Edited by Annette Flanagin, RN, MA, and Thomas B. Cole, MD, MPH
Bolton and colleagues report results of a randomized trial that assessed the effects of locally feasible interventions involving group interpersonal psychotherapy or creative play therapy on symptoms of depression, anxiety, and conduct problems among internally displaced adolescent survivors of war in Northern Uganda. Compared with adolescents allocated to a wait list for treatment at the end of the study (control group), girls but not boys in the psychotherapy group experienced significantly diminished depressive symptoms. Creative play therapy was not associated with improvement in depression severity, and neither intervention alleviated symptoms of anxiety or conduct problems.
Parental stress is a risk factor for child maltreatment, and deployment is likely stressful for military families. In an analysis of data from an Army registry of incidents of parental child maltreatment, Gibbs and colleagues examined the association between recent combat-related deployment and rates of child maltreatment among families of enlisted soldiers. In models that controlled for socioeconomic status, parental substance use, and age of children, the authors found that child maltreatment was 42% greater during times of parental deployment than during periods of nondeployment.
In a review of medical and case records of 287 repatriated girls and women who reported being trafficked from Nepal for sexual exploitation, Silverman and colleagues assessed the prevalence of and risk for human immunodeficiency virus (HIV) infection. The authors report an HIV prevalence rate of 38%. Among the risk factors for HIV infection examined, girls who were trafficked prior to age 15 years were at significantly increased risk of HIV infection compared with women 18 years or older.
In a stratified random cluster survey of 2585 adults who had been internally displaced by conflict in Northern Uganda, Vinck and colleagues found that 74.3% met the criteria for posttraumatic stress disorder (PTSD) and 44.5% had symptoms of depression. Two-thirds of the respondents believed that peace could be achieved through nonviolent means. However, persons who met the criteria for PTSD or depression symptoms were more likely to endorse violent means for ending the conflict compared with persons without these symptoms.
Bayer and colleagues interviewed 169 former Ugandan and Congolese child soldiers who were living in rehabilitation centers to assess potentially traumatic war-related exposures and symptoms of posttraumatic stress disorder (PTSD) and the relationship of PTSD symptoms to attitudes favoring reconciliation vs revenge. The authors found that the children participating in the study were a mean age of 15.3 years with a mean of 38.3 months of army service and had experienced a mean of 11.1 potentially traumatic events. As the number of PTSD symptoms increased, openness to reconciliation declined and feelings of revenge increased among these former child soldiers.
“There was no schedule to my torture. I was never charged with a crime.” From “Bearing Witness.”
Structured violence risk assessment tools may help clinicians quantify the probability that an individual with a severe mental illness will commit acts of violence.
Ursano and Shaw discuss the 3 articles in this issue that address exposure to war-related trauma, mental health symptoms, and implications for peace.
Improving intervention programs for perpetrators of violence against intimate partners.
Medical aspects of starvation and the clinical, ethical, legal, and human rights responsibilities of physicians who care for prisoners who hunger strike.
For your patients: Information about posttraumatic stress disorder.
This Week in JAMA . JAMA. 2007;298(5):489. doi:10.1001/jama.298.5.489