Rolf Gjestad

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.

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.

Personality traits predict job stress, depression and anxiety among junior physicians

BackgroundHigh levels of stress and deteriorating mental health among medical students are commonly reported. In Bergen, Norway, we explored the impact of personality traits measured early in their curriculum on stress reactions and levels of depression and anxiety symptoms as junior physicians following graduation.MethodsMedical students (n = 201) from two classes participated in a study on personality traits and mental health early in the curriculum. A questionnaire measuring personality traits (Basic Character Inventory (BCI)) was used during their third undergraduate year. BCI assesses four personality traits: neuroticism, extroversion, conscientiousness and reality weakness. Questionnaires measuring mental health (Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist 25 (SCL-25)), and stress (Perceived Medical School Stress (PMSS)) were used during their third and sixth undergraduate year. During postgraduate internship, Cooper’s Job Stress Questionnaire (CJSQ) was used to measure perceived job stress, while mental health and stress reactions were reassessed using HADS and SCL-25.ResultsExtroversion had the highest mean value (5.11) among the total group of participants, while reality weakness had the lowest (1.51). Neuroticism and reality weakness were related to high levels of perceived job stress (neuroticism r = .19, reality weakness r = .17) as well as higher levels of anxiety symptoms (neuroticism r = .23, reality weakness r = .33) and symptoms of depression (neuroticism r = .21, reality weakness r = .36) during internship. Neuroticism indirectly predicted stress reactions and levels of depression and anxiety symptoms. These relations were mediated by perceived job stress, while reality weakness predicted these mental health measures directly. Extroversion, on the other hand, protected against symptoms of depression (r = −.20). Furthermore, females reported higher levels of job stress than males (difference = 7.52).ConclusionsCertain personality traits measured early in the course of medical school relates to mental health status as junior physicians during postgraduate internship training. This relation is mediated by high levels of perceived job stress.

Is the Culture Always Right

Recently there has been a critique of the use of western models in the trauma field. In this article it is discussed whether some of this critique reflects a continuation of a denial of trauma and PTSD that has been evident in psychology and psychiatry for a number of years. Although the critique has rightfully pointed out the importance of social and political dimensions in the understanding of trauma, it is argued that some aspects of trauma are universal. The critique has also focused on the use of western models of therapy in non-western societies. However, work done in this field has often adopted a community-based model focusing on large groups of people affected by war situations rather than using medical therapy models. Thus the critique has been somewhat misplaced. Especially in helping children in war it is important not to accept the local culture too much but to rely on childrens inborn resilience and cultural traditions for preventing long-term traumatic stress. Language: en

Does socio-economic status moderate the associations between psychosocial predictors and fruit intake in schoolchildren? The Pro Children study

This study tested whether socio-economic status (SES) moderated the association between the psychosocial constructs included in the attitude-social influence-self-efficacy (ASE) model and fruit intake in Norwegian schoolchildren. The sample consisted of 962 Norwegian sixth graders, mean age 11.3 years. They were split into three SES groups, and multi-group structural equation modeling (MSEM) was used. Children in the highest SES group reported eating fruit more frequently and reported more positive ASE variables than children in the lower SES groups. This was particularly true for social environmental factors, home availability of fruit and intention to eat fruit. MSEM showed that the relationships specified in the adapted ASE model were moderated by SES, as we did not find support for equal model structure across the three samples. Model modification for each SES group separately showed that the relation between home availability and fruit intake was not significant for the medium and low SES groups, and the relation between self-efficacy and intention to eat fruit was not significant for the medium SES group. Future interventions aiming at increasing fruit intake in children need to be sensitive to such SES-related differences and should in particular affect factors that may impede fruit intake in the lower SES groups.

