• A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement.

      Neuner, F; Schauer, M; Klaschik, C; Karunakara, U; Elbert, T; Department of Clinical Psychology, University of Konstanz, Konstanz, Germany. frank.neuner@uni-konstanz.de (2004-08)
      Little is known about the usefulness of psychotherapeutic approaches for traumatized refugees who continue to live in dangerous conditions. Narrative exposure therapy (NET) is a short-term approach based on cognitive-behavioral therapy and testimony therapy. The efficacy of narrative exposure therapy was evaluated in a randomized controlled trial. Sudanese refugees living in a Ugandan refugee settlement (N = 43) who were diagnosed as suffering from posttraumatic stress disorder (PTSD) either received 4 sessions of NET, 4 sessions of supportive counseling (SC), or psychoeducation (PE) completed in 1 session. One year after treatment, only 29% of the NET participants but 79% of the SC group and 80% of the PE group still fulfilled PTSD criteria. These results indicate that NET is a promising approach for the treatment of PTSD for refugees living in unsafe conditions.
    • Exposure to violence and PTSD symptoms among Somali women

      de Jong, K; van der Kam, S; Swarthout, T; Ford, N; Mills, C; Yun, O; Kleber, R J; Médecins sans Frontières, Doctors without Borders, Amsterdam, Geneva, New York; Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Department of Clinical and Health Psychology, Utrecht University, and Foundation Arq, Diemen, the Netherlands (Wiley-Blackwell, 2011-12-05)
      Posttraumatic stress disorder (PTSD) symptoms, exposure to traumatic stressors, and health care utilization were examined in 84 women attending a primary health care clinic in Mogadishu, Somalia. The Somalia-Posttraumatic Diagnostic Scale was used in this active warzone to measure symptoms. Nearly all women reported high levels of confrontations with violence; half described being exposed to a potentially traumatizing event. Nearly one third had significant PTSD symptoms. Compared to those who did not, women who reported exposure to a traumatic stressor reported more confrontations with violence (7.1 vs. 3.3; p < . 001), health complaints (3.8 vs. 2.9; p = .03), and nearly 3 times as much (p = .03) health service utilization. A potentially traumatizing event was found to be a simplified proxy for assessing mental health distress in women attending a primary health care facility in highly insecure, unpredictable, resource-limited settings.
    • Mental Health Status of Vulnerable Tsunami-Affected Communities: A Survey in Aceh Province, Indonesia.

      Souza, R; Bernatsky, S; Reyes, R; de Jong, K; Medecins Sans Frontieres-Holland, Amsterdam, The Netherlands. (2007-06)
      The authors determined the prevalence of severe emotional distress and depressive symptoms using the Hopkins Symptoms Checklist-25 (HSCL; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) in tsunami-affected communities that had experienced armed conflict arising from the ongoing independence movement in Aceh Province, Indonesia. We also evaluated determinants of severe emotional distress. The data were collected for the purposes of a mental health assessment. In our sample (N = 262), 83.6% demonstrated severe emotional distress, and 77.1% demonstrated depressive symptoms. In multivariate regression models, severe emotional distress was positively associated with the number of tsunami-related deaths among household members. Our data suggests a need for effective interventions in this vulnerable population.
    • Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees.

      Neuner, F; Schauer, M; Karunakara, U; Klaschik, C; Robert, C; Elbert, T; Department of Psychology, University of Konstanz and Center for Psychiatry Reichenau, D-78457 Konstanz, Germany. Frank.Neuner@Uni-Konstanz.de (2004)
      BACKGROUND: Political instability and the civil war in Southern Sudan have resulted in numerous atrocities, mass violence, and forced migration for vast parts of the civilian population in the West Nile region. High exposure to traumatic experiences has been particularly prominent in the Ugandan and Sudanese of the West Nile Region, representing an indication of the psychological strain posed by years of armed conflict. METHODS: In this study the impact of traumatic events on the prevalence and severity of posttraumatic stress disorder (PTSD) in a random sample of 3.339 Ugandan nationals, Sudanese nationals, and Sudanese refugees (1.831 households) of the West Nile region is assessed. RESULTS: Results show a positive correlation between the number of traumatic events and the number of endorsed PTSD symptoms. Of the 58 respondents who experienced the greatest number of traumatizing experiences, all reported symptoms which met the DSM-IV criteria for PTSD. CONCLUSIONS: There is a clear dose-effect relationship between traumatic exposure and PTSD in the studied populations with high levels of traumatic events. In this context, it is probable that any individual could develop PTSD regardless of other risk-factors once the trauma load reaches a certain threshold.
    • The trauma of war in Sierra Leone.

      de Jong, K; Mulhern, M; Ford, N; van der Kam, S; Kleber, R; Institute of Psychotrauma, University of Utrecht, The Netherlands. (Elsevier, 2000-06-10)