Children and the Cycle of Violence in Post-Conflict Settings : Mental Health, Aggression, and Interventions in Burundi

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Zusammenfassung

In this thesis I investigated the negative impact of maltreatment on the psychological wellbeing of children and adolescents who grew up in violent environments of the post-conflict country Burundi. Furthermore, the individual risk factors of these adolescents for engaging in everyday violence were assessed. Subsequently I evaluated the Forensic Offender Rehabilitation Narrative Exposure Therapy (FORNET) as a means of reducing violent behavior among adolescents.

Research has demonstrated that trauma-related mental health disorders are common among war-affected populations. Children and adolescents growing up on the streets or in unstable family conditions in post-conflict settings are particularly vulnerable. Exposure to life-threatening situations, maltreatment and other forms of violence at early age most likely impede their development and exacerbate their risk to suffer from mental ill-health.

Furthermore, violent environments also appear to foster aggressive behavior. A large number of studies have shown that posttraumatic stress disorder (PTSD) is associated with an increased likelihood of reactive aggressive responding. However, recent studies with serious offenders showed that violent behavior might also be perceived as appetitive, i.e., as exciting, fascinating and related to feelings of power. Appetitive aggression appears to be a useful adaption to adverse environments, which may also develop among children and adolescents. The mental health and the propensity to engage in violent behavior were investigated in 112 male children and adolescents. They were recruited from the streets (n = 15), families (n = 15), a residential center for former street children (n = 32) and other vulnerable children (n = 50) in Burundi. They were between 11 and 24 years old (mean = 15.9 years; SD = 3.0
years). PTSD symptom severity was assessed with the University of California at Los Angeles PTSD Reaction Index (UCLA PTSD Index; Steinberg, Brymer, Decker, & Pynoos, 2004). The Minnesota International Neuropsychiatric Interview for Children and Adolescents (MINI-KID; Sheehan et al., 2010) was used to screen for depression, alcohol and substance dependence as well as for suicidal risk. In addition, physical health complaints were examined with a checklist. Aggression was assessed with an offense checklist, the Reactive Proactive Aggression Questionnaire (Raine et al., 2006) and the Appetitive Aggression Scale for Children (AAS-C). Among the adolescents in residential care, the 32 scoring highest in appetitive aggression were chosen to participate in an intervention study. Half of them received FORNET, the remaining 16 received treatment as usual. The follow-up assessment was conducted 4-7 months after completing treatment.

Results showed that current street children were most affected by mental disorders. The children living in the residential center suffered more from PTSD symptoms than children who still lived with their families. In residential care, the current exposure to minor violence and neglect was positively associated with increased PTSD symptom severity. The latter impeded progress in school. Appetitive aggression was negatively related to PTSD symptoms. This indicates that appetitive aggression improves resilience against mental illhealth of adolescents who grew up in precarious conditions. Furthermore, appetitive aggression was a serious risk factor for current offenses. FORNET proved to be effective in reducing the involvement in everyday violence among adolescents (Hedges g =.62). In addition, the physical health of the FORNET treated participants improved (Hedges g =.56). The results disentangled different aspects of the cycle of violence: (1) Being a victim of even minor violent acts impairs mental health, which in turn impedes progress in school. Hence providing adolescents with a violence free environment is essential for successful integration into society. (2) Children and adolescents may develop appetitive aggression as an adaption to violent environments. While this protects their mental health in precarious conditions, it also increases their involvement in everyday violence. The FORNET is a promising approach to reducing violent behavior and to improving resilience against ill-health.

Zusammenfassung in einer weiteren Sprache

In der vorliegenden Arbeit wurden die negativen Auswirkungen von Misshandlungen auf das psychische Wohlbefinden von Kindern und Jugendlichen untersucht, die unter gewalttätigen Umständen in dem Post-Konfliktland Burundi aufgewachsen sind. Weiterhin wurden individuelle Risikofaktoren untersucht, die Jugendliche motivieren alltägliche Gewalt auszuüben. Anschließend wurde die Wirksamkeit der Forensic Offender Rehabilitation Narrative Exposure Therapy (FORNET) evaluiert, gewalttätiges Verhalten bei Jugendlichen zu verringern.

Forschung hat gezeigt, dass psychische Folgeerkrankungen aufgrund traumatischer Erlebnisse sehr verbreitet sind in Bevölkerungen, die von Krieg betroffen waren oder sind.

