war conditions.

Objective To identify interplay of early maternal and paternal mental health symptoms for predicting child mental health and development. Background Research on family mental health has largely excluded fathers, although the well-being of both parents is likely to be important for child development. In this study, we analyzed (a) intrafamilial dynamics between mothers' and fathers' early mental health symptoms and (b) the importance of separate (mother and father) and joint (additive, hierarchical, and buffering) theoretical models of parental mental health for predicting child mental health and development. Method Finnish mothers and fathers (N = 763), half of whom conceived through assisted reproductive treatments (ART), reported their symptoms of psychological distress and depression from the pregnancy to 2 months and 12 months postpartum. Later, when the child was 7–8 years of age, parents (N = 485) reported the child's internalizing and externalizing symptoms and social and cognitive developmental problems. Results We identified both co-occurrence and compensation in intrafamilial early parental mental health. Further, mothers' symptoms alone (separate mother model) predicted child internalizing symptoms, whereas joint parental symptoms (additive model) predicted problems in executive function. Conclusion The pre- and postnatal mental health of mothers and fathers is important for later child development. Implications To support healthy child development, both parents need to be screened for early mental health problems, and psychological help should be offered to families across the pre- and postpartum period.

Effective emotion regulation (ER) is expected to protect mental health in traumatic stress. We first analysed the protective (moderator) function of different ER strategies and the associations between ER and mental health. Second, we tested gender differences in the protective function of ER and the associations between ER strategies and mental health. Participants were 482 Palestinian children (girls 49.4%; 10–13 years, M = 11.29, SD = .68) whose ER was assessed by the Emotion Regulation Questionnaire and mental health by post-traumatic stress (Children's Impact Event Scale), depressive, and psychological distress (Strengths and Difficulties Questionnaire) symptoms, and by psychosocial well-being (Mental Health Continuum-Short Form). War trauma involved 42 events. Results showed, first, that none of the ER strategies could protect a child's mental health from negative impact of war trauma, but self-focused ER was associated with low depressive symptoms, and other-facilitated ER with high psychological well-being. However, controlling of emotions formed a comprehensive risk for children's mental health. Second, gender differences were found in the protective role of ER, as self-focused and distractive ER formed a vulnerability among boys. The results are discussed in the context of emotional and regulative demands of war and life-threat.

Both severity and type of trauma play a role in mental health consequences. Interpersonal trauma, especially sexual abuse and intentional assaultive violence, form a risk for posttraumatic stress disorder (PTSD). However, few studies have factually compared the impact of trauma types on mental health. This study examined whether interpersonal violence (IPV), natural disasters and accidents (NDA), and life-threat and war (LTW) are differently associated with mental health problems among women. It further examined the mediating role of posttraumatic cognitions (PTCs) among the abovementioned three types of traumatic events and mental health problems. The participants were 1,569 Eastern Anatolian women (16-72 years of age). Traumatic events were assessed with the Life Events Checklist (LEC), mental health with the Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5) diagnostic criteria for PTSD, psychiatric distress symptoms with the GHQ-28 (General Health Questionnaire) scales, and PTCs with the self-related and other-related scales of the Posttraumatic Cognitions Inventory (PTCI). As hypothesized, IPV was more significantly associated with PTSD, anxiety, and somatization symptoms than with NDA. The LTW was significantly associated with all symptoms. Both self-related and other-related PTCs partially mediated the association of both IPV and NDA with mental health problems. The findings are discussed from the perspectives of women and human rights, emphasizing also the importance of cognitive processing of traumatic experiences in enhancing good mental health.

Background: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. Methods: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. Results: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. Conclusions: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

A father’s mental health is important for family well-being, but research is scarce on paternal symptoms during the transition to fatherhood. This study identified fathers’ latent mental health trajectory classes from the pre- to postnatal period and examined their associations with early fathering experiences. It further analysed, whether a family’s infertility history was associated with mental health trajectory classes and moderated their effects on fathering experiences. Finnish fathers ( N = 773) reported psychological distress (General Health Questionnaire; GHQ-36) and depressive symptoms (Beck Depression Inventory; BDI-13) in pregnancy (T1), and at 2 months (T2) and 12 months (T3) postpartum. They further reported their fathering experience (Parenting Stress Index; PSI-36) at T2 and T3. Results revealed five paternal mental health trajectory classes, differing in timing and course of symptoms across the pre- and postpartum: stable low (79%) and moderate increasing (9%) levels of symptoms, and prenatal (5%), early fatherhood (3%) and heterogeneous high levels of (4%) problems. The trajectory classes were associated with fathering experiences within parental, interactive and child domains, across the child’s first year. The stable low levels of symptoms-class showed the most positive experiences and the heterogeneous high levels of problems-class the most negative ones; mental health problems in the early fatherhood-class reported negative fathering experience, but only when the child was 2 months old. A family’s infertility history neither showed any significant association with trajectory classes nor moderated their impact on early fathering, supporting the growing evidence that infertility treatments do not place an additional burden on early fatherhood.

