Search Results (59)

Background/Objectives: Depression and anxiety in children pose a significant public health concern, with long-term implications for well-being. Over 10% of children and adolescents are affected by emotional disorders such as depression and anxiety. African American youth face disproportionate exposure to mental health risk factors, including poverty, adverse childhood events, community violence, and racial discrimination, which elevate their vulnerability to these disorders. A particularly at-risk subgroup includes African American children in kinship care arrangements (e.g., grandparents raising grandchildren), who may face additional factors such as family disruption and separation from birth parents. Methods: This mixed-methods sequential study examined how caregiver stress and birth mother–child relationship quality relate to depression and anxiety symptoms in African American children in kinship care. Phase I included survey data from 58 caregivers of children aged 5 to 12; Phase II involved interviews with 16 of these caregivers. Results: Results indicated that lower caregiver stress was associated with reduced child depression and anxiety symptoms. Furthermore, findings suggest that a high quality of the birth mother–child relationship serves as a promotive factor, particularly for depressive symptoms. Qualitative findings highlighted two themes: (1) the weight of kinship care, marked by factors such as ongoing grief and financial strain; and (2) birth parent relationships, defined by a mix of connection, conflict, and loss that affects children’s mental health. Conclusions: These findings underscore the need for greater understanding of the strengths and resources within kinship families that support positive mental health outcomes and highlight the importance of targeted interventions to reduce caregiver stress and foster supportive parent–child relationships. Full article

This study aims to illustrate the impact of accumulated traumatic experiences in adolescence and to evaluate the potential of brief focal psychotherapy (BFP) as a treatment approach for complex trauma. We present the case of a 14-year-old boy who experienced vicarious gender-based violence, child abuse, early maternal separation without alternative secure attachment figures, and forced sudden migration. The patient exhibited symptoms consistent with post-traumatic stress disorder (PTSD) and complex trauma. The culturally sensitive intervention, delivered at a public child and adolescent mental health center, consisted of twenty weekly individual sessions of 45 min each, complemented by three 45 min psychoeducation sessions with the caregiver. The assessment was conducted using a multitrait and multi-informant approach, systematically gathering information across multiple domains of functioning (emotional–behavioral, physical, cognitive, self-perception, and relational) and from different sources (the adolescent, his mother, and the clinician) through clinical interviews, projective techniques, and parental feedback. The primary therapeutic focus was the establishment of a secure therapeutic alliance to facilitate emotional exploration and trauma processing. Following treatment, the patient demonstrated significant improvements in emotional regulation, family relationships, and school performance, as measured by both self-report and parental observations. This case highlights the potential of BFP in addressing complex trauma in adolescents, particularly during a developmental stage marked by increased vulnerability to the effects of chronic trauma exposure. The findings suggest that BFP can effectively reduce both acute symptomatology and broader psychosocial consequences associated with prolonged and cumulative trauma. Further research, particularly controlled studies and longitudinal follow-ups, is needed to refine and optimize the use of BFP by mental health professionals working with adolescents affected by complex trauma. Full article

(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (n = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered. Full article

Background/Objectives: Violence in healthcare settings, especially in emergency departments (ED), remains an important public health issue worldwide. Thus, additional insight into the effect of these incidents into nurses’ professional attitudes, their work life and related implications to patient safety issues may be valuable. We investigated ED nurses’ living experience of exposure to workplace violence by healthcare service users, with focus on the impact on them. Methods: Following a qualitative study design, data were collected (January–June 2024) through semi-structured interviews with open-ended questions and were analyzed according to an inductive, content analysis approach. Participants provided informed consent, and data collection continued until theoretical saturation was reached. Results: The sample included six nurses. Various forms of workplace violence and its psychological, social, and professional consequences were identified. Violence was more frequently perpetrated by patients’ relatives, with verbal aggression being the most common form. A fundamental divergence in needs and expectation between patients and their family members/caregivers, on one side, and participants, on the other, revealed a pronounced empathy gap. Each group remained focused on its own priorities while struggling to recognize or accommodate others’ perspectives. This lack of mutual understanding contributed to tension that, in some cases, escalated even into physically violent incidents against the participants. A similar gap was identified between the participants’ needs and administrators’ attitudes and related policies. The failure of administrative measures to bridge this gap was described as a crucial factor in further escalating conflicts and tension in the ED. Conclusions: Further research on quality improvement projects, including all stakeholders, aiming to enhance empathy in all parties involved is proposed. Full article

