Atle Dyregrov

Trauma Exposure and Psychological Reactions to Genocide Among Rwandan Children

A total of 3030 children age 8–19 years from Rwanda was interviewed about their war experiences and reactions approximately 13 months after the genocide that started in April 1994. Rwandan children had been exposed to extreme levels of violence in the form of witnessing the death of close family members and others in massacres, as well as other violent acts. A majority of these children (90%) believed that they would die; most had to hide to survive, and 15% had to hide under dead bodies to survive. A shortened form of the Impact of Event Scale used in a group of 1830 of these children documented high levels of intrusion and avoidance. While children living in shelters were exposed to more trauma, they evidenced less posttraumatic reactions. Analyses showed that reactions were associated with loss, violence exposure, and, most importantly, feeling their life was in danger.

Children exposed to warfare: A longitudinal study

Following the 1991 Gulf War a group of 94 children in Iraq were interviewed at 6 months, 1 year, and 2 years after the war. The group was exposed to the bombing of a shelter where more than 750 were killed. Selected items from different inventories, including the Impact of Event Scale (IES) assessed childrens reactions. Results reveal that children continue to experience sadness and remain afraid of losing their family. Although there was no significant decline in intrusive and avoidance reactions as measured by the IES from 6 months to 1 year following the war, reactions were reduced 2 years after the war. However, the scores were still high, indicating that symptoms persist, with somewhat diminished intensity over time.

PREDICTORS OF PSYCHOSOCIAL DISTRESS AFTER SUICIDE, SIDS AND ACCIDENTS

This article compares the outcome and predictors of psychosocial distress of parents bereaved by young suicides, sudden infant death syndrome (SIDS), and child accidents. One objective is to explore whether suicide bereavement is more difficult for those left behind than other forms of bereavement. Data have been collected from 140 families, consisting of 232 parents, by the use of the Impact of Event Scale, the General Health Questionnaire, and the Inventory of Traumatic Grief. Qualitative aspects of bereavement are assessed by in-depth interviews with family members from 40 families. The results show that the similarities between the samples on outcome and predictors are more striking than the differences, which is explained by the common traumatic aspect of unexpected and violent deaths. One and a half years post-loss, 57-78% of the survivors scored above the cut-off levels for traumatic grief reactions. Although no significant differences are found between survivors of suicide and accidents, both groups evidence significantly greater subjective distress than the survivors of SIDS. Self-isolation is by far the best predictor of psychosocial distress in all three samples. Rather than focusing on the exceptional position of suicide survivors, it seems important to call attention to sudden and traumaticdeathingeneral as a factor to be associated with post-traumatic reactions and complicated mourning.

Principal components analysis of the impact of event scale with children in war

A new 13-item version of the Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979) was adminstered to 2976 9–14 year old children from Bosnia as part of a large epidemiological screening survey. The IES-13 consists of four intrusion items, four avoidance items, and five new arousal items. Factor analyses showed the scale to have an identical underlying factor structure as when it was used with British children who experienced a single-incident trauma. In addition, there was also a third factor of hyperarousal, closely related to intrusion. These results are discussed in the context of the cross-cultural validity of post traumatic stress reactions in children.

Refugee Families' Experience of Research Participation

Because refugees can experience crisis, bereavement, and traumatization, there has been a rapid increase of research carried out with refugees. This study investigated how refugee families respond to participation in research. A previous study explored how adults and children had communicated about the difficult question of repatriation after arriving in a new country. Did the in-depth interviews harm or benefit them? Are there any ethical risks in research on traumatized refugees? From an original sample of 74 Bosnian refugees (5–73 years), 30 family members from 9 families including 14 children aged 6 to 19, were re-interviewed. The refugees rated participation as positive. A few parents lacked information that could have enabled them to inform the children better before the interviews. The study shows that studies on traumatized/bereaved populations can have beneficial effects.

