Gender (in) differences in prevalence and incidence of traumatic experiences among orphaned and separated children living in five low- and middle-income countries

Abstract

Background. Approximately 153 million children worldwide are orphaned and vulnerable to potentially traumatic events (PTEs). Gender differences in PTEs in low-and middle-income countries (LMIC) are not well-understood, although support services and prevention programs often primarily involve girls.Methods. The Positive Outcomes for Orphans study used a two-stage, cluster-randomized sampling design to identify 2837 orphaned and separated children (OSC) in five LMIC in sub-Saharan Africa and Asia. We examined self-reported prevalence and incidence of several PTE types, including physical and sexual abuse, among 2235 children who were ≥10 years at baseline or follow-up, with a focus on gender comparisons. Results. Lifetime prevalence by age 13 of any PTE other than loss of a parent was similar in both boys [91.7% (95% confidence interval (CI) (85.0-95.5)] and girls [90.3% CI (84.2-94.1)] in institutional-based care, and boys [92.0% (CI 89.0-94.2)] and girls [92.9% CI (89.8-95.1)] in family-based care; annual incidence was similarly comparable between institution dwelling boys [23.6% CI (19.1,−29.3)] and girls [23.6% CI (18.6,−30.0)], as well as between family-dwelling boys [30.7% CI (28.0,−33.6)] and girls [29.3% CI (26.8,−32.0)]. Physical and sexual abuse had the highest overall annual incidence of any trauma type for institution-based OSC [12.9% CI (9.6-17.4)] and family-based OSC [19.4% CI (14.5-26.1)], although estimates in each setting were no different between genders.Conclusion. Prevalence and annual incidence of PTEs were high among OSC in general, but gender-specific estimates were comparable. Although support services and prevention programs are essential for female OSC, programs for male OSC are equally important.

Clinical risk factors among youth at high risk for suicide in South Africa and Guyana

“…Among males, greater odds of suicidal behaviors were associated with somatic complaints. Given the shorter suicidal process for youth (relative to adults) and the preventative role of social support on depressive symptoms, these data point to the need for help-seeking services, in LMICs where secondary prevention education and suicide screening will help male youths communicate emotional distress and thoughts of hopelessness (Gray et al, 2015). Another implication is that somatization may be a culturally learned and acceptable way to communicate physical and emotional pain; Schlebusch (2012) summarized that youths exposed to somatic diseases experience early life trauma and have hampered social bonds, subsequent to suicidal behavior.…”

“…Another implication is that somatization may be a culturally learned and acceptable way to communicate physical and emotional pain; Schlebusch (2012) summarized that youths exposed to somatic diseases experience early life trauma and have hampered social bonds, subsequent to suicidal behavior. Given the shorter suicidal process for youth (relative to adults) and the preventative role of social support on depressive symptoms, these data point to the need for help-seeking services, in LMICs where secondary prevention education and suicide screening will help male youths communicate emotional distress and thoughts of hopelessness (Gray et al, 2015). Professional training and suicide education that involves inquiry, probing, and an uncovering of male youth somatic symptoms would directly guide suicide prevention.…”

Child violence experiences in institutionalised/orphanage care

“…In a large (n = 1053) 5 country study, Gray et al (2015a) predicted 50.3% [95% CI: 42.5, 58.0] of those children within institutional care experienced physical or sexual abuse. In a second study (Gray et al, 2015b) from the same group predicted prevalence of physical and sexual abuse for institutionalised children at age 13 was 49.4% of males and 51.3% of females and 13.6% for males and 12% for females when confined to the last 12 months. Pinto and Maia (2013) reported on 86 children in institutional care and noted emotional abuse for 36%, physical abuse for 34.9%, emotional neglect 57%, physical neglect 45.3% and sexual abuse 21%.…”

“…Within the 66 studies only two measured any form of maltreatment such as abuse, violence or any other harsh punishment or experience. The first showed a relation to amygdalae formation as the outcome (Hanson et al, 2015) and the second showed that children in institutional settings were significantly more likely to experience forms of abuse/violence measured (Whetten et al, 2009reported in Gray et al, 2015a, 2015b. The latter were drawn from the same five country study of 6-12 year olds where no differences in cognitive outcomes had been identified -yet more abuse was recorded.…”

“…Hermenau, Kaltenbach, Mkinga, and Hecker (2015; Tanzania) noted 93% reporting physical maltreatment at baseline. Gray et al (2015aGray et al ( , 2015b noted that 50.3% of 1053 children in institutional care across 5 countries reported physical or sexual abuse with no differences by gender, but more abuse among the younger age groups. Hermenau, Hecker, Elbert, and Ruf-Leuschner (2014) in Tanzania compared reports for children who were institutionalised from 0 to 4 years of age with those 5-14 years of age, and noted that 89% reported at least one experience of abuse, more so among those institutionalised at birth.…”