Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT April 11, 2003 "The trees that are slow to grow bear the best fruit." - Moliere
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Rocky Mountain Region
Disaster Mental Health Institute -
SPRING WORKSHOP SERIES - Brochure
April 23, 24, 25 -
Crisis Counseling, Trauma, and Response:
A Multi-level Approach
- Marguerite McCormack, MA, LPC
Click here for flyer
May 3 - Suicide Risk Assessment and Risk Reduction: Tactics For The Trenches
- Jon Richard, PsyD
Disaster Mental Health Services-I (DMHS-I)
(Red Cross Course)
Location: Salt Lake City, UT
Dates: May 6-7, 2003
Contact: Lucy Houser
Email: houserlc@crossnet.org
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers:
ammp@optushome.com.au
Conference Website:
http://www.acisa.org.au/ conference2003/Summer Intensive Program
Graduate Certificate in
Disaster Mental Health
Disaster Mental Health Institute (University of South Dakota)
Location: Union Building
University of South Dakota Campus Vermillion, SD
Contact: Disaster Mental Health Institute
University of South Dakota
SDU 114 414 East Clark St
Vermillion, SD 57069-2390
Phone: 605-677-6575 or 800-522-9684
Fax: 605-677-6604
http://www.usd.edu/dmhi/Third Biennial International Conference
on Intercultural Research (IAIR)
May 16 - 19, 2003
Location: Taipei, Taiwan Contact: 2003 IAIR International Conference
C/o College of Education
NTNU, PO Box 7-763
Taipei, Taiwan 106
Tel: +(886)2-2321-3142
Fax +(886)2-2394-9243
Email: t14004@cc.ntnu.edu.tw
VIII European Conference
on Traumatic Stress(ECOTS)
May 22 - 25, 2003
Location: Berlin, GERMANY
Contact: Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail: trauma-conference@kfb-berlin.de
4th International Symposium on Bilingualism
April 30 - May 3, 2003
Location: Tempe, Arizona, USA
Contact:
4th International Symposium on Bilingualism
Arizona State University
PO Box 870211
Tempe, AZ 85287-0211, USA
Email: isb4@asu.edu
PARENTS CAN HELP CHILDREN COPE WITH WAR'S REALITIES
With graphic images of bombs and casualties invading American homes, parents should monitor carefully the thoughts, feelings and television viewing habits of their children, according to an expert in Penn State's College of Agricultural Sciences. "Kids' reaction to war, and how you respond, will often depend on their age," says Daniel Perkins, associate professor and extension specialist in family and youth resiliency. "You need to be prepared to talk to your children and explain the war in terms they can understand." Perkins urges parents with children under 10 to be open and supportive, reassuring, keep a regular schedule and routine, don't dwell on the war, and "let kids be kids." Read the full story at http://live.psu.edu/index.php?cmd=vs&story=2611
DEALING WITH THE STRESS OF ARMED CONFLICT AND TERRORISM
Health Canada has recently published 4 brochures on responding to the stress of armed conflicts and terrorism:
1) Taking Care of Ourselves, Our Families & Our Communities
2) Helping your child cope
3) Helping your teens cope
4)Care for the caregiversThe brochures are available at the following website:
http://www.hc-sc.gc.ca/pphb-dgspsp/emergency-urgence/index_e.html
Senior UN officials express growing alarm for Iraqi civilians, children
9 April – Senior United Nations officials expressed growing alarm today over the mounting civilian death toll in Iraq and the fate of children who may be cut off from aid. For full story, go to: http://www.un.org/apps/news/story.asp?NewsID=6703&Cr=Iraq&Cr1=relief
UN doing 'whatever we can' to rush emergency medical aid to Baghdad - Annan
9 April – Secretary-General Kofi Annan said today the United Nations was trying to do everything possible to rush emergency medical supplies to Baghdad. For the full story, go to: http://www.un.org/apps/news/story.asp?NewsID=6705&Cr=iraq&Cr1=relief
Humanitarian crisis looms in Iraq because of breakdown of law and order - UN
9 April – United Nations relief agencies warned today that looting and the breakdown of law and order in Iraq threatened to unleash a humanitarian crisis as their operations were obstructed, and they called on the occupying military forces to afford the necessary security for their aid work to function. For the full story, go to: http://www.un.org/apps/news/story.asp?NewsID=6708&Cr=iraq&Cr1=relief
War-Fear Strategies: A Newsmaker Interview With David Riggs, PhD