The process in psychological debriefings

Critical Incident Stress Debriefings have become an intervention method used in various cultures, countries and groups following critical incidents. Although the structure of such meetings has been adequately described, utilization of the group processes involved has received less attention. A model, process debriefing (PD), based on experiences from Europe, is presented. Some differences between the current CISD process in the United States and the Europe based model are outlined. Various factors that impact the process of debriefings are discussed with a special emphasis on leadership, and implications of these group process variables for psychological debriefing are presented. It is emphasized that the continued exploration and discussion of process issues is critical to advance the understanding of the critical elements of debriefing.

Enhancing Autobiographical Memory Specificity Through Cognitive Training An Intervention for Depression Translated From Basic Science

The objective of this study was to investigate the efficacy of memory specificity training (MEST) on autobiographical memory recall and depression. Afghan adolescents with depression were randomly assigned to a MEST group or to a control group. At baseline, both groups completed Persian versions of the Autobiographical Memory Test (AMT) and the Mood and Feelings Questionnaire (MFQ). The MEST group then had five weekly group sessions of MEST. The control group had no additional contact. The AMT and MFQ were then readministered to all participants, and the MFQ was readministered at 2-month follow-up. The MEST group retrieved a higher proportion of specific memories following training and had lower levels of depression at 2-month follow-up than did the control group. Change in memory specificity predicted follow-up depression over and above baseline depression and mediated the relationship between receipt of MEST and reduction in later depression. The results suggest that MEST can improve autobiographical memory performance and drive subsequent reduction in depression symptoms.

Bullying and PTSD Symptoms

PTSD symptoms related to school bullying have rarely been investigated, and never in national samples. We used data from a national survey to investigate this among students from grades 8 and 9 (n = 963). The prevalence estimates of exposure to bullying were within the range of earlier research findings. Multinomial logistic regression showed that boys were 2.27 times more likely to be exposed to frequent bullying than girls. A latent variable second-order model demonstrated an association between frequency of bullying exposure and PTSD symptoms (beta = 0.49). This relationship was not moderated by gender. However, the average levels of PTSD symptoms as well as clinical range symptoms were higher for girls. For all bullied students, 27.6% of the boys and 40.5% of the girls had scores within the clinical range. A mimic model showed that youth who identify as being both a bully and a victim of bullying were more troubled than those who were victims only. Our findings support the idea that exposure to bullying is a potential risk factor for PTSD symptoms among students. Future research could investigate whether the same holds for PTSD through diagnostic procedures, but this will depend on whether or not bullying is decided to comply with the DSM-IV classification of trauma required for diagnosis. Results are discussed with regard to their implications for school interventions.

Voluntary and Professional Disaster-Workers: Similarities and Differences in Reactions

Forty-three rescuers responding to a bus crash that killed 12 children and 4 adults and injured many more answered questionnaires at 1 and 13 months following the crash. This study compared the responses of the voluntary and professional helpers, using the Impact of Event Scale (IES) and the General Health Questionnaire (GHQ). For all helpers taken together, the decline in IES-intrusion and IES-total scores was significant from 1 to 13 months. The voluntary helpers reported significantly more intrusion and avoidance on the IES at 1 month than professional helpers, and for avoidance the voluntary helpers still evidenced a significantly higher score than professional helpers at 13 months. The GHQ scores at 13 months reflected that the long-term negative impact of the event was low.

Traumatic War Experiences and Their Effects on Children

With the growing number of countries involved nowadays in armed conflict, more children have come to suffer the atrocities of war. Displacement, witnessing violent acts, bearing arms, being victims of direct hostilities are some of the traumatic experiences children face growing up in war-torn countries. There is no question that such overwhelming experiences have an impact on the development of children, their attitudes toward society, their relationships with others, and their outlook on life in general. In this chapter, we will examine the nature of childhood war traumata and their potential deleterious effects on children. Based on our own experiences, and drawing from the literature on traumatic stress, this chapter also outlines different treatment approaches to childhood posttraumatic stress disorder (PTSD) and discusses the implementation of such approaches in countries involved in armed conflict.