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Introduction Eastern Congo has been affected by armed conflict for decades while the rampant use of sexual violence has left many women and girls dealing with a wide range of consequences of sexual violence. For adolescent victims the psychosocial impact of sexual violence is devastating. However, the role of avoidant/disengagement coping and family support on the mental health impact of sexual violence remains unclear. Methods The study design was a cross-sectional, population-based survey in which 1,305 school-going adolescent girls aged 11 to 23 participated. Mental health symptoms (IES-R and HSCL-37A), family support (MSPSS), avoidant/disengagement (Kidcope), war-related traumatic events (ACEES), experiences of sexual violence, daily stressors, and stigmatization (ACEDSS) were administered through self-report measures. Hierarchical multiple regression analysis was carried out with mental health outcomes as dependent variables for different types of sexual violence. Finally, several ANCOVA models were defined to explore possible interaction effects of avoidant/disengagement coping and family support with stigmatization, daily stressors and war-related traumatic exposure. Results For girls who did not report sexual violence, avoidant/disengagement coping has a direct negative effect on all psychological symptoms. For victims of sexual violence, when high levels of stigma were reported, avoidant/disengagement coping possibly served as a protective factor, as shown by the interaction effect between avoidance/disengagement coping and stigmatization on mental health outcomes. In victims of sexual violence however, high levels of daily stressors combined with avoidant/disengagement strategies showed a strong increase in posttraumatic stress symptoms. Interestingly, the mental health impact of sexual violence was not mitigated by support by family members. For girls who reported a nonconsensual sexual experience without labelling it as rape and at the same time testified to have a lot of family support, there was a positive association between stressors (daily stressors, stigma, and war-related trauma) and posttraumatic stress symptoms. Conclusions These results of this study underwrite to the importance of looking beyond the straightforward negative impact of avoidant/disengagement coping strategies on mental health in adolescent victims of sexual violence. While avoidant/disengagement coping can have a negative impact on psychosocial well-being on adolescent victims of sexual violence, in case of high levels of stigmatization it can as well protect them from posttraumatic stress or anxiety. Furthermore these findings speak to the importance of exploring the diversified relationship between risk and protective factors, such as avoidant/disengagement coping strategies and family support, that shape the mental health impact of sexual violence in adolescent victims.

The objective of the current study is to investigate the association between time in treatment and participants' perceptions of the treatment process in therapeutic communities (TCs) for addictions. Using a linear mixed effect model, we assessed whether the rate of participant change was related to motivation, cluster B personality traits, and psychological distress. Longitudinal data were gathered among 155 adults in 4 traditional TCs for addictions in Belgium. The results provide evidence that with time in treatment participants develop more profound perceptions regarding the TC concepts and processes of self-change, which denotes the theoretical assumption of identity change and right living in TC treatment.

Despite more than 40 years of research, limited evidence is available for the effectiveness of drug-free therapeutic communities (TCs). Worldwide, TCs have attempted succesfully to integrate innovative and evidence-based interventions, while adhering to the “community as method” (De Leon, 2000). This article is a case study of scientific research on practice and innovations in a TC, De Kiem (Belgium), over the past 40 years, illustrating how research and innovative approaches have shaped the TC into its current practice. From the start, scientific research was used to develop and adapt the TC program. International collaboration introduced new ideas, instruments, and methods and promoted a culture of inquiry. Several interventions that were implemented have contributed successfully to increased program retention, like the introduction of a welcome house phase, social network support, and a mother and child program.

Few studies on transnationalism have focused on migrants who return to their country of origin with insufficient resources and limited mobility. This study sheds light on the transnational connections of those who went back to Georgia and Armenia from Belgium on a voluntary assisted return and reintegration programme. Using Boccagni's (2012) analytical framework, we reveal the returnees' interpersonal, institutional and symbolic transnational ties. Although these ties were often limited and had little effect on their daily lives, and although the migrants' desire to participate in the transnational field rarely matched their ability to do so, they nonetheless attached great value to them symbolically and emotionally. Our findings question current conceptualizations of transnationalism and the focus on the home country as the sole context in which transnational ties should have an impact. We believe that there is a need to pay greater attention to the subjective and symbolic dimensions of the return–transnationalism field, including the relationship between integration and return migration policies.

Child soldiering affects the well-being of thousands of young people globally and inflicts significant challenges on entire socio-ecological systems, confronting them with culminating stressful living conditions and immense loss. This study sought to explore how former child soldiers’ transition trajectories are shaped by the dynamic interplay between these encountered challenges and available personal and communal resources. We conducted and analyzed in-depth interviews with 48 northern Ugandan former child soldiers using cluster analysis ( K-means) and interpretative-phenomenological analysis. The results showed divergent post-child soldiering trajectories of stability, improvement, or decline across time. Regarding resources, the cases showed ongoing resource depletion, threat to remaining resources in the face of significant challenge, and loss of resources that could not be replenished. However, there was also evidence that halting the depletion of resources, utilizing existing resources, and valuing remaining resources could offset distress, especially when individual initiatives were environmentally scaffolded. This study calls for a comprehensive approach to the interconnected challenges and resources as well as the intersecting personal and communal responses to these challenges in the aftermath of child soldiering.