Little is known about the buffering role of social support among orphans living in Africa. This study examined (1) how perceived social support (PSS) varied across orphan-related characteristics (e.g., orphan status, such as single, maternal or paternal, and their living environments, such as in child-headed households, on the street, in an orphanage or in a foster home) and (2) the relative importance of sources of PSS (relatives/community/adults and peers) and functional social support (emotional/informational/instrumental and social) and its association with emotional well-being and mental distress. The participants included 430 orphaned Rwandan children and youth aged between 10 and 25 years (Mean age= 17.74), of whom (n =179, 41.6 percent) were females and (n = 251, 58.4 percent) were males. Result showed that children living in an orphanage exhibited a higher level of PSS from all sources of social support than did children in other living environments. A higher level of PSS from relatives, communities and adults was associated with high level of emotional well-being, and only adult support was associated with low level of mental distress. Furthermore, the functional PSS indicated that emotional support and companionship support were equally important in their association with higher levels of emotional well-being and lower levels of mental distress. The findings highlight the importance of having different sources of social support and their functions in relation to psychosocial well-being.

Maternal mental health problems can negatively impact children's physiological stress regulation. Yet, little is known of their long-term effects, especially related to the timing of maternal symptoms. We examined how maternal mental health problems during pregnancy versus in the early postpartum period predict children's cortisol levels and diurnal patterns at 10–12 years. Participants were a selection (N = 102) of an original sample of 805 Finnish families, who were followed from the second trimester of pregnancy (T1) to child's age of 2 months (T2) and 12 months (T3), and again at child's age of 10–12 years (T4). Based on the timing of psychological distress and depressive symptoms (T1–T3), the mothers could be assigned to three distinct mental health trajectory groups: mothers with prenatal mental health problems (n = 15), mothers with early postpartum mental health problems (n = 15) and mothers without mental health problems (n = 72). Children's cortisol (T4) was measured by saliva samples through five within-1-day assessments. The results show that maternal prenatal mental health problems predicted a relatively steep increase of child cortisol from awakening to 1 h later, indicating an intensified cortisol awakening response (CAR). Mothers' early postpartum mental health problems instead predicted a reduced CAR. Both maternal prenatal and postnatal mental health problems thus predicted children's later stress regulation, but in unique ways. We discuss the specific roles of direct biochemical effects during pregnancy and postpartum mother–infant interaction quality as modifiers of the hypothalamic–pituitary–adrenal system. Copyright © 2015 John Wiley & Sons, Ltd.

Background Women at pre partum and post partum are especially susceptible to war trauma because they struggle to protect their infants from danger. Trauma research suggests increased problems in maternal mental health and infant development. Yet many cognitive-emotional processes affect the trauma survivors' mental health, such as post-traumatic growth and post-traumatic cognition. The aim of this study was to examine whether a mother's high post-traumatic growth and optimal post-traumatic cognition could protect their own mental health and their infant's stress regulation from the effects of traumatic war experiences. Methods This three-wave prospective study involved Palestinian women living in the Gaza Strip who were at the second trimester of pregnancy (T1), women with infants aged 4 months (T2), and women with children aged 12 months (T3) months. The participants reported their war experiences in a 30-item checklist of losses, destruction, and atrocities in the 2008–09, 2012, and 2014 military offensives. Post-traumatic growth was assessed by a 21-item scale and post-traumatic cognition by a 36-item scale. Maternal mental health was assessed by post-traumatic stress disorder (PTSD), depressive, anxiety, and dissociation symptoms at T1 and T3, and infants' stress regulation was assessed with the Infant Behaviour Questionnaire at T2 and T3. Findings We included 511 women at T1, 481 women at T2, and 454 women at T3. High maternal post-traumatic growth and post-traumatic cognition had protective roles. Post-traumatic growth had a protective effect on maternal mental health since severe exposure to traumatic war experiences was not associated with maternal PTSD, depression, and dissociation if women showed high post-traumatic growth, as indicated by the significant interaction effect between post-traumatic growth and war trauma on each of the three symptoms. Post-traumatic cognition had a protective effect on infant development since severe exposure was not associated with dysfunctional infant emotion regulation when mothers reported optimal post-traumatic cognition, as indicated by the significant interaction effect between post-traumatic cognition and war trauma on each of negative affectivity and surgency or extraversion. Interpretation The nature of cognitive emotional processing of war trauma could explain the distinct roles of post-traumatic growth and post-traumatic cognition. High post-traumatic growth involves increased social affiliation, spiritual awareness, and psychological strengths resulting from painful and traumatic experiences. In the national struggle for independence, post-traumatic growth is often associated with heroism and even hardiness, which might benefit a mother's mental health but not their infant's wellbeing. Optimal post-traumatic cognition indicates successful and harmonious trauma processing, which enables mothers to be more reflective and sensitive to their infant's needs. Interventions to promote healthy infant development in war settings should encourage and support mothers' effective cognitive-emotional processing of traumatic experiences. Funding The Academy of Finland and University of Tampere, Finland.

