Darfur refugees in Cairo: mental health and interpersonal conflict in the aftermath of genocide

Hundreds of thousands of Darfur people affected by the Sudanese genocide have fled to Cairo, Egypt, in search of assistance. Collaborating with Africa and Middle East Refugee Assistance (AMERA), the authors conducted a mental health care needs assessment among Darfur refugees in Cairo. Information was collected using individual and focus group interviews to identify gaps in mental health care and develop understandings of emotional and relationship problems. The refugee mental health care system has a piecemeal structure with gaps in outpatient services. There is moderate to severe emotional distress among many Darfur refugees, including symptoms of depression and trauma, and interpersonal conflict, both domestic violence and broader community conflict, elevated relative to pregenocide levels. Given the established relationships between symptoms of depression/traumatic stress and interpersonal violence, improving mental health is important for both preventing mental health decompensation and stemming future cycles of intra- and intergroup conflict.     

Changing the Domestic Violence Narrative: Aligning Definitions and Standards

Many states use a broad legal definition of domestic violence that includes intimate partner violence along with family violence, and it is from this broader conceptualization that the criminal justice system intervenes and often treats all types of offenders in the same way. This judicial response can include a mandate to attend a Batterer Intervention Program-type group, which does little to address violence that occurs outside of the “traditional” partner violence paradigm. In order to advance interventions for physical partner violence that adequately address both male and female perpetration, as well as the broader conceptualization of domestic violence, we must align definitions and standards among researchers, service providers, advocates, policymakers, and the public health and criminal justice systems. Examples of how this misalignment has stalled progress in offender treatment are discussed and a plan for enabling continued innovation in the field is presented.     

The Importance of the Caregiver and Adolescent Relationship for Mental Health Outcomes Among Youth in Foster Care

Youth in foster care have often been exposed to in-home violence and violence exposure is associated with higher mental health concerns. This study used multiple regression mediation analyses with bootstrapping to identify specific current foster caregiver-adolescent relationship factors and their mediating qualities between in-home violence exposure and adolescent internalizing, externalizing, and trauma symptoms. Using a national dataset of adolescents in foster care (n?=?175), the results of this study suggested that an adolescent’s perception of feeling emotionally secure in their relationship with their caregiver mediated the relationships between exposure to violence and youth internalizing, externalizing, and trauma symptoms. Additionally, current foster caregiver involvement and structure mediated the associations between exposure to violence and adolescent internalizing and externalizing outcomes, but not trauma symptoms. Further discussion of the results is included. Findings have important implications for mental health interventions aimed towards youth in foster care.     

Violence and trauma: the past 20 and next 10 years

The issues of violence and trauma over the past 20 years have generated a significant amount of research. However, the development of each field has remained, for the most part, exclusive from the other. Therefore, the goal of this article is to address this shortcoming within the literature by responding to three important questions: (a) What is the most important thing we have learned about violence and trauma in the past 20 years? (b) What is the most important thing we need to learn in the next 10 years? and (c) What is the most promising methodological innovation in the past 20 years for the study or treatment of trauma or interpersonal violence? This article concludes that by increasing the discourse between the two fields, both research fields may be better able to develop conceptually, methodologically, and empirically.     

School-Based Group Interventions for Children Exposed to Domestic Violence

Children exposed to the trauma of domestic violence tend to experience difficulties with internalized and externalized behavior problems, social skills deficits, and academic functioning. Mental health practitioners in the school setting, including school counselors, school psychologists, and school social workers, can address developmental concerns that impede development through group counseling interventions that include both structured activities and play therapy. The school environment offers an ideal setting in which to work with child survivors of trauma, as all students have accessibility to school mental health resources. This article outlines the primary objectives and corresponding procedures for a developmentally- appropriate group interventions for elementary-aged children who have been exposed to the trauma of domestic violence.     