The outbreak of war, increased potential for terrorist attacks, and intense media coverage may heighten stress in many, and pathological anxiety in some. Medscape Medical News 2003 For the full article online, go to: http://www.medscape.com/viewarticle/451140
CNMI Disaster Assistance Tops $17 Million For Typhoon Pongsona
Dededo, Guam -- Disaster relief and assistance to the Commonwealth of the Northern Mariana Islands following Typhoon Pongsona has climbed to $17.4 million since President George W. Bush declared the area eligible for federal disaster aid on December 11. For the full story, go to: http://www.fema.gov/diz02/d1447n16.shtm
WHAT'S IN THE NEWS: TRACKING A KILLER
The latest edition of "What's in the News," a current events program produced for school children by Penn State Public Broadcasting, takes a look at the efforts of many experts to understand and contain Severe Acute Respiratory Syndrome (SARS), a mysterious new virus. SARS harkens back to the infamous 1918 flu, which first affected soldiers during World War I and eventually spread to millions worldwide. In 2001, researchers mapped the entire genetic code of the 1918 virus, an experience that may help the SARS investigators. Read the full story at http://live.psu.edu/index.php?cmd=vs&story=2562
Psychosocial Interventions for ADHD
A combination of different psychosocial interventions maintained for an extended period of time, together with psychopharmacology, are an effective tool for managing ADHD symptoms. For the full article online, go to: http://www.medscape.com/viewarticle/448258
Medicaid Proposal Creating Concerns Among MH Advocates
The Bush administration's proposal to change the Medicaid program is creating both white-hot concern and cool detachment among mental health and other advocates. Mental Health Weekly 13(10) 2003 For the full article online, go to: http://www.medscape.com/viewarticle/450883
THE MEDICAL MINUTE: ALLERGIES ARE MORE THAN SNIFFLES AND SNEEZES
Spring has arrived. The scent of fragrant flowers is in the air. Birds are singing and noses sneezing. According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, allergic rhinitis, often called "hay fever," comes from the immune system's response to a foreign substance, typically plant pollen. The word "rhinitis" refers specifically to inflammation of the nose, but allergies often affect the ears, throat, eyes and lungs, as well. Plant allergies are common, but allergy sufferers can also react to many other things, such as pet dander. Allergic problems are not benign. Perhaps a quarter of all Americans are affected, resulting in 3.8 billion missed days of work and school per year at a cost of $4.5 billion annually. There are an estimated 5,000 deaths attributed to allergies each year, according to the Centers for Disease Control and Prevention. For the full article by John Messmer, visit http://www.psu.edu/ur/2003/medicalminute029.html
CHILDREN AND WAR
With the recent advent of involvement of children in military conflicts such as in Africa (Mozambique), the Middle East (Palestine and Lebanon), and Southeast Asia (Cambodia), psychologists have taken a keen interest in examining the psychological effects such conflicts reap on children. Hence, a growing but modest body of literature has been amassed within the past 20 yrs on the subject.
Health professionals and other agencies coming in contact with children who have been affected by war and political violence need to be trained in detection and treatment of such presentations. Children living in war zones can express acute distress from various traumatic events through emotional problems that are not usually recognized. Vizek-Vidovic, Kuterovac-Jagodic & Arambasic, (2000) examined affective and behavioral symptomatology in children (aged 8-16 yrs) who were traumatized to different degrees during the war in Croatia. 1,034 children completed the Questionnaire on Children's Stressful and Traumatic War Experiences and other instruments. Their results show a cumulative effect of traumatic and stressful events, with higher levels of traumatic and stress reactions and less successful adaptation in Ss with more traumatic and stress experiences. Older females reported more posttraumatic stress reactions, psychosomatic reactions, and anxiety, but had higher scores on the measure of psychosocial adaptation than did males. Younger Ss reported more posttraumatic stress disorder symptoms than did older Ss.