Background: Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective: This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children’s mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers (N = 325) and their children (one per family; 49.4% girls; 10–13 years old; mean ± SD age = 11.35 ± 0.57 years) after the Gaza War of 2008–2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child’s internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children’s Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children’s Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n = 44). Further, families with discrepant experiences (23.0%; n = 65) and moderate security and neutral relationships (25.2%; n = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic interventions for children should, thus, also involve parents and siblings. Knowledge of unique family attachment patterns is fruitful for tailoring therapeutic treatments and preventive interventions for war-affected children and families.

STUDY QUESTION Do children born after assisted reproductive techniques (ART; IVF/ICSI) display more mental health issues or social and cognitive developmental problems at 7-8 years than naturally conceived (NC) controls, and does child gender play a role? SUMMARY ANSWER ART children do not differ with regard to mental health or social and cognitive developmental problems when compared with controls, but some gender-specific differences do exist. WHAT IS KNOWN ALREADY Systematic reviews have not found any evidence of delays in neurocognitive or sensorimotor development in ART children. However findings on the effect of the type of ART treatment (IVF versus ICSI) on the offspring's physical and mental development have not been uniform. Knowledge of the role of child gender in ART research is scarce. STUDY DESIGN, SIZE, DURATION This prospective follow-up study compares mental health and social and cognitive developmental problems between 7-8-year-old ART and NC children, controlling for the father's age, length of the parents' partnership, mother's parity, child's gestational age, and the need of neonatal intensive care unit (NICU). Further, within the ART group, we analysed whether the treatment type (IVF versus ICSI) and the child's gender are associated with the mental health and developmental outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS In this study, 255 singleton ART children (IVF and ICSI) were compared with 278 NC children on parent-reported internalizing and externalizing symptoms, and social (social skills and peer relations) and cognitive development (executive functioning, perception, memory, and language). Within the ART group, 164 IVF and 76 ICSI children were compared on the same outcomes. Statistics included analyses of covariates (ANCOVA) with group main effects, group and gender interaction effects, and Bonferroni post hoc tests. MAIN RESULTS AND THE ROLE OF CHANCE ART and NC children did not differ generally in terms of their internalizing and externalizing symptoms or in the number of social and cognitive developmental problems (Group main effects, P > 0.05), but gender-specific group differences existed. The ART boys showed lower levels of cognitive problems than the NC boys, whereas ART girls showed higher levels of cognitive problems than the NC girls (Group × Gender-interaction effects with Bonferroni post hoc tests on mother-reports, P < 0.01). Further, unlike in the NC group, where boys showed more externalizing symptoms and social and cognitive developmental problems than girls (Group × Gender-interaction effects with Bonferroni post hoc tests for both parents' reports, P < 0.05), gender differences were not found in the ART group. Within the ART group, IVF and ICSI children did not differ in terms of mental health or developmental outcomes, and no significant gender differences emerged. LIMITATIONS, REASONS FOR CAUTION The information on children's mental health and development was based on parental reports only. The dropout rate between the child's first year and the school age assessments was very high for fathers (57.4%) and substantial for mothers (30.1%), and the participating group was biased for older age of both parents and for better education of the fathers. WIDER IMPLICATIONS OF THE FINDINGS The findings indicate the importance of considering child gender in learning about multiple developmental outcomes among children born after ART. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Academy of Finland (#11232276), the Emil Aaltonen Foundation, The Family Federation of Finland, Helsinki University Central Hospital Research Funds, and the National Graduate School of Psychology. None of authors has any competing interests to declare.

Objective Research shows great individual variation in changes in posttraumatic stress symptoms (PTSSs) after major traumas of terrorist attacks, military combat, and natural disasters. Earlier studies have identified specific mental health trajectories both in children and adults. This study aimed, first, to identify potential PTSS-related trajectories by using latent class growth analyses among children in a three-wave assessment after the 2008/2009 War on Gaza, Palestine. Second, it analyzed how family- and child related factors (e.g., attachment relations, posttraumatic cognitions (PTCs), guilt, and emotion regulation) associate with the trajectory class membership. Methods The sample consisted of 240 Palestinian children (49.4% girls and 50.6% boys) of 10–13 years of age (M=11.29, SD=0.68), who completed PTSS (CRIES) assessments at 3 (T1), 5 (T2), and 11 (T3) months after the war. Children reported their personal exposure to war trauma, attachment style, cognitive trauma processing, and emotion regulation, and their parents reported family war trauma exposure and attachment style. Results Results revealed a three-trajectory solution, a majority of children belonging to the Recovery trajectory (n=183), and a minority belonged either to Resistant trajectory (n=29) or to Increasing symptoms trajectory (n=28). Low levels of negative posttraumatic cognitive appraisals, feelings of guilt and emotion regulation were characteristic of children in the Resistant trajectory as compared to Increasing symptoms trajectory. Father׳s attachment security was further associated with the Resistant trajectory membership. Children׳s attachment avoidance and high parental trauma were typical to children in Recovery trajectory (as compared to the Increasing symptoms trajectory).