A forensic medicine perspective on recurring episodes of intimate partner violence

During a three year period, 418 victims of intimate partner violence (IPV) were examined and their injuries documented at the Center for Victims of Violence (CVV) in Hamburg, Germany. All victims were questioned if their acute injuries were attributable to recurring acts of violence by the same intimate partner. The victims' experiences with recurring IPV were analyzed and associated risk factors as well as findings of acute physical injuries were integrated into the assesment. Overall, women were significantly more often victims of recurring episodes of IPV than men. In 35.4% of cases, victims of recurring IPV sustained injuries to three or more body regions. However, women who were victimized during a single act of violence, presented with the same distribution of injuries in only 21.1% of cases (p = 0.01). The results emphasize the fact that IPV often manifests itself in a spiraling escalation of physical violence. Furthermore, blunt force trauma to the head was diagnosed significantly more often (p = 0.05). The risk of sustaining a head injury was equally high for women who experienced a first-time violent episode by their ex-partner as it was for married women or women living in a non-marital partnership during recurring episodes of IPV. In an effort to reduce the increased risk for victims of IPV, health care personnel are highly encouraged to partake in forensic medicine based continuing education. This preventative measure may prepare clinicians to recognize IPV earlier as well as to treat and advise clients appropriately.     

Nature-nurture interplay: genetically informative designs contribute to understanding the effects of trauma and interpersonal violence

The past two decades have seen an explosion in research in the fields of violence and trauma and behavior genetics. These two fields came into direct conflict when Lisabeth Fisher DiLalla and Irving I. Gottesman outlined a fundamental conceptual limitation of trauma and violence research: that rather than being causal, the well-documented relationship between exposure to trauma or violence and later negative outcomes could be explained by gene-environment correlation. In the past decade, researchers have addressed this limitation by studying the effects of trauma and violence using genetically informative designs. This report briefly discusses the gains made from this research approach and the promising future for genetically informative trauma and violence research.     

Substance Use and Intimate Violence Among Incarcerated Males

The purpose of this study was to examine substance use patterns among a sample of incarcerated males who report engaging in levels of intimate violence, as well as identifying similarities and differences in demographic, economic status, mental health, criminal justice involvement, relationships, and treatment factors for three groups of incarcerated males - those who report perpetrating low intimate violence, those who report perpetrating moderate intimate violence, and those who report perpetrating extreme intimate violence the year preceding their current incarceration. Findings indicated that low intimate violence group's perpetration consisted almost exclusively of emotional abuse. Moderately intimate violent males and extremely intimate violent males, however, report not only high rates of emotional abuse but physical abuse as well. The distinction between moderate and extremely violent groups was substantial. Findings also indicated that perpetrators at different levels of violence in this study did not vary significantly in age, employment history, marital status, or race. However, the three groups showed significant differences in three main areas: (1) cocaine and alcohol use patterns, (2) stranger violence perpetration and victimization experiences, and (3) emotional discomfort. Implications for substance abuse and mental health treatment interventions and for future research are discussed.     

Public hospitals in China: privatisation, the demise of universal health care and the rise of patient-doctor violence

Ensuring the safety of staff and patients has become a major problem for hospitals in China. This article examines whether one of the reasons for this violence may be the emerging injustice and inequality that have manifested in the Chinese health care system as a result of privatisation reforms since the early 1980s. It considers approaches to these issues that may assist the Chinese Government, and other nations contemplating similar policy changes, to create efficient but equity-based health care systems that minimise collateral trauma to patients and their families.     

Trauma symptoms and life skill needs of domestic violence victims

This study identified the trauma symptoms and life skill needs of 84 domestic violence victims from three domestic violence programs. Women completed two self-report tools: Trauma Symptom Inventory (TSI) and Occupational Self Assessment (OSA). Staff members participated in focus groups regarding their perceptions of the women's needs. Women scored within the clinical range on the Defensive Avoidance (39.8%), Intrusive Experiences (30.1%), and Tension Reduction Behavior (24.1%) clinical scales of the TSI. On the OSA, the groups' priorities differed although all demonstrated a desire to function more independently. Their mental health functioning and prioritization of needs differed based on their level of involvement with the service delivery system. Staff members believe women lack skills in the areas of money management, seeking and obtaining employment, locating permanent housing, independently completing self-care and home management activities, managing stress, and parenting. The findings indicate that both mental health and life skills needs must be addressed.     