The return of migrants to their country of origin and the development of efficient return measures have become more prominent on the political agenda of many Western European countries. Since policymakers prefer ‘voluntary’ return, governmental programmes to support the return of migrants – Assisted Voluntary Return (AVR) programmes – were developed as far back as the 1970s and have played an increasingly important role in migration policy over the last three decades. At the same time, general migration policy and welfare systems have undergone profound change, including in the meanings and connotations attached to social welfare, return support and return policy. This raises questions about the implications of these broader societal and policy changes for the widely implemented AVR programmes. In this article, we discuss the interpretation and evolution of AVR programmes by analyzing how one particular European country, Belgium, has developed its AVR programme over time. We explore the evolution of the programme’s content, target group and institutional positioning, which shed light on its changing goals and are closely linked to a broader shift towards a ‘managerial’ approach to migration policy and the welfare state. We argue that return support may become decontextualized when it adopts ‘conditional entitlement’ as a central principle. This leads to strong differentiation, based on personal responsibility, between ‘deserving’ and ‘undeserving’ migrants, the levelling down of the support given to returnees, and a more coercive voluntary return policy in which social support is linked to deportation.

The reintegration of formerly recruited youth typically engenders a range of relational and social challenges, affecting both formerly recruited youth and the communities to which they return. Yet, research rarely studies the perspectives of community members, hampering the design of much-needed community-based interventions. This study aimed to understand how communities in northern Uganda experience and deal with relational and social challenges during the reintegration of youths who were formerly recruited into the Lord's resistance army (LRA). The study was undertaken in 2012 in Lira district. Participatory Ranking Methodology (PRM) was conducted with 267 participants, of whom 49 were formerly recruited youths. The results show five themes that give insight into how communities experience and handle relational and social challenges in the reintegration of formerly recruited youth: (i) letting go of fear, (ii) getting used to life after captivity, (iii) resentment and forgiveness, (iv) reducing insults and nicknaming and (v) coping with ongoing relational and social challenges. We discuss how formerly recruited youths and other community members frame relational and social challenges differently, and value similar resources for different reasons. The results of this study suggest that multiple experiences of and perspectives on relational and social challenges following child soldiering should be taken into account to develop interventions that are supported and valued by the community. Furthermore, interventions should draw upon the strategies that communities have already developed in response to relational and social challenges. Copyright © 2015 John Wiley & Sons, Ltd.

The recent focus on extending risk assessment and treatment in forensic mental health with protective factors relates to the increasing interest in strengths-based approaches in various professional disciplines: law (e.g. human rights), criminology (e.g. desistance), mental health care (e.g. recovery), forensic psychology (e.g. the Good Lives Model), special needs education (e.g. Quality of Life) and family studies (e.g. family recovery). In this article, we will discuss the available knowledge with regard to strengths-based approaches for offenders with mental illness, in relation to these different disciplines. Several dilemmas are observed across these disciplines: (1) “Living apart together”: the integration of different disciplines; (2) “Beyond Babylonian confusion and towards more theoretical research”: conceptualization of strengths-based practices in different fields; (3) “No agency without autonomy”: the individual in context; and (4) “Risks, strengths and capabilities”: the search for an integrated paradigm. In our view, these different disciplines share a shift in how humankind is viewed, respecting agency in the interaction with people who have offended. Yet, differences apply to the objectives that the disciplines strive for, which warrants not to eclectically consider strengths-based working in each of the disciplines as ‘being small variations of the same theme’.

Although addiction is increasingly considered as a chronic problem, only a limited number of studies have addressed quality of life (QoL) in therapeutic communities (TCs) for addictions. This reflective conceptual article assesses the history, philosophy, and background of the TC movement as modern concept, with roots in existentialism and phenomenology, as well as the QoL approach as a “postmodern” concept, with a positive vision on wellbeing and happiness, grounded in Aristotelian rationalism. The exploration of the QoL concept situated in the context of TC values, facts, and subjects leads to the finding that both visions can go alternatively together and fertilize each other.

Purpose This article explores resources that help formerly recruited young people in dealing with war-related adversity and subsequent challenges, hence fostering their resilience. Methods Self-reports on pertinent resources were collected from 1,008 northern Ugandan youth, of whom 330 had formerly been recruited by the Lord's Resistance Army. Based on the conceptual framework developed by the Psychosocial Working Group, the reported resources were thematically clustered and quantitatively analyzed. Results This study identified a range of human, social, and cultural resources, with little difference between groups. Religious beliefs, social support, and mental health resources were most frequently reported by former child soldiers. Conclusions These results reveal a multitude of resources and suggest that it is important to build on these resources in interventions that aim to support former child soldiers in the aftermath of armed conflict.