Background: Among adults there is strong evidence about peritraumatic dissociation (PD) predicting posttraumatic stress disorder (PTSD), yet evidence among children is very limited. It has been suggested that disturbances in memory functioning might explain the association between PD and PTSD, but this has not yet been empirically tested. Objective: We aimed to test the hypotheses that greater PD would be associated with more posttraumatic stress disorder (PTSD) symptoms, and that some of this association would be mediated by disorganized and non-verbal memories about the traumatic event. Method: The sample included 197 Palestinian children (10–12-years) living in the Gaza Strip, participating in the aftermath of the 2008/9 war. Self-report questionnaires were used to measure PD (Peritraumatic Dissociative Experiences Questionnaire) three months post-war, as well as trauma-related memory (Trauma Memory Quality Questionnaire) and PTSD symptoms (Children’s Revised Impact of Event Scale) six months later. Exposure to war trauma was assessed by a checklist. Structural equation modelling was used to examine direct and indirect paths from PD to posttraumatic PTSS, controlling for number of traumatic war events. Results: Structural equation modelling results showed that greater self-reported PD predicted higher levels of PTSS nine months post-war, and that a significant part, but not all, of this relationship was mediated via the quality of trauma-related memories. Conclusions: This study provided empirical evidence that, among war-affected children, greater PD during traumatic events is linked with higher levels of PTSD symptoms several months later, even when accounting for their personal exposure to war trauma. Further, the study supported the idea that the detrimental effects of dissociation during a traumatic event may be due to dysfunctional memories characterized by disorganization and lack of access to verbal and coherence. Further tests of these hypotheses with larger samples and more points of measurement are called for.

The purpose of this controlled study was to examine the outcome of psychodynamic mother-infant group psychotherapy (PGT) outpatient intervention for drug-abusing perinatal mother-infant dyads. PGT comprised 20 to 24 weekly 3-hr sessions with 3 to 5 months of follow-up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother-infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother-infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug-abusing dyads in PGT, 25 in PSS, and 50 dyads in a non-drug-abusing comparison group. Assessments were pre-intervention and at 4 and 12 months' follow-up, including maternal depressive symptoms and mother-child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother-infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high-risk dyads.

This study examined (1) how attachment style predicts changes in mental health, and (2) whether change in emotion regulation (ER) intensity mediates that association in the context of psychosocial intervention among war-affected children. Participants were 482 Palestinian children whose school classes were randomized to either intervention (Teaching Recovery Techniques, TRT) or waiting-list groups. Attachment style, emotion regulation, and mental health were measured. The children with secure attachment were more likely to gain improved mental health in both conditions, but also preoccupied-insecure children showed improved mental health in the TRT. In the control group, instead, children with more attachment avoidance reported deteriorated mental health, and no changes in mental health was found among preoccupied children. Changes in the ER intensity did not mediate the association between attachment style and mental health in either groups. Discussion focuses on attachment-specific mechanisms underlying recovery from war trauma.

In this study, we analyzed the manifestation of somatic-affective and cognitive depressive symptoms among older Somali refugees and native Finns. Second, we explored how depressive symptoms, alexithymia, and somatization are associated in the two groups. Finally, we analyzed how two psychosocial factors, sense of coherence (SOC) and social support, are connected to depressive symptoms among Somalis and Finns. The participants were examined with the Beck Depression Inventory (BDI) for depressive symptoms, the Symptom Checklist–90–Revised (SCL-90-R) for somatization, Toronto Alexithymia Scale (TAS-20) for alexithymia, and the Sense of Coherence (SOC-13) concept for SOC. Social support was indicated by help received from social networks and marital status. Results showed that Somalis manifested more somatic-affective symptoms of depression than Finns, whereas Finns manifested more cognitive symptoms than Somalis. The association between depressive symptoms and alexithymia was stronger in the Finnish group, whereas the association between depressive symptoms and somatization was stronger in the Somali group. The association between alexithymia and somatization did not differ between the groups. A weak SOC explained depressive symptoms among Somalis and Finns, but poor social support did not explain depression in either group. The results are discussed in relation to Somali and Finnish cultures, mental health beliefs, and immigrant populations.

Mental and somatic health was compared between older Somali refugees and their pair-matched Finnish natives, and the role of pre-migration trauma and post-migration stressors among the refugees. One hundred and twenty-eight Somalis between 50–80 years of age were selected from the Somali older adult population living in the Helsinki area ( N = 307). Participants were matched with native Finns by gender, age, education, and civic status. The BDI-21 was used for depressive symptoms, the GHQ-12 for psychological distress, and the HRQoL was used for health-related quality of life. Standard instruments were used for sleeping difficulties, somatic symptoms and somatization, hypochondria, and self-rated health. Clinically significant differences in psychological distress, depressive symptoms, sleeping difficulties, self-rated health status, subjective quality of life, and functional capacity were found between the Somali and Finnish groups. In each case, the Somalis fared worse than the Finns. No significant differences in somatization were found between the two groups. Exposure to traumatic events prior to immigrating to Finland was associated with higher levels of mental distress, as well as poorer health status, health-related quality of life, and subjective quality of life among Somalis. Refugee-related traumatic experiences may constitute a long lasting mental health burden among older adults. Health care professionals in host countries must take into account these realities while planning for the care of refugee populations.

