Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2008

Open Access 01-12-2008 | Research article

Family violence, war, and natural disasters: A study of the effect of extreme stress on children's mental health in Sri Lanka

Authors: Claudia Catani, Nadja Jacob, Elisabeth Schauer, Mahendran Kohila, Frank Neuner

Published in: BMC Psychiatry | Issue 1/2008

Login to get access

Abstract

Background

The consequences of war violence and natural disasters on the mental health of children as well as on family dynamics remain poorly understood. Aim of the present investigation was to establish the prevalence and predictors of traumatic stress related to war, family violence and the recent Tsunami experience in children living in a region affected by a long-lasting violent conflict. In addition, the study looked at whether higher levels of war violence would be related to higher levels of violence within the family and whether this would result in higher rates of psychological problems in the affected children.

Methods

296 Tamil school children in Sri Lanka's North-Eastern provinces were randomly selected for the survey. Diagnostic interviews were carried out by extensively trained local Master level counselors. PTSD symptoms were established by means of a validated Tamil version of the UCLA PTSD Index. Additionally, participants completed a detailed checklist of event types related to organized and family violence.

Results

82.4% of the children had experienced at least one war-related event. 95.6% reported at least one aversive experience out of the family violence spectrum. The consequences are reflected in a 30.4% PTSD and a 19.6% Major Depression prevalence. Linear regression analyses showed that fathers' alcohol intake and previous exposure to war were significantly linked to the amount of maltreatment reported by the child. A clear dose-effect relationship between exposure to various stressful experiences and PTSD was found in the examined children.