This study aims to explore the factors that explain the mental sequelae of war-related sexual violence and focuses in particular on the role of stigmatization. Drawing on a large-scale quantitative survey undertaken in the war-affected region of eastern Democratic Republic of the Congo, we analyze how stigmatization mediates the mental health impact of sexual violence on adolescent girls who were victims of rape. Twenty-two secondary schools were randomly selected out of a stratified sample in Bunia, Eastern Congo. In a cross-sectional, population-based survey, 1,305 school-going adolescent girls aged 11-23 completed self-report measures assessing war-related traumatic events, experiences of sexual violence, stigmatization, and mental health symptoms. Of the 1,305 participants, 38.2% (n=499) reported experiences of sexual violence. Victims of sexual violence reported more war-related traumatic events and more stigmatization experiences. Several hierarchical regression analyses examined the mediating impact of stigmatization on the relationship between sexual violence and mental health outcomes, thereby controlling for sociodemographics (age, parental availability, and socioeconomic status) and war-related traumatic exposure. Our findings show that this stigmatization largely explains the mental health impact of sexual violence, in particular, on adolescent girls' reported symptoms of depression (full mediation) and posttraumatic stress (avoidance and total PTSD: full mediation; hyperarousal: partial (40%) mediation). No evidence of mediation by stigmatization was found for symptoms of anxiety and intrusion. Stigmatization plays thus an important role in shaping the mental sequelae of sexual violence, a finding with major consequences for clinical practice. Language: en

The detention and deportation of (undocumented) non-citizens has become one of the political priorities in the realisation of states' internal migration control. The increase in detention and deportation of migrants raises questions about these practices' implicit functions and their impact on the migrants subjected to detention. This paper aims to contribute to our understanding of the contemporary expansion of immigration detention by focusing on detained migrants' lived experiences and perspectives on detention practices. On the basis of interviews with 31 detainees in Belgian detention centres, we explore how migrants' self-perceptions relate to current legal and societal discourses. By referring to their connections with the host country through material, familial or emotional ties, the interviewees strongly oppose their detention and upcoming deportation. Thereby, they bring the (contested) experience of belonging firmly to the centre of this paper, referring to the connection between ‘body’ and ‘place’. They also point to the large and growing gap between their lived experiences on the one hand and the realities and political discourses of (legal) belonging on the other. In addition, detainees' lived experiences shed light onto the burden and consequences of lacking citizenship, and, simultaneously, demonstrate how individuals try to assert alternative, identity-based claims, and/or deny – or at least avoid – the idea of deportation. We hereby hypothesise that this denial, as also the growing gap between detainees' own perspectives and policy and public discourses might have a major impact on migrants' wellbeing and their reintegration processes back ‘home’. Copyright © 2014 John Wiley & Sons, Ltd.

Purpose – The purpose of this paper is to investigate the prevalence of anxiety in youngsters with emotional and behavioral disorders, and its relation to other problems, using different informants. Design/methodology/approach – Data were collected in a Flemish treatment center. Educators completed a Child Behavior Checklist (CBCL) for each child, teachers completed a Teacher Report Form (TRF), and youth themselves completed a Youth Self Report (YSR) and a Screen for Child Anxiety Related Emotional Disorders (SCARED). Findings – Analyses indicated an explicit presence of anxiety. A clear relation was found between anxiety symptoms and internalizing problem behavior on the YSR, whereas only a slight relationship was found with the CBCL, and practically no relationship was found with the TRF. Only few correlations between anxiety and externalizing problems were found. Finally, youth themselves indicated strong correlations between anxiety and thought problems, whereas educators indicated strong correlations between youths’ anxiety and social problems. Originality/value – Several studies describe professionals’ difficulties to get a comprehensive perceptions of youths’ problems. This paper provides detailed insights in the nature of the informant discrepancies.

Aims: The use of illegal drugs is well documented in some alternative, underground music scenes, like the Goa trance scene. The aim of this article is to explore harm reduction practices employed by attendees of the Goa trance scene in order to identify potential pathways for targeted interventions in (underground) music scenes, such as Goa trance.Methods: Following pilot observations at Goa parties, in-depth interviews were conducted with 19 Goa party attendees in Belgium. Respondents were recruited using snowball sampling methods.Findings: Participants reported that solidarity is apparent in the Goa trance scene and is an important variable in minimising drug-related harm, particularly with respect to providing help and support to people in need (communitarian values). On the other hand, personal controls on drug consumption were also employed to minimise harm, such as buying drugs from trusted people, trying to keep drug use limited to weekends and adhering to one's own limits (neo-liberal values).Conc...

Despite increasing numbers of unaccompanied refugee minors (UM) in Europe and heightened concerns for this group, research on their mental health has seldom included the factor "time since arrival." As a result, our knowledge of the mental health statuses of UM at specific points in time and over periods in their resettlement trajectories in European host countries is limited. This study therefore examined the mental health of UM shortly after their arrival in Norway (n = 204) and Belgium (n = 103) through the use of self-report questionnaires (HSCL-37A, SLE, RATS, HTQ). High prevalence scores of anxiety, depression and posttraumatic stress disorder (PTSD) symptoms were found. In addition, particular associations were found with the number of traumatic events the UM reported. The results indicate that all UM have high support needs on arrival in the host country. Longitudinal studies following up patterns of continuity and change in their mental health during their trajectories in the host country are necessary.