In a longitudinal study of war-affected children, we tested, first, whether posttraumatic cognitions (PTCs) mediated the relationship between initial and later posttraumatic stress symptoms (PTSSs). Second, we analyzed the relative strength of influences that PTCs and PTSSs have on each other in cross-lagged models of levels and latent change scores. The participants were 240 Palestinian children 10-12 years of age, reporting PTSSs and PTCs measures at 3, 5, and 11 months after a major war. Results show that PTCs did not mediate between initial and later PTSSs. The levels and changes in PTCs statistically significantly predicted later levels and changes in PTSSs, but PTSSs did not statistically significantly predict later PTCs. The results are consistent with the hypothesis that PTCs have a central role in the development and maintenance of PTSSs over time, but they do not support the hypothesis that initial PTSSs develop to chronic PTSSs through negative PTCs.

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 study examines the effectiveness of the School Mediation Intervention (SMI) in preventing mental health problems and promoting social functioning among children living in armed conflict. The participants were 225 Palestinian children in the Gaza Strip, divided into the intervention group (n = 141) from schools where the SMI was implemented and the control group (n = 84) from a school with no SMI implementation. The SMI aimed at improving pupils’ social functioning through methods of problem solving, conflict resolution, and dialogue skills and at enhancing mental health through caring for peers and preventing disruptive and aggressive behavior. Older students acted as responsible school mediators and teachers as supervisors. Participants reported symptoms of posttraumatic stress disorder (PTSD), depression (CDI), psychological distress (SDQ), and quality of friendship, prosocial behavior, and …

The aim of this study was to examine, first, how past traumatic stress and present acculturation indices, and discrimination are associated with mental health; and, second, whether religiousness can buffer the mental health from negative impacts of war trauma.Participants were 128 older (50-80 years) Somali refugees living in Finland. They reported experiences of war trauma and childhood adversities, and filled-in questionnaires of perceived ethnic discrimination, religiousness (beliefs, attendance, and observance of Islamic faith), and symptoms of posttraumatic stress disorder (PTSD), depressive (BDI-21), psychological distress (GHQ-12), and somatization (SCL-90).Symptom-specific regression models showed that newly arrived refugees with non-permanent legal status and severe exposures to war trauma, childhood adversity, and discrimination endorsed greater PTSD symptoms, while only war trauma and discrimination were associated with depressive symptoms. Results confirmed that high religiousness could play a buffering role among older Somalis, as exposure to severe war trauma was not associated with high levels of PTSD or somatization symptoms among highly religious refugees.Health care should consider both unique past and present vulnerabilities and resources when treating refugees, and everyday discrimination and racism should be regarded as health risks.

We examined the effectiveness of a psychosocial intervention in reducing mental health symptoms among war-affected children, and the role of peritraumatic dissociation in moderating the intervention impact on posttraumatic stress symptoms (PTSS). School classes were randomized into intervention (n = 242) and waitlist control (n = 240) conditions in Gaza, Palestine. The intervention group participated in 16 extracurriculum sessions of teaching recovery techniques (TRT) and the controls received normal school-provided support. Participants were 10- to 13-year-old Palestinian girls (49.4%) and boys (50.6%). Data on PTSS, depressive symptoms, and psychological distress were collected at baseline (T1), postintervention (T2), and 6-month follow-up (T3). Peritraumatic dissociation was assessed only at baseline. Regression analyses that took regression to the mean and cluster sampling into account were applied. The results on intervention effectiveness were specific to gender and peritraumatic dissociation. At T2, the intervention significantly reduced the proportion of clinical PTSS among boys, and both the symptom level (R(2) = .24), and proportion of clinical PTSS among girls who had a low level of peritraumatic dissociation. The results have implications for risk-specific tailoring of psychosocial interventions in war conditions.

Some mothers who have recently lost a significant attachment figure may become mentally incoherent and sporadically even enter a trancelike, dissociative state. Such states of mind have been shown to predict infant attachment disorganization. Infants born close to the time of a parental loss are at a greater risk for intergenerational trauma. A background of maternal substance abuse is also known to increase such risk. We illustrate by way of a case study how a mother–infant group psychotherapy programme aimed at substance-abusing mothers may help to prevent the transmission of mother’s unresolved trauma to the infant. Another goal was to discuss how attachment-derived methods (namely, Adult Attachment Interview, Strange Situation Procedure and the Emotional Availability Scales) may aid in understanding the effects of the intervention.