As part of a UNICEF-sponsored Psychosocial Program in Bosnia, Smith, Perrin, Yule & Rabe-Hesketh (2001) collected data from a representative sample of 339 children aged 9-14 yrs, their mothers, and their teachers to investigate risk and moderating factors in children's psychological reactions to war. Self-report data from children revealed high levels of posttraumatic stress symptoms and grief reactions, but normal levels of depression and anxiety. Mothers' self-reports also indicated high levels of post-traumatic stress reactions, but normal levels of depression and anxiety. Child distress was related to both their level of exposure and to maternal reactions. Structural equation modeling was used to quantify the relationships between these risk factors and child distress, and to examine putative pathways to account for the association between child and maternal health. Children's adjustment was associated significantly with both exposure and maternal mental health. Modeling also revealed a significant distorting effect of mother's own mental health on behavioral ratings of her child. Results suggest that although evidence exists for an association between maternal mental health and mother rating errors, there is also a substantive association between maternal mental health and children's adjustment following war.
Smith, Perrin, Yule, Hacam & Stuvland (2002) collected data from a community sample of 2,976 children in Bosnia-Hercegovina aged between 9 and 14 years. Children completed standardized self-report measures of posttraumatic stress symptoms, depression, anxiety, and grief, as well as a report of the amount of their own exposure to war-related violence. Results showed that children reported high levels of posttraumatic stress symptoms and grief reactions. However, their self-reported levels of depression and anxiety were not raised. Levels of distress were related to children's amount and type of exposure. Girls reported more distress than boys, but there were few meaningful age effects within the age band studied. Results suggest methods for both service development for children in war and for more effective coping methods.
Thabet, Abed & Vostanis (2002) assessed the nature and severity of emotional problems in 91 Palestinian children (aged 9-18 yrs) exposed to home bombardment and demolition during Al Aqsa Intifada and 89 age-matched controls who had been exposed to other types of traumatic events related to political violence. The Ss completed self-report measures of post-traumatic stress (PTS), anxiety, and fears. Significantly more children exposed to bombardment and home demolition reported symptoms of PTS and fear than controls. 54 (59%) of 91 exposed children and 22 (25%) of 89 controls reported PTS reactions of clinical importance. Exposure to bombardment was the strongest socioeconomic predictor of PTS reactions. By contrast, children exposed to other events, mainly through the media and adults, reported more anticipatory anxiety and cognitive expressions of distress than children who were directly exposed.
MacMullin & Odeh (1999) used a 4-part method to identify and understand the things that worry children in the Gaza Strip. 194 Gazan children, aged 8-14 yrs, were asked to generate lists of the things about which they worried. These data were then used to construct a survey questionnaire which allowed a rank ordering of children's worries and the exploration of developmental and gender differences. The final part of the study employed focus groups in which the children elaborated on their worries, spoke about the strategies they use to manage these concerns, and proffered advice for younger children who might have to face similar concerns in the future. Issues about which the children worried ranged from politics, war and religion to personal friendships and exam anxiety.
In summary, these studies suggest that children's adjustment following a war is significantlt associated with levels of exposure, maternal reactions, and maternal mental health. Children's age and sex appear to be significant variables in terms of stress levels experienced. Girls seem to become more distressed than do boys.
Gender, Age and Cultural Factors
Ronen & Rosenbaum (2003) assessed children's reactions to the stress induced by the 1991 Gulf War as a function of gender and age. They conducted their assessment during the third week of the 1991 Gulf War in Israel. The participants were 229 boys and 189 girls who attended the 2nd, 6th, and 10th grades (aged 8, 12, and 16 yrs, respectively). The children were asked to report behavior problems (for before and during the war), anxiety level (before and during the war), and war-related symptomatic behavior. The findings indicate that the war had an adverse effect on the well being of children, in particular girls. Girls in comparison to boys reported higher levels of anxiety and more behavior problems for the war period as well as more war related symptoms. Gender differences were mostly found for the data relating to the war period and not for the pre-war period. Age moderated the effect of gender on war related symptoms and on anxiety. Whereas among the younger children (2nd grade) no gender effects were found, among the older ones (6th and 10th grades) the gender effects were apparent. In summary the Gulf war had an adverse effect on the well being of children, in particular on the well being of girls and the gender effects appeared only among the older children.
Baker & Shalhoub-Kevorkian (1999) examined the universal and culture-specific correlates of political and military trauma. Specifically, they focused on the psychological symptoms children display following their exposure to such traumatic events. They suggest that special emphasis be placed on anxiety, phobic, psychosomatic, and depressive symptoms. Examination should be made to ascertain which factors (e.g. psychosocial, cultural, and political) serve to shield or predispose children to psychological dysfunction. Furthermore, the analyses should be gender specific. Attempts should be made to delineate a paradigm that explains the relationship between trauma, culture, and personality.