This article presents the findings of a qualitative study in a Flemish centre for children and adolescents with emotional and behavioural disorders. The change in demand for care for this highly troubled population has created a need for intervention models that address students' socio-emotional needs. When preparing an organisation to implement such intervention models, it is critical to obtain a thorough needs assessment or pre-implementation evaluation of staff in the organisation. Fifty interviews with different staff members were performed, guided by three research questions: (1) How do staff perceive the children and youth cared for, including behaviour, needs and demands of these youths?; (2) How do staff attempt to translate this demand for care into treatment, and what obstacles could possibly stand in the way?; and (3) What are, according to staff, critical issues to take into account when implementing EBP, both on the individual and the organisational level? Using a grounded theory approach, the analysis resulted in a pre-implementation model. In the following article, this model will be discussed and illustrated with quotes from staff members.

Background The relationship between war-related trauma exposure, depressive symptoms and multiple risk behaviors among adolescents is less clear in sub-Saharan Africa. Methods We analyzed data collected from a sample of school-going adolescents four years postwar. Participants completed interviews assessing various risk behaviors defined by the Youth Self Report (YSR) and a sexual risk behavior survey, and were screened for post-traumatic stress, anxiety and depression symptoms based on the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Multivariate logistic regression was used to assess factors independently associated with multiple risk behaviors. The logistic regression model of Baron and Kenny (1986) was used to evaluate the mediating role of depression in the relationship between stressful war events and multiple risk behaviors. Results Of 551 participants, 139 (25%) reported multiple (three or more) risk behaviors in the past year. In the multivariate analyses, depression symptoms remained uniquely associated with multiple risk behavior after adjusting for potential confounders including socio-demographic characteristics, war-related trauma exposure variables, anxiety and post-traumatic stress symptoms. In mediation analysis, depression symptoms mediated the associations between stressful war events and multiple risk behaviors. Limitations The psychometric properties of the questionnaires used in this study are not well established in war affected African samples thus ethno cultural variation may decrease the validity of our measures. Conclusions Adolescents with depression may be at a greater risk of increased engagement in multiple risk behaviors. Culturally sensitive and integrated interventions to treat and prevent depression among adolescents in post-conflict settings are urgently needed.

BACKGROUND: Armed conflict imposes huge hardship on young people living in war zones. This study assessed former child soldiers' experience and perception of stress in common war events during the armed conflict in northern Uganda and compares it with their non-recruited counterparts. AIM: To investigate whether child soldiers experienced more severe exposure to war events, and explore how war might affect youths differently, depending on the co-occurrence of these events. METHODS: The study was undertaken in four northern Ugandan districts in 22 secondary schools with a sample size of 981 youths, about half of whom had been child soldiers. The participants completed a questionnaire on socio-demographic characteristics and stressful war events which was analyzed using descriptive statistics, a probabilistic index and correlation network analysis. RESULTS: Former child soldiers had significantly greater experience of war events than their non-recruited counterparts. The violence of war is more central in their experience and perception of stress, whereas the scarcity of resources and poor living conditions are most central for non-recruited participants. The extent to which a war event, such as separation from the family, is perceived as stressful depends on the experience and perception of other stressful war events, such as confrontation with war violence for former child soldiers and life in an Internally Displaced Persons' camp for non-recruited participants. CONCLUSION: The network approach permitted demonstration of the many ways in which war-affected youths encounter and appraise stressful war events. War events might function as moderators or mediators of the effect that other war events exert on the lives and well-being of young people living in war zones. This demands comprehensive and individualized assessment. Language: en

This study explores coping strategies used by war-affected eastern Congolese adolescents across age and sex, and the association between post-traumatic stress symptoms and engagement and disengagement coping. Cross-sectional data were collected in 11 secondary schools across four areas in the Ituri province, Democratic Republic of Congo. A total of 952 pupils (45.3% girls, 54.7% boys) aged 13-21 years (M = 15.83, standard deviation = 1.81) participated in self-report assessment, using instruments that were either specifically developed (Adolescent Complex Emergency Exposure Scale, assessing traumatic exposure), validated (Impact of Event Scale Revised, assessing post-traumatic stress symptoms) or reviewed (Kidcope, assessing coping strategies) for the study population. Reported coping strategies varied with age, and boys more frequently reported problem solving and resignation as compared with girls. Disengagement coping was associated with lower symptom scores in younger adolescent girls, as was the interaction effect between engagement and disengagement coping. We conclude that disengagement coping is not necessarily a maladaptive reaction to stressful events in war-affected situations and that future research should aim to better understand the heterogeneous patterns of stress and coping responses, including the role of factors such as the nature and appraisal of stressors, available resources for coping and cultural preferences.

