Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system

Abstract

BackgroundThe number of orphans in Sub-Saharan Africa is constantly rising. While it is known that family or community care is preferable over institutional care of African orphans, little is known about the quality of care in orphanages and possibilities of improvement.Study 1MethodsExposure to traumatic stress, experiences of violence in the home, school and orphanage, as well as mental ill-health and aggression of 38 children (mean age of M = 8.64 years) living in an orphanage in rural Tanzania were assessed at two time points. The severity of post-traumatic stress disorder symptoms (PTSD), depressive symptoms, and internalizing and externalizing problems were used as indicators of mental ill-health.ResultsViolence experienced in the orphanage correlated more strongly with all indicators of mental ill-health than violence in the former home, school or neighborhood at time point 1. Additionally, violence experienced in the orphanage had a positive relationship with the aggressive behavior of the children at time point 2.Study 2MethodsWith the help of the pre-post assessment of Study 1, the implementation of a new instructional system and psychotherapeutic treatment (KIDNET) for trauma-related illness were evaluated.ResultsIn response to both, a change in the instructional system and psychotherapeutic treatment of PTSD, a massive decline in experienced violence and in the severity of PTSD-symptoms was found, whereas depressive symptoms and internalizing and externalizing problems exhibited little change.ConclusionsThese studies show that violence, especially in the orphanage, can severely contribute to mental ill-health in orphans and that mental health can be improved by implementing a new instructional system and psychotherapeutic treatment in an orphanage. Moreover, the results indicate that the experience of violence in an orphanage also plays a crucial role in aggressive behavior of the orphans.

Maltreatment and Mental Health in Institutional Care—comparing Early and Late Institutionalized Children in Tanzania

“…Accordingly, we replicated our previous findings (Hermenau et al., ) that adverse childhood experiences in institutional care (e.g., exposure to violence) were positively related to mental health problems, but this was true only for early institutionalized children. Therefore, we conclude that adverse childhood experiences in institutional care play an especially important role in children who are institutionalized at a very young age and that children who are institutionalized very early in life may need special attention and care.…”

“…Research has shown that institutional care can lead to developmental delay and mental health problems in children (Hermenau et al., ; Johnson et al., ; Levin & Haines, ; St. Petersburg–USA Orphanage Research Team, ). To fill the gap in research concerning consequences of institutional care in Sub‐Saharan African countries, we compared early and late institutionalized Tanzanian children regarding adverse childhood experiences over their entire lifetimes in the family of origin and in institutional care and mental health at primary school age.…”

“…The questions assess how often a child has shown a specific aggressive behavior and are rated on a scale of 0 ( never ), 1 ( sometimes ), and 2 ( often ). Following Hermenau et al (), 1 of the original 23 items was removed because it was not appropriate for conditions in Tanzania (Item 18: “Made obscene phone calls for fun.”), and 1 item was slightly rephrased for better understanding (Item 9: “Gang fight” was replaced with “fight.”) This study used the Total Aggression Score, which ranges from 0 to 44. In the present sample, the Cronbach's α coefficient was .84, and the Cohen's κ coefficient was .99 (range = .94–1).…”

Aggression inoculates against PTSD symptom severity—insights from armed groups in the eastern DR Congo

“…Exposure to severe and traumatic stress may lead to the development of posttraumatic stress disorder (PTSD). Prior research has consistently shown that the greater the cumulative exposure to traumatic experiences, including organized violence, the greater the risk of trauma-related disorders, including depression or substance abuse (Amone-P'Olak, Garnefski, & Kraaij, 2007; Catani, Jacob, Schauer, Kohila, & Neuner, 2008; Chapman et al, 2004; Edwards, Holden, Anda, & Felitti, 2003; Hermenau et al, 2011). …”

Estudo do "Ages and Stages Questionnaires" com cuidadores de crianças institucionalizadas

“…Oferecer cuidados de qualidade seria o mínimo que um local que se propõe a proteger dos maus-tratos poderia oferecer para quem ainda é dependente de todo estímulo para crescer e se desenvolver naturalmente. Um local que não oportuniza uma boa estrutura de vigilância em atenção precoce à criança pode contribuir, juntamente com outros fatores pré-natais, caso presentes, com o surgimento de adolescentes e adultos com sérios problemas de origem emocional/mental, que podem se traduzir, entre outras coisas, em comportamentos de agressividade difíceis de reverter (Hermenau, Hecker, Ruf, Schauer, Elbert & Schauer 2011;Smyke, Koga, Johnson, Fox, Marshall, Nelson & Zeanah, 2007).…”