Exposure to violence is one of the most common adverse effects. In recent years, there has been a particular interest in understanding the link between exposure to violence and the perpetration of other forms of violence, such as child-to-parent violence, a complex family problem that severely affects the relationships between family members. Objective: We aimed to examine the mediating role of instrumental and reactive reasons in the relationship between exposure to violence and child-to-parent violence in different contexts. To fulfill this objective, it was necessary to analyze the evidence of validity and psychometric properties of the Violence Exposure Scale with Colombian adolescents. Methods: A total of 981 Colombian adolescents between aged 12 and 18 years participated. The participants responded to two psychometric scales: one on exposure to violence and the other on child-to-parent violence. Results: The Violence Exposure Scale presented an excellent psychometric model and evidence of adequate validity and reliability. Girls reported greater exposure to violence at home and boys reported greater exposure to violence at school and on the street. In general, older adolescents reported greater exposure to domestic violence. Instrumental and reactive reasons were significant predictors in the perpetuation of child-to-parent violence, with victimization in the home being the best predictor and reactive reasons the strongest mediating variables. Conclusions: Exposure to violence in the home is a key predictor; however, the co-occurrence of violence in other settings plays an important role in polyvictimization and predicting future violent behavior. Full article

Background: Suicide is a global public health issue, particularly in low- and middle-income countries and among vulnerable groups such as adolescents. Despite increasing research efforts, understanding the psychosocial factors associated with suicidal behavior remains a challenge. This study examines family and personal histories of suicidal behavior, exposure to violence, empathy, and perceived social support in adolescents who have received healthcare services in Ecuador. Methods: A cross-sectional study was conducted with 438 adolescents aged 12 to 18 years. Participants were classified into suicide attempt survivors (AS, n = 58) and non-attempters (NAS, n = 380). A characterization questionnaire was applied (prior hospitalization for suicide attempt, family history, and survivor condition), the Alexian Brother Urge to Self-Injure scale, the Plutchik Suicide Risk Scale, the Multidimensional Scale of Perceived Social Support, and the Cognitive and Affective Empathy Test. Results: Adolescents with a history of suicide attempts exhibited higher levels of self-injurious behavior impulse (OR = 8.90, CI 95% [4.28–18.52], p < 0.001), Gravity attempt (OR = 8.162, CI 95% [4.34–15.37], p < 0.001), and suicide risk (OR = 2.90, CI 95% [1.42–5.94], p = 0.006). A significant association was found between suicide attempts and exposure to domestic (p = 0.000), school (p = 0.000), and sexual violence (p = 0.000). A family history of suicide attempts increased the likelihood of suicidal behavior in adolescents (OR = 2.40, CI 95% [1.12–5.16], p = 0.022). In contrast, perceived family support acted as a potential protective factor (OR = 0.36, CI 95% [0.15–0.91], p = 0.055). Conclusions: These findings highlight the need for prevention strategies that address social and developmental factors. Full article

Background: Refugees face numerous challenges, including conflict, displacement, family separation, human rights violations, limited access to basic needs, and exposure to violence and torture. These experiences significantly impact their psychological well-being, leading to increased stress, anxiety, and depression. Syrian refugees in Jordan may experience higher levels of depression and anxiety than those in Spain due to harsher living conditions, limited economic opportunities, uncertain legal status, inadequate mental health services, and ongoing proximity to the Syrian conflict, whereas refugees in Spain benefit from better integration, stronger support systems, and greater stability. Objective: This study aimed to assess and compare the psychological symptoms experienced by Syrian refugees in Jordan and Spain. Methods: A cross-sectional correlational design was employed to evaluate the psychological impact on Syrian refugees in both developed (Spain) and developing (Jordan) country. A sample of 200 refugees from camps, residences, and refugee centers was recruited. Psychological symptoms were measured using the Depression Anxiety Stress Scale (DASS-21). Results: The majority of participants had low income, secondary education, and were unemployed. Overall, 55.5% reported stress, 63.5% anxiety, and 68.5% depression. Higher levels of stress and depression were observed among females, unemployed individuals, and low-income groups. Age also played a critical role, with individuals aged 40–49 reporting elevated stress, anxiety, and depression compared with other age groups. Discrimination and living arrangements further influenced mental health, with low-social-connectivity communities and rural areas associated with higher anxiety and depression. Higher levels of stress and depression were observed among females in Spain and significant mental health disparities across age and income groups in Jordan. These findings underscore the need for targeted interventions addressing sociodemographic vulnerabilities to improve refugee mental health outcomes. Refugees in Jordan reported significantly higher levels of depression and anxiety compared with those in Spain. Conclusions: The findings highlight the profound psychological burden faced by Syrian refugees, particularly in Jordan, where living conditions and systemic challenges exacerbate mental health issues. Factors such as age, gender, marital status, low education, and low income were strongly associated with higher stress levels in both countries. These results underscore the need for targeted mental health interventions, improved access to psychological support, and policies that address the socioeconomic and legal challenges faced by refugees. Enhancing integration, reducing discrimination, and providing comprehensive mental health services are critical steps toward improving the well-being of this vulnerable population. Full article