Intervening in domestic violence as a police task: legal reform and policing versus citizens’ perspective

Violence in Western societies has received increased public and legal attention during the past few decades, while simultaneously, evidence of decreased violent behaviour has been identified. A specific type of violence that has undergone changes in visibility and increased legal intervention is domestic violence (DV). Have people become more sensitive to all kinds of violence? In this case, DV would not stand out as a crime demanding increasing police intervention. In this article, the public’s perceptions of the importance of intervening in DV as a police task are analysed. Comparisons with the assessed importance of other types of police tasks are made to evaluate the changes in a broader attitudinal context, and official police statistics are reflected against the trends identified from the survey data. In the results, DV stands out in the comparison of change in the importance of police tasks. The hypothesis of increased cultural sensitivity is not confirmed concerning all types of crimes – or even violent crimes. The results can be understood to support the theory about increased cultural sensitivity concerning an issue previously seen as a private matter rather than a criminal act and police matter – DV.     

Advances and future directions in the study of children's neurobiological responses to trauma and violence exposure

One of the most exciting developments to emerge from the field in the past 20 years is the increasing attention to neurobiological responses to violence and trauma exposure. Although researchers have yet to identify a consensual pattern of neurobiological response to violence and trauma exposure, it does appear that some type of alteration in the hypothalamic pituitary adrenal (HPA) axis is likely. This article briefly reviews the multiple moderating factors that help account for the divergent patterns in HPA function as well as methodological advances that will continue to improve the assessment of HPA function in youth exposed to violence and trauma.     

The most important things learned about violence and trauma in the past 20 years

In the past 2 decades, important insights have been gained regarding violence and trauma. Complications occur in how violence and trauma, their causes, and their effects on victims should be defined. Violence and abuse to women--physical, sexual, and emotional--are not rare events and are most often perpetrated by partners or acquaintances rather than strangers and occur in nonmarital as well as marital relationships, including same-sex relationships. A promising methodological innovation in the study of violence and trauma is the use of longitudinal designs. Innovations in treatments for victims such as evidence-based interventions have been slow to emerge; they include eye movement desensitization and reprocessing (EMDR) and the Seeking Safety group intervention for drug-abusing women with trauma histories. Future research should address increased understanding of variation in individual responses to violence and trauma, matching of treatment to different types of male offenders, better understanding of how culture affects violence perpetration and victimization, and evaluation of domestic violence interventions.     

Public charge,legal estrangement,and renegotiating situational trust in the US healthcare safety net

US immigration law increasingly excludes many immigrants materially and symbolically from vital safety-net resources. Existing scholarship has emphasized the public charge rule as a key mechanism for enacting these exclusionary trends, but less is known about how recent public charge uncertainty has shaped how noncitizens and healthcare workers negotiate safety-net resources. Drawing on ethnographic observations and interviews with 80 safety-net workers and patients in three US states from 2015 to 2020, I argue that intensifying anti-immigrant rhetoric surrounding public charge has extended a sense of surveillance into clinical spaces in previously unexamined ways. Drawing on theories of medical legal violence, system avoidance, and legal estrangement, I demonstrate how these dynamics undermined immigrants' health chances and compromised clinic workers' efforts to facilitate care. I also reveal how participants responded to this insinuation of legal violence in healthcare spaces by promoting situational trust in specific procedures and institutions.     