Al-Krenawi, Slonim-Nevo, Maymon, & Al-Krenawi (2001 ) investigated the well being of Arab adolescents who live under the threat of ongoing blood vengeance, and assessed the impact of socio-demographic characteristics, cultural context, and family functioning as mediating factors. Their sample consisted of 100 adolescents (aged 12-14 yrs) in grades 6-8. Self-reported standardized measures were used to assess the participants' level of self-esteem (Rosenberg's scale), mental health (the Brief Symptom Inventory BSI), and perceived family functioning (the McMaster Family Assessment Device FAD). The participants of this study demonstrated higher levels of distress and symptomatic behavior as compared to the Israeli norms. General Family Functioning emerged as the major predictor associated with mental health. Female participants reported a higher anxiety level than their male counterparts. Male participants, on the other hand, were more willing to continue the feud of blood vengeance. Their findings suggest that there are similarities among children and adolescents who live in war zones and those who live under a threatening blood vengeance. Family functioning appears as the major mediator of well being.
Papageorgiou, Frangou-Garunovic, Iordanidou, Yule, Smith & Vostanis (2000) described the pattern of psychopathology in a sample of 95 children aged 8-13 yrs, who had experienced war in Bosnia. The children were assessed with a battery of standardized measures during a psychosocial support program in Northern Greece. They either came from refugee families or had suffered significant family loss (a parent had been killed in 28% and the father was injured or absent in 27% of cases). Children recalled a substantial number of war traumatic experiences. According to previously established cut-off scores on self-report measures, 45 children scored within the clinical range on the Depression Self-Rating Scale for Children, 28 on the Revised Children's Manifest Anxiety Scale, and 65 on the Impact of Event Scale (IES) measuring posttraumatic stress disorder (PTSD) reactions. There was a significant association between the number of war traumatic experiences and the intrusion and avoidance scores on the IES. Findings suggest setting up intervention programs for children who are victims of war and their families.
Stein, Comer, Gardner & Kelleher (1999) examined the psychological symptoms of Bosnian children exposed to war and trauma, and detected the changes in these symptoms over time. A total of 147 displaced children (5-12 yrs old) residing in refugee centers in Bosnia completed self-report assessments of anxiety, depressive, and posttraumatic stress disorder (PTSD) symptoms at two time points approximately eight months apart. Symptoms of PTSD, anxiety, and depression showed a greater decrease in boys relative to girls over time. Gender may be an important factor in the natural course of trauma-related symptoms among war traumatized children.
Oclander Goldie (1999) presents an interesting case study. She uses material from the treatment of a young child whose development became seriously arrested from the time of a traumatic experience during a war. This experience, combined with the impact of the birth of a younger sibling while he was still a baby himself, had catastrophic consequences. He could only communicate his feelings of terror and fear of dying through the use of projective identification. The persecutory anxiety of this child was such that for a while he could not tolerate hearing the interpretations, and was prone to violent outbursts. Oclander Goldie describes how she had to bear the projections and manage the physical attacks while trying to maintain the capacity to observe and think clearly. This setting produced an experience of containment that gradually allowed this child to accept and understand interpretations which diminished the power of feelings that had overwhelmed him in the past. Through introjection of the experience of being understood during his sessions, he began to develop the capacity to think about his feelings. This allowed him to gradually recover, develop, and make use of his intelligence and imagination, and the behavioral difficulties that brought him to treatment disappeared.
Military Families
The potential for war is a pervasive threat to the security and family structure of children in military families. Ryan-Wenger (2001) compared 91 children (8-11 yrs old) of active-duty, reserve, and civilian families with respect to their perceptions of war, origin of fears related to war, levels of manifest anxiety, coping strategies, and projection of emotional problems in human figure drawings. Her findings regarding the adaptation of children in military families suggest the need for further research from children's perspectives is important for understanding adaptations and responses of military children.
Conclusion
Cultural differences, age, sex, family structure, maternal mental health, anxiety and depression levels are among the variables that need to be addressed when assessing and treating children following war-related trauma. The role of the father was not adequately addressed in these studies in terms of effects on children's post-war adjustment. Further research is needed to better understand the psychological effects of war trauma on children, and the natural course of posttraumatic symptoms, so as to improve interventions targeted to this vulnerable population.