Suicidality in schizophrenia spectrum disorders: The relationship to hallucinations and persecutory delusions

BACKGROUND Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia spectrum disorders. METHODS One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at the time of admission were examined with multinominal logistic regression and structural equation modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation. RESULTS Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety, Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight with Suicidal ideation and Suicide plans. CONCLUSIONS The study contributes to an increasing evidence base supporting an association between hallucinations and suicide risk. We want to emphasise the importance of treating depression and hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing drug abuse in order to lower suicide risk. TRIAL REGISTRATION ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529.

Phobic anxiety and depression as predictor variables for treatment outcome. A LISREL analysis on treated female alcoholics

The study focuses on the relationship between phobic anxiety and depression, alcohol abuse, treatment and drinking outcome in female alcoholics. A structural equation analysis (LISREL) was used to test the strength and direction of predictor variables, enabling the development of models for the process of change taking place following treatment. Participants were patients attending a specific treatment programme for women with alcohol problems at Karolinska Hospital, Stockholm, Sweden. One hundred and twenty female alcoholics consecutively admitted during 1991–1993 were followed up 2 years after treatment. The Alcohol Use Inventory (AUI) and Symptom Check List-90 were used at intake and follow-up. Duration of problem drinking and depression at follow-up affected drinking outcome directly and negatively, whereas duration of treatment affected drinking outcome directly and positively in all our models. Phobic anxiety on the other hand affected drinking outcome negatively and indirectly, via shorter treatment duration and higher depression at follow-up. Using different outcome variables as an end product resulted in only minor changes. Thus, the model presented is viewed as robust and clinically meaningful. The results underscore the importance of phobic anxiety and recurrent or sustained depression – in addition to the pre-treatment duration of problem drinking – for the drinking outcome among female alcoholics.

Sexuality Following the Loss of a Child

The aim of study was to increase our understanding of sexuality and intimacy following the loss of a child. A questionnaire on intimacy and sexuality was sent to 1,027 members of the 2 major bereavement support organizations for parents who have lost children in Norway. A total of 321 (33%) were returned. In addition, 10 couples were interviewed in depth about their experiences. The final sample (n = 285) consisted of 169 women (59.3%) and 116 men (40.7%) who represented 175 couples. Parents who were neither married nor cohabitants were excluded, as were nonbiological parents. Around 2/3 of the parents had resumed sexual contact within the first 3 months after their childs death. The activity of about 1/3 had been reduced. Significantly fewer mothers than fathers experienced sexual pleasure and close to 30% of the mothers reported that this had been reduced since the death. Only 11% noted that sexuality as an issue was raised in follow-up conversations. Many parents have only a few sexuality-related problems following a childs death, but a fairly large minority, especially women, experience major problems. There are clear gender differences in reactions and perceptions, often agreed upon by the 2 genders. Men are ready to resume activity in the sexual area much earlier than women. Women suffer much more from grief that in different ways intrudes on the sexual act and they more often perceive sex as somehow being wrong. Men also easily misunderstand womens need for closeness as a wish for sex.

Cannabis use is associated with 3 years earlier onset of schizophrenia spectrum disorder in a naturalistic, multi-site sample (N = 1119)

BACKGROUND Patients with schizophrenia spectrum disorders and substance use may have an earlier onset of illness compared to those without substance use. Most previous studies have, however, too small samples to control for confounding variables and the effect of specific types of substances. The present study aimed to examine the relationship between substance use and age at onset, in addition to the influence of possible confounders and specific substances, in a large and heterogeneous multisite sample of patients with schizophrenia spectrum disorders. METHODS The patients (N=1119) were recruited from catchment areas in Oslo, Stavanger and Bergen, Norway, diagnosed according to DSM-IV and screened for substance use history. Linear regression analysis was used to examine the relationship between substance use and age at onset of illness. RESULTS Patients with substance use (n=627) had about 3years earlier age at onset (23.0years; SD 7.1) than the abstinent group (n=492; 25.9years; SD 9.7). Only cannabis use was statistically significantly related to earlier age at onset. Gender or family history of psychosis did not influence the results. CONCLUSION Cannabis use is associated with 3years earlier onset of psychosis.