Pregnancy and early motherhood involve uncertainty and change, which can evoke mental health problems. We identified maternal mental health trajectories in pre- and postnatal period, and examined their association with later child mental health and development. Finnish mothers reported psychological distress (General Health Questionnaire [GHQ-36]) and depressive (Beck Depression Inventory [BDI-13]) symptoms in pregnancy (T1; N = 788) and two months (T2; N = 657) and 12 months (T3; N = 545) postpartum. Both parents accounted their child’s mental health (Behavior Assessment System for Children [BASC]) and social (Social Skills Rating System [SSRS], Child Behavior Scale [CBS]) and cognitive development (Five to Fifteen [FTF]) when the child was 7–8 years old (T4; N = 485). We identified five trajectories depicting unique timing and course of maternal mental health from pregnancy into 1 year of mothering: Stable low levels of mental health symptoms (75%) and prenatal (6%), early postpartum (9%) and late postpartum (6%) mental health problems. The fifth trajectory, heterogeneous high levels of mental health problems (4%) was an unclassified post hoc class, combining mothers with chronic high or highly variable mental health profiles. Results show some trajectory-related timing effects on children’s mental health and cognitive development. The trajectories of early postpartum and heterogeneous high levels of mental health problems predicted higher level of internalizing symptoms as compared to stable low-levels trajectory. The heterogeneous high-levels trajectory predicted higher levels of problems in executive functions than the stable low and late postpartum trajectories, and in memory tasks than children in other trajectories. We discuss the timing and course of maternal mental health from the viewpoint of infant and child development.

The authors examined how different types of torture methods are associated with posttraumatic stress disorder (PTSD) and somatic symptoms among political ex-prisoners. Participants were 275 Palestinian men who reported their experiences in detention and imprisonment, PTSD (the Harvard Trauma Questionnaire), and somatic symptoms. A principal component analysis revealed physical torture, psychological torture, sensory discomfort and deprivation, and beatings as dimensions of exposure to torture. Both physical and psychological torture methods were associated with increased PTSD symptoms, especially when combined. Psychological torture was also associated with increased somatic symptoms. The results are discussed in relation to their contribution to the current debate on the nature and definition of torture.

Long periods of use of Information and Communication Technology (ICT) may raise strong emotions and lead to cog-nitive fatigue. The current study focused on the impact of ICT use the preceding day on the next-day salivary cortisol pattern in 72 school-aged children (39 at the age ten and 33 at the age 13). Salivary cortisol levels were measured at five time points from awakening to bedtime. Time spent in different ICT activities the day before salivary sampling was measured by an activity diary. Results showed that the participants who had used ICT on an average three hours the preceding day showed a significantly reduced cortisol increase one hour after awakening (awakening response) com-pared to those who had used ICT not at all or less than one hour after controlling for pubertal status and the level of depression. The results suggest a stress response as a consequence of a long period of ICT use.

Increasing research is available on the preconditions for child mental health and optimal development in traumatic conditions, whereas less is known how to translate the findings into effective interventions to help traumatized children. This literature review analyses the effectiveness of psychosocial preventive interventions and treatments and their theoretical bases among children traumatized in the context of armed conflicts (war, military violence, terrorism and refugee). The first aim is to evaluate the effectiveness of preventive interventions in preventing emotional distress and impairment and promoting optimal emotional-cognitive and social development. The second task is to analyze the nature of the underlying mechanisms for the success of preventive interventions, and the theoretical premises of the choice of intervention techniques, procedures and tools. We found 16 relevant published studies, but an examination of them revealed that only four of them had experimental designs strong enough that they could be included in the meta-analysis. While the subjective reports of the researchers suggested that systematic preventive interventions were effective in decreasing PTSD and depressive symptoms among children traumatized due to armed conflict, the more objective results of the meta-analysis and the weaknesses in designs uncovered during the meta-analysis undermine such a conclusion. Additionally, a majority of the reported preventive interventions focused only on children's biased cognitive processes and negative emotions, while only a few aimed at influencing multiple domains of child development and improving developmental functioning on emotional, social and psychophysiological levels. It is concluded that substantial additional work needs to be done in developing effective preventive interventions and treatments for children traumatized by exposure to war and violence.

Prenatal expectations are important for the future parent-child relationship. The authors examined how maternal and paternal prenatal expectations of the relationship with the child predicted 1st-year parenting stress and whether these expectations were violated over the transition to parenthood. They further examined how former infertility affected these associations. The participants were 745 Finnish couples, 367 having undergone a successful assisted reproductive treatment and 378 conceiving spontaneously. Couples completed a questionnaire of family representations during pregnancy and when the child was 2 and 12 months old and Abidin's Parenting Stress Index at 2 and 12 months postpartum. The hypothesis of moderately high expectations predicting the lowest level of parenting stress was substantiated only concerning paternal expectations of own autonomy with the child. Generally, however, negative expectations of own and spouse's relationship with the child were linearly associated with higher parenting stress. Postnatal representations were more positive or equal to expectations, except for negative violation occurring in maternal expectation of the father-child relationship, especially among normative mothers. The results are discussed in relation to family dynamic considerations and special features of formerly infertile couples.

Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations.

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...