This article presents the findings of a qualitative study in a Flemish centre for children and adolescents with emotional and behavioural disorders. The aim of this study was twofold. First, we wanted to examine how youth reflect on their own behaviour and that of their peers'. Secondly, we wanted to know what, according to the youth, are the most significant helpful elements of treatment. Analysis shows a continuum of negative behaviour, ranging from relatively ‘normal’ disruptive behaviour such as arguing, up to serious disruptive behaviour such as physical aggression. This behaviour has a negative influence on the climate of the organization. ‘Availability of staff’, ‘nearness of staff’, ‘a clear set of rules and boundaries’, and ‘some time on my own/some alone time’ are perceived as helpful elements of treatment. ‘Strictness’, ‘not listening’, and ‘inappropriate staff attitudes and interventions’ are perceived as counterproductive elements of treatment. Results are discussed and recommendations both on the orthopedagogical as well as on the scientific level are formulated.

Despite growing numbers of unaccompanied refugee minors (UMs) in Europe, and evidence that this group is at risk of developing mental health problems, there still remain important knowledge gaps regarding the development of UMs' mental health during their trajectories in the host country and, in particular, the possible influencing role of traumatic experiences and daily stressors therein. This study therefore followed 103 UMs from the moment they arrived in Belgium until 18 months later. Traumatic experiences (SLE), mental health symptoms (HSCL-37A, RATS) and daily stressors (DSSYR) were measured at arrival in Belgium, after 6 and 18 months. UMs reported generally high scores on anxiety, depression and post-traumatic stress disorder (PTSD). Linear mixed model analysis showed no significant differences in mental health scores over time, pointing towards the possible long-term persistence of mental health problems in this population. The number of traumatic experiences and the number of daily stressors leaded to a significant higher symptom level of depression (daily stressors), anxiety and PTSD (traumatic experiences and daily stressors). European migration policies need to reduce the impact of daily stressors on UMs' mental health by ameliorating the reception and care facilities for this group. Moreover, regular mental health screenings are needed, in combination with, if needed, adapted psychosocial and therapeutic care.

BackgroundThis study aimed to identify classes of quality of life (QoL) among opiate-dependent individuals five to ten years after starting methadone treatment in order to tailor services to the needs of this population.MethodsA cross-sectional study of 159 opiate-dependent individuals who started outpatient methadone treatment in the region of Ghent, Belgium, between 1997 and 2002. A face-to-face structured interview was administered based on the Lancashire Quality of Life Profile, the EuropASI, Brief Symptom Inventory and the Verona Service Satisfaction Scale for Methadone Treatment. Latent class analysis was used to determine patterns of QoL. Analyses of variance and chi-square tests were used to test whether class membership was related to socio-demographic, health- and drug-related variables.ResultsBased on fit criteria, a three-class model was selected. Class Low (14.5%), ‘opiate-dependent individuals living in marginal conditions’, is characterised by low QoL scores on all domains. Class Intermediate (25.8%), ‘stabilized, but socially excluded opiate-dependent individuals’ shows high scores on the domains ‘safety’ and ‘living situation’, but low scores on all other QoL domains. Class High (59.7%), ‘socially included opiate-dependent individuals’, is characterised by high QoL scores on all domains, except ‘finances’.ConclusionThe findings of this study illustrate the existence of different profiles of QoL among opiate-dependent individuals after starting methadone maintenance treatment and demonstrate the need for a continuing care approach. Insight into distinct classes of QoL can be used to design person-centred support, relevant to an individual's personal life.Keywords: Methadone treatment, Opioid substitution treatment, Quality of life,Person-centred outcomes

Although former child soldiers face considerable challenges after their return from the warring faction to the war-affected society, the presence of resources enables many to maintain well-being in the wake of child soldiering. Academic research has recently engaged with identifying these salient resources, but has left the question why they are helpful to former child soldiers largely unaddressed. This study therefore focuses on the meaning underlying certain phenomena that causes them to become resources. Semistructured in-depth interviews and a free-listing task on resources were conducted with 48 northern Ugandan former child soldiers. The phenomenological hermeneutical method is applied to analyze their lived experiences and the meaning they assign to resources. Four essential themes emerge from this study, representing the fourfold meaning of resources for former child soldiers in helping them (a) to break with their former existence as child soldiers, (b) to be able to overcome the challenges in their current life, (c) to belong to others and the environment to which they have returned, and (d) to become the person they aspire to be. Considering these research themes in the context of former child soldiers’ return process, parallels with theories on transition are recognized and further explored so as to contextualize this emerging meaning. As such, this research delivers empirical evidence illustrating how resources help to pilot former child soldiers through transition in the wake of child soldiering.

This study examined the factor structure, reliability, and validity of the Antisocial Process Screening Device–Self-Report (APSD-SR), the Youth Psychopathic Traits Inventory (YPI), and the YPI–Short Version (YPI-SV) in detained female adolescents aged 12 to 17 years. The proposed three-factor structure of the YPI and YPI-SV was replicated, whereas the proposed three-factor structure of the APSD-SR or alternate models did not yield adequate fit. Overall, reliability indices for the YPI and YPI-SV were higher than those reported for the APSD-SR. APSD-SR and YPI scales were positively related with each other, except the affective dimensions of the instruments. All questionnaires showed good criterion validity but the YPI’s factor structure and reliability was superior to the APSD-SR. This superiority is not because of the larger number of items in the YPI, because we also demonstrated that the factor structure and reliability of the YPI-SV was better than that of the APSD-SR.