Introduction: Child-to-parent violence (CPV) is influenced by factors such as sex, age, dating violence, psychopathy traits, and antisocial and law-violating behaviors. This study explores how these variables relate to aggression towards parents, identifying key explanatory factors. Methods: This research engaged 136 Spanish adolescents aged 15–18 (mean age = 16.47; 51% female). Assessments included the Conflict in Adolescent Dating Relationships Inventory (CADRI) for dating violence, the Psychopathy Content Scale (P-16) for psychopathy, the Antisocial and Criminal Behavior Scale in Adolescents (ECADA) for antisocial and law-violating behaviors, and the Conflict Tactics Scales (CTS2) for CPV. Analyses of associations included linear regression and qualitative comparative analysis (QCA). Results: Females exhibited higher levels of verbal violence, less delinquency, and more frequent CPV towards mothers. Psychopathy, antisocial and law-violating behaviors, and exposure to verbal violence were correlated with filial aggression. Violence towards mothers was associated with older age, female sex, verbal violence exposure, and psychopathy (47% variance explained), while violence towards fathers was linked to younger age and psychopathy (28% variance explained). QCA results indicated that specific combinations of having experienced violence and psychopathic traits contribute to CPV towards both parents. Conclusions: These findings highlight the importance of addressing psychological and sociodemographic risk factors for CPV. Prevention efforts should focus on reducing exposure to violence, identifying at-risk adolescents, and implementing targeted interventions to promote family well-being. Full article

Aim: To understand the factors that influence family violence towards First Nations women, to inform practises and policies to support these women and improve their engagement in maternal child health services. Design: A qualitative study, using narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’, and thematic analysis of the data. Materials and Methods: Survey of 10 Maternal Child Health nurses in 2019, and interviews of 35 Aboriginal mothers in 2021. Results: The nurses identified drugs, alcohol, socio-economic issues, the history of effects of colonisation on First Nations peoples, and stress as perceived factors influencing family violence, and acceptance, fear, cultural beliefs, and mistrust, for women’s low reporting of violence. Factors that influenced nurses’ ability to identify family violence were mistrust and understanding of Aboriginal culture. Low self-esteem, lack of belonging, and not being heard were identified by the mothers as factors that influence family violence. Fear of child protective services, shame, mistrust, and poor rapport with the nurses contributed to their low reporting of violence. The most significant factor for the mothers to disclose violence is fear of losing her child, mistrust, and the questioning process. Conclusions: Nurses’ understanding of Indigenous culture is critical to develop trust and improve the engagement of First Nations women. A significant difference in the synthesis of data between the nurses and their First Nations consumers was conspicuous. Research regarding the benefit of models and interventions that recognise the social determinants of health and well-being on health outcomes as well as the value of culturally strong health services aimed to encourage an earlier identification of risk, ideally from the antenatal period to the child’s fifth birthday, is imperative. The implications of this research are of international importance for First Nations families and challenge current nursing practises to address the human rights challenge of the inequity in health outcomes between First Nation and non-First Nation children, their exposure to family violence, and their over-representation in child protection services. Full article

Resilience research is concerned with studying the complex interplay of personal and ecological resources that promote positive adaptation following adversity in different populations. Although much research has investigated adjustment in young persons exposed to intimate partner violence (IPV), most of this research has taken a deficit approach by focusing on the negative cascades of effects that exposure to IPV has on the functioning of this group. In this paper, we discuss a mixed methods integration of two independent strength-based or resilience-focused studies involving Canadian youth exposed to IPV. Study 1 is a qualitative constructive grounded theory study that aimed to identify the coping strategies that youth exposed to IPV use to effectively cope with the traumatic experience of growing up in an IPV-affected family. This study included 13 youths with a history of IPV exposure who completed individual in-depth interviews, the drawing of ecomaps, and photovoice projects. Study 2 is a quantitative population-based study that aimed to identify profiles of adjustment in a cohort of 3886 youth who had previously experienced IPV exposure, as well as the specific risk and promotive factors that significantly predicted membership in the identified adjustment profiles. Both studies independently identified personal and ecological resources that were instrumental in supporting the resilience of study participants. By comparing and contrasting the two sets of findings, the present mixed methods integration provides further evidence on the complex interactions of mechanisms that promote positive adaptation in youth exposed to IPV, which aligns with a multisystemic understanding of resilience in this population. We provided recommendations for practice and policy based on the integrated findings. Full article