The role of individual and group treatment and self and other representations in predicting posttraumatic symptoms and growth was examined among 115 Palestinian former political prisoners. Twenty participated in individual therapy and 19 in group therapy; 76 belonged to the control group. The results showed that posttraumatic symptoms decreased only in the individual therapy, whereas no decrease was found in group therapy or control groups across 1 year. Somatic symptoms decreased generally, whereas no general or treatment-related change was found in posttraumatic growth. As hypothesized, representations characterized by positive contents (benevolent, ambitious, and nonpunitive) predicted decrease in symptoms and increase in posttraumatic growth. Furthermore, positive content and mature, differentiated, and nonambivalent structure of representations predicted decrease in posttraumatic …

In this study, we compared dream narratives of children and adolescents living under conditions of enduring interpersonal violence (n = 220) versus those living in peaceful surroundings (n = 99) on content variables that have been associated with traumatic experiences in Rorschach (Exner, 1995) imagery. As predicted, children and adolescents living in circumstances of enduring violence reported a higher proportion of content scorable by Armstrong and Loewenstein's (1990) Trauma Content Index and a much higher proportion of aggressive objects in their dreams (AgC; Gacono & Meloy, 1994). In support of discriminant validity, no consistent group differences were observed for the relative frequencies of Animal (A), Clothing (Cg), or Cooperative movement (COP) content. The modest association between manifest dream content and psychological symptom scales suggests that the former may alternatively reflect adaptive or psychopathological processes. Our findings suggest that content analysis of dreams may be a valuable adjunct in tapping the psychological state of children traumatized by violence.

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...

Objective The aim was to examine how traumatic and stressful events, responses to violence, child characteristics, and mothering quality, as measured in middle childhood predict psychological distress and positive resources in adolescence. Method The participants were 65 Palestinian adolescents (17 ± .85 years; 52% girls), who had been studied during the First Intifada (T1), during the Palestinian Authority rule (T2) and before the Second Al Aqsa Intifada (T3) in Gaza. Psychological distress was indicated by PTSD, and depressive symptoms and positive resources by resilient attitudes and satisfaction with quality of life, all measured at T3. The predictors that were measured at T1 were exposure to military violence, active coping with violence and children's intelligence, cognitive capacity, and neuroticism. Mothering quality and stressful life-events were measured at T2, the former reported by both the mother and the child, and the latter by the mother. Results Adolescents’ PTSD symptoms were most likely if they had been exposed to high levels of traumatic and stressful experiences and had poor cognitive capacity and high neuroticism in middle childhood. Only high levels of childhood military violence and stressful life-events predicted high depressive symptoms and low satisfaction with quality of life in adolescence. Conclusions Military violence in childhood forms risks for both increased psychological distress and decreased positive resources. However, child characteristics such as cognitive capacity and personality are important determinants of psychological vulnerability in military trauma.

Post traumatic cognitions (PTCs) are important determinants of post traumatic stress symptoms (PTS symptoms). We tested whether risk factors of PTS symptoms (trauma, demographics, social and family-related factors) predict PTCs and whether PTCs mediate the association between risk factors and PTS symptoms among war-affected children. The participants were 240 Palestinian children 10-12 years old, half boys and half girls, and their parents. Children reported about psychological maltreatment, sibling and peer relations, war trauma, PTCs, PTS symptoms, and depression. Parents reported about their socioeconomic status and their own PTS symptoms. The associations between the variables were estimated in structural equation models. In models which included all the variables, PTCs were predicted by and mediated the effects of psychological maltreatment, war trauma, sibling conflict, and peer unpopularity on PTS symptoms. Other predictors had statistically non-significant effects. Psychological maltreatment had the largest indirect effect (b* = 0.29, p = 0.002) and the indirect effects of war trauma (b* = 0.10, p = 0.045), sibling conflict (b* = 0.10, p = 0.045), and peer unpopularity (b* = 0.10, p = 0.094) were lower and about the same size. Age-salient social relationships are potentially important in the development of both PTCs and PTS symptoms among preadolescents. Furthermore, PTCs mediate the effects of the risk factors of PTS symptoms. The causality of the associations among the variables is not established but it could be studied in the future with interventions which improve the negative aspects of traumatized children's important social relationships.

Aims: The study had two aims: First, we assess the prevalence of resilience based on the person-based classification depicting a balance between the severity of trauma and occurrence of PTSD. Second, we examine the role of resilience characteristics of commitment, control and challenge in protecting children’s mental health from negative trauma impacts. Methods: The participants were 386 Palestinian children and adolescents from Gaza (age 13.41+2.96, 52.07% boys and 47.93% girls). The results revealed a 25% prevalence of resilient children, and resilience was more common in well-educated families and children from geographical areas exposed to heavily Israeli shelling and destruction. Children were interviewed by sociodemographic scale, Gaza Traumatic Events Checklist, Child Depression and Anxiety Scale, UCLA PTSD Index for DSM-IV-Adolescent Version, and Resilience Attitude Scale. Results: There were generally no gender differences in the exposure to traumatic events, as all. Neither were there gender differences in the mean number of traumatic events related to Israeli military violence or Palestinian factional fighting. According to the DSM-IV criterion, 12.4% of the children and adolescents reported probable PTSD, and 22.37% filled the two criteria partial PTSD, and 26.7% the one criteria partial PTSD (re-experiencing or avoidance or hyper arousal). More than a third (38.4% of the children did not have PTSD. There were no significant differences between boys and girls in PTSD. For depression and anxiety, boys and girls did not differ in the levels of PTSD, depressive and anxiety symptoms. Also only one marginal gender difference was found concerning resilience characteristics: girls reported more feelings of control than boys. The results revealed that 25.0% of the participants was classified as resilient indicating presence of high exposure to traumatic events and absence of PTSD and 22.2% as traumatized, i.e., presence of both high exposure to trauma and occurrence of PTSD. Of the children 12.7% were classified as vulnerable, and 40.1% were spared of both high trauma and PTSD. As hypothesized, resilience characteristics protected children’s mental health from trauma, e.g., military trauma was less associated with PTSD and anxiety among children showing high commitment. Discussion focuses on specific functions of resilience in the context of different kind of traumatic events of war, political and military violence.