The return of refugees and migrants back to their country of origin is an important topic on the agenda of Western European governments, as return is considered as the most “durable solution” for the “refugee problem”, and as an instrument with which to tackle “illegal” migration. However, these migration policies generally lack a clear evidence base, as little studies have focused on returnees' current living situations and on their perspectives on the re-migration process. In this paper we therefore try to listen to returnees' voices, through in-depth interviews with four Nepalese migrants both before (in Belgium) and after (in Nepal) their return, and with 16 returnees after their return to Nepal. The interviews show how most returnees start with a disadvantageous “point of departure” to realize a “successful” return: mostly, they do not really depart “voluntarily”, and they only have limited possibilities for preparing their return and setting realistic expectations. But also, back in the “home country”, most returnees judge their current economic, social and political living situation as bad, meeting little of the expectations that they set before they returned. The participants consider the support they received through the NGOs' return programmes as minimal, because they are mostly limited to a small amount of financial support, and thus of little significance in these returnees' efforts to rebuild their lives in their “home” country. If return programmes want to make a difference in returnees' lives, they should have two extensive components in the “home” and the “host” country, incorporating in both components an integral approach, including economic, political, social and psychological aspects. Viewing these findings, it is not surprising that most interviewees eventually evaluate their return as unsuccessful, and many returnees consider re-emigration, all of which clearly questions the current basis of worldwide migration policies.

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

Background: Substance users’ quality of life (QoL) is influenced by several variables, including psychiatric comorbidity and addiction severity. Thus far, the impact of the type of dependence (alcohol, drug or dual dependence) remains unclear. Therefore, the objectives of the study were to evaluate QoL in a clinical sample of alcohol-, drug- and dual-dependent patients and to assess the independent impact of psychiatric comorbidity, addiction severity and type of dependence on QoL. Methods: Face-to-face interviews with 274 patients admitted to residential substance abuse treatment were conducted using the European Addiction Severity Index (EuropASI), the Mini-International Neuropsychiatric Interview and the Assessment of Personality Disorders self-report questionnaire. Results: Multivariate analyses showed that anxiety, mood or personality disorder, employment status and the severity rating on the EuropASI domain alcohol use were associated with overall QoL. Gender, anxiety disorder and the severity ratings on the EuropASI domains alcohol use, drug use, physical health and emotional and psychological health were associated with overall perception of health. Conclusion: Addiction severity and psychiatric comorbidity explained the greatest amount of QoL variance, whereas the type of dependence did not play a central role.

Large numbers of migrants daily decide to undertake an often risky and protracted journey to leave their country, escaping from violence and poverty, in an effort to reach their ultimate goal: building a better life. Although extensive evidence shows how pre- and post-flight experiences can significantly threaten migrants’ wellbeing, little research investigates the impact of the flight itself and the way migrants cope with these flight experiences while ‘on the way’. The study took place in the waiting rooms of the police station near the Belgian port of Zeebrugge, where intercepted migrants stay for some time. Because of the constraints inherent in the study setting, we relied on the messages that migrants themselves chose to leave—in their mother tongues—on the police station’s walls and furniture. A discourse analysis of 179 inscriptions made by intercepted migrants revealed how these migrant communities show great solidarity, agency and resilience in dealing with their feelings and experiences in a political and social context that is marginalizing, depersonalizing or criminalizing them.

Introduction In Belgium, offenders who are deemed criminally irresponsible for their criminal actions because of mental illness or intellectual disability are subject to a specific safety measure with the dual objective of protecting society and providing mandated care to the offender. While Belgian law requires that offenders who are deemed criminally irresponsible should be in a hospital, clinic or other appropriate institution outside of prison, in practice, about one-third of all such offenders still reside in prison. Whether imprisoned or living in settings outside prison, there is a dearth of knowledge on the characteristics of the aging population among the criminally irresponsible offenders. Objective This paper aimed to explore the characteristics of older offenders categorized as criminally irresponsible in Flanders (northern Belgium) with a focus on the differences between imprisoned older offenders deemed criminally irresponsible and their peers who are residing outside prison. Method A retrospective case note study of all offenders deemed criminally irresponsible, > 60 years of age (n = 174), was conducted in the four Commissions of Social Defense, which implement the procedure in the case of those deemed criminally irresponsible in Flanders. The files were screened for (1) demographic characteristics, (2) criminal history as well as (3) mental and physical health issues. Results One-fourth of the population were > 70 years of age. A total of 30.5% were in prison. Compared to their non-imprisoned peers, the imprisoned offenders had a history of having committed more serious violent crimes towards persons, such as homicides and sexual crimes. In addition, imprisoned older offenders categorized as criminally irresponsible are characterized more explicitly by personality traits that are likely to reduce their chances of being transferred to more appropriate settings in the community. Implications A comprehensive and systematic screening of all older offenders deemed criminally irresponsible with regard to health needs and social functioning, including age-related deterioration, alcoholism, and other causes of social disadvantages, is warranted to detect potentially hidden problems.