Insbesondere Kinder und Jugendliche, die auf der Straße oder in instabilen, familiären Bedingungen in Post-Konfliktländern aufwachsen, sind gefährdet. Das Erleben von lebensbedrohlichen Situationen, Misshandlungen und anderen Formen von Gewalt im frühen Alter wirkt sich vermutlich negativ auf ihre Entwicklung aus und erhöht ihr Risiko, an psychischen Störungen zu erkranken. Darüber hinaus scheinen gewalttätige Umgebungen aggressives Verhalten zu fördern. Der Zusammenhang von Posttraumatischer Belastungsstörung (PTBS) und reaktiv aggressivem Verhalten wurde in einer Vielzahl von Studien belegt. Neuere Studien mit schweren Gewalttätern zeigten darüber hinaus, dass die Ausübung von Gewalt auch als appetitiv, d.h. als aufregend, faszinierend und mit Machtgefühlen einhergehend erlebt werden kann. Appetitive Aggression scheint eine nützliche Anpassung an widrige Lebensumstände zu sein, die sich auch bei Kindern und Jugendlichen entwickeln könnte.

Es wurde die psychische Gesundheit und die Gewaltbereitschaft von 112 männlichen Kindern und Jugendlichen erhoben. Diese wurden von der Straße (n = 15), in ihren Familien (n = 15) und in einem Heim für ehemalige Straßenkinder (n = 32) und andere Kindern ausschwierigen Verhältnissen (n = 50) in Burundi rekrutiert. Die Studienteilnehmer waren 11 - 24 Jahre alt (Mittelwert = 15.9 Jahre; SD = 3,0 Jahre). Die PTSD Symptomschwere wurde mit dem University of California at Los Angeles PTSD Reaction Index (UCLA PTSD Index; Steinberg, Brymer, Decker, & Pynoos, 2004) erhoben. Das Minnesota International Neuropsychiatric Interview for Children and Adolescents (MINI-KID; Sheehan et al., 2010) wurde eingesetzt, um das Vorliegen von Depressionen, Alkohol- und Substanzabhängigkeiten sowie Selbstmordgefährdung zu überprüfen. Darüber hinaus wurden körperliche Beschwerden mit einer Checkliste erhoben. Gewaltbereitschaft wurde mit einer Deliktcheckliste, dem Reactive Proactive Aggression Questionnaire (Raine et al., 2006) und der Appetitive Aggression Scale for Children (AAS-C) untersucht. Unter den im Heim wohnenden Jugendlichen wurden 32 für eine Interventionsstudie ausgewählt. Diese hatten die höchsten Werte in appetitiver Aggression berichtet. Die Hälfte dieser Jugendlichen wurde mit FORNET behandelt, während die restlichen 16, wie es in dem Heim üblich war behandelt wurden. Die Nacherhebung fand 4 - 7 Monate im Anschluss an die Behandlung statt. Die Ergebnisse zeigten, dass die derzeitigen Straßenkinder am meisten unter psychischen Störungen litten. Die Heimkinder berichteten mehr PTBS-Symptome als die Kinder, die noch mit ihren Familien zusammenlebten. Unter den Heimkindern wurde ein Zusammenhang zwischen aktuell erlebter geringfügiger Gewalt bzw. Vernachlässigung und PTBS Symptomschwere gefunden. Letztere erschwerte den Fortschritt in der Schule.

Appetitive Aggression sagte die PTSD Symptomschwere negativ vorher. Dies indiziert, dass appetitive Aggression die Resilienz gegen psychische Erkrankungen von Jugendlichen erhöht, die in prekären Verhältnissen aufgewachsen sind. Darüber hinaus war appetitive Aggression ein ernstzunehmender Risikofaktor für gewalttätiges Verhalten. Die FORNET erwies sich als wirksam, um Gewaltausübung von Jugendlichen entgegenzuwirken.

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150 Psychologie
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ISO 690CROMBACH, Anselm, 2013. Children and the Cycle of Violence in Post-Conflict Settings : Mental Health, Aggression, and Interventions in Burundi [Dissertation]. Konstanz: University of Konstanz
BibTex
@phdthesis{Crombach2013Child-25632,
  year={2013},
  title={Children and the Cycle of Violence in Post-Conflict Settings : Mental Health, Aggression, and Interventions in Burundi},
  author={Crombach, Anselm},
  address={Konstanz},
  school={Universität Konstanz}
}
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