20 years of research into violence and trauma: past and future developments

This reflection on major developments in the past, present, and future of the wider field of violence and trauma is a personal (and probably biased) sampling of what the authors hold to be important. The authors reviewed advances for victims and perpetrators of violence separately. For victims, the authors note that empirical research has established the potential traumatic impact of violence as well as various predictors of what makes persons vulnerable to adverse psychological consequences. The authors also note that the definitions of violence and trauma have evolved to include such behavioral patterns as stalking. Finally, encouraging evidence regarding the efficacy of exposure-based treatments for victims of violence is reviewed, as well as discouraging evidence regarding the efficacy of single-session debriefing following trauma. For the perpetrators, the importance of individual assessment in planning interventions is underscored, and advances in explicit and implicit assessment techniques are discussed.     

Homicidal Ideation and Individuals on the Autism Spectrum

Interest in the relationship between autism and violence has increased in recent years; however, no link has clearly been established between them. Researchers remain curious if autistic people with certain traits (e.g., a history of trauma) are at greater risk of violence than those individuals with autism alone. In this article, we detail two individuals with homicidal ideation (HI) admitted to inpatient psychiatric units who were found to have a diagnosis of autism without language impairment. These cases illustrate the need for mental health providers to consider autism in their differential diagnosis when evaluating an individual with HI. Broadly, we consider how an autistic individual could be susceptible to developing HI and explore treatments specific to autistic individuals that may be helpful in such cases.     

The relationship between trauma and violence in a jail inmate sample

Research suggests there is a link between trauma and violence, although the nature of the relationship is rather equivocal. This study explored this relationship by examining self-reported trauma as a predictor of self-reported violence in 93 jail inmates. Ninety-six percent of the sample reported experiencing a traumatic event, and 67% reported having been violent during the year preceding incarceration. Inmates reporting trauma were more than twice as likely to report having been violent than nonviolent. Stepwise multiple regression analyses suggested traumatic events, as a combined model, significantly contributed to violence perpetration. In addition, witnessing serious violence predicted perpetration of violence. Implications and limitations of the present study are discussed.     

Polytraumatization and trauma symptoms in adolescent boys and girls: interpersonal and noninterpersonal events and moderating effects of adverse family circumstances

The objective of this study was to investigate the cumulative effect of interpersonal and noninterpersonal traumatic life events (IPEs and nIPEs, respectively) on the mental health of adolescents and to determine if the adverse impacts of trauma were moderated by adverse family circumstances (AFC). Adolescents (mean age 16.7 years) from the normative population (n = 462) completed the questionnaire, the Link?ping Youth Life Experience Scale (LYLES), together with Trauma Symptom Checklist for Children (TSCC). The lifetime accumulation of interpersonal, noninterpersonal, and AFC was independently related to trauma-related symptoms in both boys and girls. The number of AFCs moderated the mental health impact of both IPEs and nIPEs in boys but not in girls. Cumulative exposure to both interpersonal and noninterpersonal traumatic events is important for the mental health of adolescents, and, at least for boys, family circumstances seem to be relevant for the impact of trauma. Our results suggest that broader approaches to the study, prevention, and treatment of trauma, including consideration of cumulative exposure, different types of trauma, and additional social risk factors, could be fruitful.     

Trauma and violence research: taking stock in the 21st century

Thirty years after the first national estimates of intimate partner violence were published, the field has reached such a level of maturity that complex questions can be posed and sophisticated research studies can be designed to answer them. Out of this body of research, one of the most important things that researchers have learned is that violence and trauma are experienced in different ways by different individuals and as a result, require different types of prevention and intervention approaches. With this greater understanding of the problems of violence and trauma, together with a commitment to inclusive and practical research, the field is poised to move forward toward the ultimate goal of violence prevention.     

"For us it is like living in the dark": Ethiopian women's experiences with domestic violence

This article discusses the experiences of domestic violence among Ethiopian refugees and immigrants in the United States. A subset (n=18) of the larger study sample (N=254) participated in three focus groups with Amharic-speaking survivors of domestic violence who were currently in or had left abusive relationships. The research was conducted through a public health department, University, and community agency partnership. Findings show domestic violence as taking place within a context of immigration, acculturation, and rapid changes in family and social structure. Participants expressed a need for language and culture-specific domestic violence support and advocacy as well as education programs regarding U.S. laws and resources.