We aimed to analyse and compare prevalence and associated clinical features of suicidal ideation, self-harm behaviour with no suicidal intent and suicide attempts among adolescent outpatients with depressive mood disorders with or without comorbidity. A sample of 218 consecutive adolescent outpatients aged 13–19 years with depressive mood disorders was interviewed using K-SADS-PL for DSM-IV Axis I diagnoses. They filled out self-report questionnaires assessing depressive and anxiety symptoms. Suicidal behaviour was assessed by K-SADS-PL suicidality items. Half of the subjects reported suicidal ideation or behaviour. There was no difference in prevalence of suicidal behaviour between non-comorbid and comorbid mood disorder groups. Multivariate logistic regression analyses produced the following associations: (1) suicidal ideation with self-reported depressive symptoms and poor psychosocial functioning, (2) deliberate self-harm behaviour with younger age and poor psychosocial functioning, and (3) suicide attempts with self-reported depressive symptoms and poor psychosocial functioning. Depressed mood disorders, whether comorbid or not, are associated with suicidal ideation and suicide attempts. Diagnostic assessment should be supplemented by self-report methods when assessing suicidal behaviour in depressed adolescents.

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 aims of this study were, first, to examine how exposure to war trauma, maternal neuroticism and psychological distress are associated with child psychological distress, and, second, whether good maternal mental health and low neuroticism can moderate the negative impact of war trauma on child mental health. Third, we examined whether mother-child dyads’ psychological distress was dependent on who was the main war trauma victim in the family: the mother, the child or both. Fourth, we tested whether mother-child dyads express similar or different symptoms. The sample consists of 121 Palestinian children (aged 6-16 years; 45% girls and 55% boys), and their mothers (aged 21-55 years) living under conditions of military violence and war in Gaza. Child psychological distress was measured using the CPTS-RI (child-reported) and Rutter Parent Questionnaire (mother-reported), and mothers’ mental health was measured using the SCL-90-R. The results failed to show any moderating effect of good maternal mental health or low neuroticism in protecting child mental health from negative impact of war trauma. The main effects showed that the child’s young age, war trauma and poor maternal mental health were associated with children’s internalizing symptoms, and male gender, maternal neuroticism and poor mental health with children’s externalizing symptoms. There were gender differences in psychological distress depending on whether the mother, the child or both were the main war trauma victim in the family: girls showed particularly high psychological distress when their mothers were exposed to war trauma (family systems model), whereas boys showed high levels of distress when both they themselves and their mothers were exposed to war trauma (accumulative impact model). Similarities were confirmed in dyadic symptom expression: significant associations were found between mothers’ depressive and children’s internalizing symptoms, and between mothers’ hostile and children’s externalizing symptoms.

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...

We examined how trauma-specific appraisals and coping efforts mediate between traumatic experiences, acuteness of trauma, and length of imprisonment and posttraumatic stress symptoms (PTS) among 103 Palestinian former political prisoners. The findings provide support for both direct and mediated models of trauma. The acuteness of trauma (time since release), appraisal of prison experience as harmful and involving loss, and use of both emotion- and problem-focused coping efforts were associated with high levels of PTS symptoms. Torture and ill-treatment had a direct association with intrusion, and recent release from prison with avoidance symptoms. Acuteness of trauma turned out to be important in the coping and symptom association: emotion-focused coping was associated with a low level of PTS symptoms in the long run, whereas problem-focused coping was associated with a low level of PTS symptoms in the short run.

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

The study examines, first, the effectiveness of a psychosocial intervention based on Teaching Recovery Techniques (TRT) to increase resiliency among Palestinian children, exposed to a major trauma of war. Second, it analyses the role of family factors (maternal attachment and family atmosphere) as moderating the intervention impacts on resilience. School classes in Gaza were randomized into intervention (N=242) and control (N=240) groups. The percentage of girls (49.4%) and boys (50.6%) were equal, and the child age was 10-13 years in both groups. Children reported positive indicators of their mental health (prosocial behaviour and psychosocial well-being) at baseline (T1), post-intervention (T2) and at a six-month follow-up (T3). At T1 they accounted their exposure to war trauma. Mothers reported about their willingness to serve as an attachment figure, and the child reported about the family atmosphere. Resilience was conceptualized as a presence of positive indications of mental health despite trauma exposure. Against our hypothesis, the intervention did not increase the level of resilience statistically significantly, nor was the effect of the intervention moderated by maternal attachment responses or family atmosphere.