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REFERENCES Al-Krenawi, Alean, Slonim-Nevo, Vered, Maymon, Yaniv & Al-Krenawi, Salem (Apr 2001). Psychological responses to blood vengeance among Arab adolescents. Child Abuse & Neglect, Vol 25(4), pp. 457-472. Journal URL: http://www.elsevier.com/inca/publications/store/5/8/6/
Baker, Ahmad & Shalhoub-Kevorkian, Nadera (Dec 1999). Effects of political and military traumas on children: The Palestinian case. Clinical Psychology Review, Vol 19(8), Special Issue: Mental health issues in middle east societies. pp. 935-950. Journal URL: http://www.elsevier.com/inca/publications/store/6/5/2/
MacMullin, Colin & Odeh, Jumana (Fal 1999). What is worrying children in the Gaza Strip? Child Psychiatry & Human Development, Vol 30(1), pp. 55-70. Journal URL: http://www.wkap.nl/journalhome.htm/0009-398X
Oclander Goldie, Silvia S. (Dec 1999). The impact of a war experience on the inner world of a young child. International Journal of Psycho-Analysis, Vol 80(6), pp. 1147-1164.
Papageorgiou, V., Frangou-Garunovic, A., Iordanidou, R., Yule, W., Smith, P. & Vostanis, P. (Jun 2000). War trauma and psychopathology in Bosnian refugee children. European Child & Adolescent Psychiatry, Vol 9(2), pp. 84-90. Journal URL: http://link.springer.de/link/service/journals/00787/index.htm
Ronen, Tammie & Rosenbaum, Michael (Mar 2003). Children's reactions to a war situation as a function of age and sex. Anxiety, Stress & Coping: An International Journal, Vol 16(1), pp. 59-69. Journal URL: http://www.tandf.co.uk/journals/gb/10615806.html
Ryan-Wenger, Nancy A. (Apr 2001). Impact of the threat of war on children in military families. American Journal of Orthopsychiatry, Vol 71(2), pp. 236-244.
Smith, Patrick, Perrin, Sean, Yule, William & Rabe-Hesketh, Sophia (Mar 2001). War exposure and maternal reactions in the psychological adjustment of children from Bosnia-Hercegovina. Journal of Child Psychology & Psychiatry & Allied Disciplines, Vol 42(3), pp. 395-404. Journal URL: http://uk.cambridge.org/journals/cpp/
Smith, Patrick, Perrin, Sean, Yule, William, Hacam, Berima & Stuvland, Rune (Apr 2002). War exposure among children from Bosnia-Hercegovina: Psychological adjustment in a community sample. Journal of Traumatic Stress, Vol 15(2), pp. 147-156. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867
Stein, B., Comer, D., Gardner, W. & Kelleher, K. (Sep 1999). Prospective study of displaced children's symptoms in wartime Bosnia. Social Psychiatry & Psychiatric Epidemiology, Vol 34(9), pp. 464-469. Journal URL: http://link.springer.de/link/service/journals/00127/index.htm
Thabet, Abdel Aziz Mousa; Abed, Yehia & Vostanis, Panos (May 2002). Emotional problems in Palestinian children living in a war zone: A cross-sectional study. Lancet, Vol 359(9320), pp. 1801-1804.
Vizek-Vidovic, Vlasta, Kuterovac-Jagodic, Gordana & Arambasic, Lidija (Dec 2000). Posttraumatic symptomatology in children exposed to war. Scandinavian Journal of Psychology, Vol 41(4), pp. 297-306. Journal URL: http://www.blackwellpublishers.co.uk/asp/journal.asp?ref=0036-5564
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
130 Questions Children Ask About War and Terrorists: Comforting Your Child in Uncertain Times
by Stephen Arterburn, David A. Stoop
Book Description
According to experts, TV's indelible images of castastrophy will linger in the minds of our children long after they fade from the television screens. In this new era of America's "war on terrorism," Drs. Stephen Arterburn and David Stoop provide reassuring answers to children's questions about war--answers that will help turn children's fears into opportunities for healing and growth. Easy to use topical format with answers that can be read to children.
Additional Readings at: Terrorism and Stress in the search engine. Also try looking here for Psychology and Terrorism.
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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