Life space crisis intervention (LSCI) is a therapeutic and verbal strategy used to intervene when children are in crisis. It has its roots in the work of Aichorn, Redl, Wineman and Bettelheim, and is part of the milieu-therapeutic tradition. In 2000, LSCI was introduced at the Orthopedagogical Observation and Treatment Centre, a school and day unit for 60 children with emotional and behavioural disorders affiliated with the Department of Orthopedagogy at Ghent University (Belgium). The particular position of orientation towards 'therapeutic environments' in the department's history has encouraged the integration of LSCI in the daily activities of the departments' school (Broekaert et al., Int J Ther Communities 30(2):122-145, 2009). In 2003, LSCI was implemented and studied in several Flemish Institutes. Positive effects were found on school results, attendance in the classroom and number of conflicts. In this article, the reflections of the caretakers are taken into account. Analyses of these reflections resulted in 4 major themes: content of job and tasks, the youth in the centre, working with the youth in the centre, and cooperation with colleagues and other teams. The results of this analysis will be discussed.

ObjectiveParents are considered to be crucial informants in child psychiatry, particularly for disorders in which age of onset is included in the diagnostic criteria. In detained adolescents, however, parents all too often are difficult to reach or reluctant to cooperate. The clinical relevance of gathering parental information in this context should therefore be demonstrated. This study examines if parent reports of attention-deficit-hyperactivity disorder (ADHD) and age of onset subtypes of conduct disorder (CD) predict official criminal recidivism.MethodParticipants were 110 detained male adolescents from all three Youth Detention Centers in Flanders. Between January 2005 and February 2007, both youth and a parent were interviewed with the Diagnostic Interview Schedule for Children Version IV. Two to 4years later, information on criminal recidivism was retrieved.ResultsYouth self-reported ADHD and CD (subtypes) were not related with recidivism. Parent-reported ADHD, CD and childhood-onset CD predicted serious property recidivism, while parent-reported adolescent-onset CD predicted future violent arrests. In reverse, childhood-onset CD as reported by parents was negatively associated with violent recidivism.ConclusionObtaining parental diagnostic information in delinquent adolescents is crucial for predicting recidivism. This finding emphasizes the need of including parents when studying mental disorder in detained adolescents.

Background Attention from researchers and health care workers to the quality of life (QoL) of opiate users is growing, but most studies are quantitative, giving limited attention to the consumer's perspective. No information is available on how opiate-dependent individuals themselves perceive QoL and what they see as the important components that contribute to a good QoL. Objectives This qualitative study aims to expand our knowledge concerning opiate-dependent individuals' perceptions of a good QoL and the impact of methadone on components of a good QoL. Methods In-depth interviews were conducted with 25 opiate-dependent individuals aged between 26 and 46 years old who started a methadone maintenance treatment at least 5 years ago. Purposive sampling was used to recruit participants with different socio-demographic characteristics and drug use profiles. The interviews were audio-tape recorded, transcribed verbatim and analysed thematically. Results Thematic analyses revealed five key themes contributing to a good QoL for opiate-dependent individuals: (1) having social relationships, (2) holding an occupation, (3) feeling good about one's self, (4) being independent and (5) having a meaningful life. Opiate-dependent individuals valued methadone's ability to help them function normally, overcome their psychological problems and dependence on illicit opiates, and support them in achieving certain life goals. On the other hand, stigmatisation, discrimination, dependence on methadone and the drug's paralysing effects on their emotions were mentioned as common negative consequences. Conclusions The findings of this study highlight the importance of supporting opiate-dependent individuals in their daily life by means of practical, social and environmental support (alongside pharmacological treatment) in order to improve their QoL. This study further illustrates the ambivalent influence of methadone on opiate-dependent individuals' QoL, and demonstrates how something commonly perceived as a ‘good' can also be a ‘bad' for some people. Efforts should be made to limit the negative consequences of methadone on opiate-dependent individuals' QoL, while increasing its potential benefits.

Although Synanon has been extensively studied, attention has seldom been paid to the question of how the many ex-members who left Synanon before or at its dissolution ‘survived’ their community and indoctrination, and how they now evaluate their involvement. This article explores how ex-members react to their previous affiliation to Synanon, the cradle of the therapeutic community (TC) for addiction. A series of critical incidents, following Synanon's public proclamation restyling itself as a religion, which led to the dismantlement of Synanon, are highlighted and contrasted with the achievements of the movement. For this research study, we used a social constructivist methodology. Following qualitative snowball targeted sampling, open interviews and text analysis, 14 statements, representing the main reactions, were retained. These served as the basis for a web-based survey. It was found that ex-Synanon members still believe in the positive realizations of their experience. On the other hand, they are no...