Conclusion

Data argue for a relationship between war violence and violent behavior inflicted on children in their families. Both of these factors, together with the experience of the recent Tsunami, resulted as significant predictors of PTSD in children, thus highlighting the detrimental effect that the experience of cumulative stress can have on children's mental health.
Appendix
Available only for authorised users
Literature
1.
2.
Kaldor M: New and old wars: organized violence in a global area. 1999, Stanford, California , Stanford University Press
3.
Saigh PA: The development of posttraumatic stress disorder following four different types of traumatization. Behav Res Ther. 1991, 29 (3): 213-216. 10.1016/0005-7967(91)90110-O.CrossRefPubMed
4.
Ruf M, Neuner F, Gotthardt S, Schauer M, Elbert T: PTSD among Refugee Children - Prevalence and Treatment.: Stockholm, Sweden.2005, ,
5.
Schaal S, Elbert T: Ten years after the genocide: trauma confrontation and posttraumatic stress in Rwandan adolescents. J Trauma Stress. 2006, 19 (1): 95-105. 10.1002/jts.20104.CrossRefPubMed
6.
Kuwert P, Spitzer C, Trader A, Freyberger HJ, Ermann M: Sixty years later: post-traumatic stress symptoms and current psychopathology in former German children of World War II. Int Psychogeriatr. 2007, 19 (5): 955-961. 10.1017/S104161020600442X.CrossRefPubMed
7.
Elbert T, Schauer M, Schauer E, Huschka B, Hirth M, Rockstroh B, Neuner F: Trauma-related impairment in children – an epidemiological survey in Sri Lankan provinces affected by armed conflict. Child Abuse Negl. 2007, in print:
8.
Goenjian AK, Najarian LM, Pynoos RS, Steinberg AM, Manoukian G, Tavosian A, Fairbanks LA: Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. Am J Psychiatry. 1994, 151 (6): 895-901.CrossRefPubMed
9.
Goenjian AK, Steinberg AM, Najarian LM, Fairbanks LA, Tashjian M, Pynoos RS: Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. Am J Psychiatry. 2000, 157 (6): 911-916. 10.1176/appi.ajp.157.6.911.CrossRefPubMed
10.
Goenjian AK, Molina L, Steinberg AM, Fairbanks LA, Alvarez ML, Goenjian HA, Pynoos RS: Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane Mitch. Am J Psychiatry. 2001, 158 (5): 788-794. 10.1176/appi.ajp.158.5.788.CrossRefPubMed
11.
Goenjian AK, Pynoos RS, Steinberg AM, Najarian LM, Asarnow JR, Karayan I, Ghurabi M, Fairbanks LA: Psychiatric comorbidity in children after the 1988 earthquake in Armenia. J Am Acad Child Adolesc Psychiatry. 1995, 34 (9): 1174-1184. 10.1097/00004583-199509000-00015.CrossRefPubMed
12.
Catani C, Schauer E, Onyut PL, Schneider C, Neuner F, Hirth M, Elbert T: Prevalence of PTSD and Building-Block Effect in School Children of Sri Lanka’s North-Eastern Conflict Areas: Stockholm, Sweden.2005, ,
13.
Neuner F, Schauer M, Karunakara U, Klaschik C, Robert C, Elbert T: Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry. 2004, 4: 34-10.1186/1471-244X-4-34.CrossRefPubMedPubMedCentral
14.
Neuner F, Schauer E, Catani C, Ruf M, Elbert T: Post-tsunami stress: a study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. J Trauma Stress. 2006, 19 (3): 339-347. 10.1002/jts.20121.CrossRefPubMed
15.
Maxfield MG, Widom CS: The cycle of violence. Revisited 6 years later. Arch Pediatr Adolesc Med. 1996, 150 (4): 390-395.CrossRefPubMed
16.
17.
Dixon L, Browne K, Hamilton-Giachritsis C: Risk factors of parents abused as children: a mediational analysis of the intergenerational continuity of child maltreatment (Part I). J Child Psychol Psychiatry. 2005, 46 (1): 47-57. 10.1111/j.1469-7610.2004.00339.x.CrossRefPubMed
18.
Pears KC, Capaldi DM: Intergenerational transmission of abuse: a two-generational prospective study of an at-risk sample. Child Abuse Negl. 2001, 25 (11): 1439-1461. 10.1016/S0145-2134(01)00286-1.CrossRefPubMed
19.
Pittaway E: The Ultimate Betrayal: An examination of the experiences of domestic and family violence in refugee communities. Occasional Paper. 2004, Centre for Refugee Research, UNSW
20.
Glenn DM, Beckham JC, Feldman ME, Kirby AC, Hertzberg MA, Moore SD: Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder. Violence Vict. 2002, 17 (4): 473-489. 10.1891/vivi.17.4.473.33685.CrossRefPubMed
21.
Solomon Z: The effect of combat-related posttraumatic stress disorder on the family. Psychiatry. 1988, 51 (3): 323-329.PubMed
22.
Margolin G, Gordis EB: The effects of family and community violence on children. Annu Rev Psychol. 2000, 51: 445-479. 10.1146/annurev.psych.51.1.445.CrossRefPubMed
23.
Chaffin M, Kelleher K, Hollenberg J: Onset of physical abuse and neglect: psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse Negl. 1996, 20 (3): 191-203. 10.1016/S0145-2134(95)00144-1.CrossRefPubMed
24.
Dube SR, Anda RF, Felitti VJ, Croft JB, Edwards VJ, Giles WH: Growing up with parental alcohol abuse: exposure to childhood abuse, neglect, and household dysfunction. Child Abuse Negl. 2001, 25 (12): 1627-1640. 10.1016/S0145-2134(01)00293-9.CrossRefPubMed