Background/Aims: Studies on determinants of quality of life (QoL) among opiate-dependent individuals are scarce. Moreover, findings concerning the role of severity of drug use are inconsistent. This exploratory study investigates the association between domain-specific QoL and demographic, social, person, health and drug-related variables, and potential indirect effects of current heroin use on opiate-dependent individuals’ QoL. Methods: A cohort of opiate-dependent individuals who started outpatient methadone treatment at least 5 years previously (n = 159) were interviewed about their current QoL, psychological distress, satisfaction with methadone treatment and the severity of drug-related problems using the Lancashire Quality of Life Profile, the Brief Symptom Inventory, the Verona Service Satisfaction Scale for Methadone Treatment and the EuropASI. Results: None of the QoL domains were defined by the same compilation of determinants. No direct effect of current heroin use on QoL was retained, but path analyses demonstrated its indirect effects on the domains of ‘living situation’, ‘finances’ and ‘leisure and social participation’. Conclusion: These findings illustrate the particularity of each QoL domain and the need for a multidimensional approach to the concept. The relationship between current heroin use and various domains of opiate-dependent individuals’ QoL is complex, indirect and mediated by psychosocial and treatment-related variables.

According to the EUPRIS-study on mental health in prisons (2007), available data on mental disorders in prison are scarce. Therefore, this study aims at summarizing and discussing the available knowledge on incarcerated mentally ill offenders concerning: (1) the screening and assessment for detecting mental health; (2) the psychiatric expertise in order to evaluate the mental status; and (3) the development and provision of forensic psychiatric treatment and care. These findings will be applied to the current situation in Belgium, which is a particularly interesting case. Belgium is currently facing difficulties concerning a large population of interned mentally ill offenders residing in correctional establishments. Implications with regard to the penal code, general or mental health legislation, screening, assessment, and treatment could deliver interesting viewpoints on how this problem could be tackled more effectively. Therefore, the findings will be discussed with reference to the international scientific and policy debate, focusing on ethical implications.

Background: While the current knowledge base on the mental health effects of displacement is mainly limited to refugees residing in industrialised countries, this paper examines the impact of war-induced displacement and related risk factors on the mental health of Eastern Congolese adolescents, and compares currently internally displaced adolescents to returnees and non-displaced peers. Methods: Data were collected from a community sample of 819 adolescents aged 13 to 21 years, attending one of 10 selected schools across the Ituri district in the Democratic Republic of Congo. Respondents completed culturally adapted self-report measures of posttraumatic stress symptoms (using the Impact of Event Scale - Revised) and internalising and externalising behaviour problems (by means of the Hopkins Symptoms Checklist - 37 for Adolescents). Associated factors studied were age, sex, parental death, exposure to war-related violence and daily stressors. Results: Internally displaced persons (IDPs) reported highest mean scores for the IES-R and the HSCL-37A internalising scale, followed by returnees, while non-displaced adolescents scored significantly lower. However, ANCOVA tests showed that posttraumatic stress and internalising symptoms were mainly associated with traumatic exposure and daily stressors and not with displacement status. Externalising problem scores were associated with traumatic exposure, daily stressors and displacement. Remarkably, death of father was associated with fewer externalising problems. Sex was differently associated with internalising and externalising problems through traumatic and daily stressors. Conclusions: As IDPs are highly exposed to violence and daily stressors, they report most psychological distress, when compared to returnees and non-displaced peers. The distinct mental health outcomes for returned youngsters illustrate how enhancing current socio-economic living conditions of war-affected adolescents could stimulate resilient outcomes, despite former trauma or displacement. Language: en

Purpose This study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals QoL. Methods Participants (n = 159) were interviewed about their current QoL, psychological distress and severity of drug-related problems, using the Lancashire Quality of Life Profile, the Brief Symptom Inventory and the Addiction Severity Index. Potential determinants of QoL were assessed in a multiple linear regression analysis. Results Five years after the start of methadone treatment, opiate-dependent individuals report low QoL scores on various domains. No association was found between drug-related variables and QoL, but a significant negative impact of psychological distress was identified. Severity of psychological distress, taking medication for psychological problems and the inability to change ones living situation were associated with lower QoL. Having at least one good friend and a structured daily activity had a significant, positive impact on QoL. Conclusions Opiate-dependent individuals QoL is mainly determined by their psychological well-being and a number of psychosocial variables. These findings highlight the importance of a holistic approach to treatment and support in methadone maintenance treatment, which goes beyond fixing the negative physical consequences of opiate dependence.

Internationaal onderzoek wijst op een hoge prevalentie van psychiatrische stoornissen bij gedetineerden. Het ontbreekt echter veelal aan systematische en accurate procedures om deze stoornissen te diagnosticeren. In dit artikel bespreken we de ontwikkeling van een aangepast protocol voor screening en assessment van psychiatrische stoornissen en drugsgerelateerde stoornissen bij nieuw-aangemelde gedetineerden in Belgische gevangenissen. De sensitiviteit en specificiteit van de screeningsinstrumenten BJMHS en SSI-SA in dit protocol werd uitgetest in een kleinschalige pilotstudie (N = 91). Er kon een vrij goede sensitiviteit aangetoond worden voor zowel SSI-SA als BJMHS. De specificiteit van beide instrumenten is evenwel matig. Aanvullend onderzoek bij een grotere steekproef die uitsluitend bestaat uit nieuw-aangemelde gedetineerden en geinterneerden is noodzakelijk.