25.
Khantzian EJ: The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry. 1985, 142 (11): 1259-1264.CrossRefPubMed
26.
Stewart SH: Alcohol abuse in individuals exposed to trauma: a critical review. Psychol Bull. 1996, 120 (1): 83-112. 10.1037/0033-2909.120.1.83.CrossRefPubMed
27.
Schauer E, Kohiladevy M, Catani C, Onyut P, Schauer M, Neuner F, Elbert T: Building local capacity for mental health service provision in the face of large-scale traumatisation: a cascade-model from Sri Lanka.: Stockholm, Sweden.2005, ,
28.
Sivajokan S, Mahendrarajah K, Somasundaram D: Child Mental Health: Teacher's handbook to help primary school children. 2003, Shanthiham, Jaffna , GTZ/ BECARE, Vavuniya
29.
Bremner JD, Vermetten E, Mazure CM: Development and preliminary psychometric properties of an instrument for the measurement of childhood trauma: the Early Trauma Inventory. Depress Anxiety. 2000, 12 (1): 1-12. 10.1002/1520-6394(2000)12:1<1::AID-DA1>3.0.CO;2-W.CrossRefPubMed
30.
Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J: Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994, 151 (8): 1132-1136.CrossRefPubMed
31.
Pynoos R, Rodriguez N, Steinberg A, Stuber ML, Frederick C: UCLA PTSD Index for DSM-IV. 1998
32.
Steinberg AM, Brymer MJ, Decker KB, Pynoos RS: The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psychiatry Rep. 2004, 6 (2): 96-100. 10.1007/s11920-004-0048-2.CrossRefPubMed
33.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59 Suppl 20: 22-33;quiz 34-57.PubMed
34.
Fantuzzo JW, Mohr WK: Prevalence and effects of child exposure to domestic violence. Future Child. 1999, 9 (3): 21-32. 10.2307/1602779.CrossRefPubMed
35.
Tolan P, Gorman-Smith D, Henry D: Family violence. Annu Rev Psychol. 2006, 57: 557-583. 10.1146/annurev.psych.57.102904.190110.CrossRefPubMed
36.
Straus MA, Hamby SL, Finkelhor D, Moore DW, Runyan D: Identification of child maltreatment with the Parent-Child Conflict Tactics Scales: development and psychometric data for a national sample of American parents. Child Abuse Negl. 1998, 22 (4): 249-270. 10.1016/S0145-2134(97)00174-9.CrossRefPubMed
37.
38.
Freisthler B, Merritt DH, LaScala EA: Understanding the ecology of child maltreatment: a review of the literature and directions for future research. Child Maltreat. 2006, 11 (3): 263-280. 10.1177/1077559506289524.CrossRefPubMed
39.
Dubner AE, Motta RW: Sexually and physically abused foster care children and posttraumatic stress disorder. J Consult Clin Psychol. 1999, 67 (3): 367-373. 10.1037/0022-006X.67.3.367.CrossRefPubMed
40.
Pelcovitz D, Kaplan SJ, DeRosa RR, Mandel FS, Salzinger S: Psychiatric disorders in adolescents exposed to domestic violence and physical abuse. Am J Orthopsychiatry. 2000, 70 (3): 360-369. 10.1037/h0087668.CrossRefPubMed
41.
Kilpatrick KL, Williams LM: Post-traumatic stress disorder in child witnesses to domestic violence. Am J Orthopsychiatry. 1997, 67 (4): 639-644. 10.1037/h0080261.CrossRefPubMed
42.
Mertin P, Mohr PB: Incidence and correlates of posttrauma symptoms in children from backgrounds of domestic violence. Violence Vict. 2002, 17 (5): 555-567. 10.1891/vivi.17.5.555.33712.CrossRefPubMed
43.
Thabet AA, Abed Y, Vostanis P: Comorbidity of PTSD and depression among refugee children during war conflict. J Child Psychol Psychiatry. 2004, 45 (3): 533-542. 10.1111/j.1469-7610.2004.00243.x.CrossRefPubMed
44.
Thienkrua W, Cardozo BL, Chakkraband ML, Guadamuz TE, Pengjuntr W, Tantipiwatanaskul P, Sakornsatian S, Ekassawin S, Panyayong B, Varangrat A, Tappero JW, Schreiber M, van Griensven F: Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in southern Thailand. Jama. 2006, 296 (5): 549-559. 10.1001/jama.296.5.549.CrossRefPubMed
Metadata
Title
Family violence, war, and natural disasters: A study of the effect of extreme stress on children's mental health in Sri Lanka
Authors
Claudia Catani
Nadja Jacob
Elisabeth Schauer
Mahendran Kohila
Frank Neuner
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2008
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-8-33

Other articles of this Issue 1/2008

BMC Psychiatry 1/2008 Go to the issue

Research article

In the aftermath of teenage suicide: A qualitative study of the psychosocial consequences for the surviving family members

Research article

Substance abusers' personality disorders and staff members' emotional reactions

Research article

A factor analytic investigation of the Tripartite model of affect in a clinical sample of young Australians

Research article

Identifying patterns in treatment response profiles in acute bipolar mania: a cluster analysis approach

Research article

The co-administration of quetiapine or placebo to cognitive-behavior therapy in treatment refractory depression: A preliminary trial

Research article

Factor analysis of the Zung self-rating depression scale in a large sample of patients with major depressive disorder in primary care