In African culture, widowhood is frequently accompanied by rites that must be carried out by the widow. Widows are compelled to carry out these rites and may not feel comfortable executing them since they involve violence. The minority who dares to refuse to participate can face serious consequences because they are persecuted by their families and society. Research shows that widows suffer from fear and coercion, stigmatisation, dehumanising experiences, movement and social restrictions, and exposure to harmful traditional practices. This article examines violent aspects of widowhood rites within the South African context. A qualitative study that examined oppressive structures and how they impacted social injustice and the marginalisation of widows was employed. The data were collected from a purposeful sample of widows in Gauteng province, South Africa. Semi-structured interviews were used to gather data from 28 widows, which were then subjected to thematic analysis. Our findings showed that widows were subjected to painful widowhood rites, which were frequently performed against their preferences. The rites affected them both physically and emotionally. The article recommends that policies be put in place to safeguard the rights of widows and protect them from exploitative cultural beliefs. Full article

This study explains the Venezuelan migration involving unaccompanied or separated adolescents (UASA) on the Colombian–Venezuelan border, specifically in Norte de Santander-Táchira. This explanation is framed within the concept of the social moratorium, highlighting three subcategories that contribute to the early abandonment of childhood: 1. the violation of rights, 2. working life, and 3. confrontation of dangers. These subcategories compel UASA to transition prematurely into youth, assuming social, labor, or family responsibilities. Methodologically, we adopt a narrative approach, conducting group interviews with 24 immigrant children and adolescents. Furthermore, 14 interviews are conducted in 2 local markets, and the remaining 10 on 2 central avenues in the city of Cúcuta, Colombia. We conduct a theoretical analysis drawing upon key concepts, including the social moratorium, social constructionism, interaction, and moral and cognitive development. This theoretical framework helps us understand the consequences for the life prospects of this generation. They arise from factors such as school dropout, exposure to health risks, and the absence of free leisure time. These indicators reflect socioeconomic problems, including poverty, abuse, and violence. Full article

Victims of intimate partner violence (IPV) and their children may be at an increased risk for negative health outcomes and may present to healthcare settings. The objective of the current study is to examine the profile of medical-referred child welfare investigations of exposure to IPV in Ontario, Canada. Data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 were used. We compared medical-referred investigations with all other investigations of exposure to IPV. Descriptive and bivariate analyses as well as a logistic regression predicting transfers to ongoing services were conducted. Six percent of investigations of exposure to IPV conducted in Ontario in 2018 were referred by a medical source. Compared to other investigations of exposure to IPV, these investigations were more likely to involve younger children (p = 0.005), caregivers with mental health issues (p < 0.001) and few social supports (p = 0.004), and households noted to be overcrowded (p = 0.001). After controlling for clinical case characteristics, investigations of exposure to IPV referred by healthcare sources were 3.452 times as likely to be kept open for ongoing child welfare services compared to those referred by other sources (95% CI [2.024, 5.886]; p < 0.001). Children and their families who are identified in healthcare settings for concerns of exposure to IPV tend to receive extended child welfare intervention compared to those identified elsewhere. There is a clear difference in service provision in healthcare-originating investigations of exposure to IPV versus investigations originating from other sources. Further research into the services provided to victims of IPV and their children is needed. Full article

Homes in which families are experiencing stressful and challenging circumstances can foster a social space that engenders violent behaviours in parents, inadequate childcare, and the exposure of children to criminal and antisocial behaviours at an early age in addition to many other negative social and health consequences throughout their development. Family Skills Training offers a combination of parenting knowledge, skill building, competency enhancement, and support to strengthen family protective factors, such as communication, trust, problem-solving skills, and conflict resolution. Through over a decade-long experience piloting evidence-based family skills packages globally, we developed a universal open-source family skills package, “Family UNited” (FU), designed for families with children aged 8 to 15 years living in low- and middle-income countries (LMIC). The current study aims to explore the efficacy, fidelity, and acceptability of FU in Trentino and Parma, Italy. We plan to conduct a multi-site, non-blinded, two-armed, cluster-randomised controlled trial to assess efficacy in 160 families: the intervention group receiving FU and the waitlist/control group only receiving FU after the completion of all data collection points. We will prospectively collect outcome data, assessing changes in parenting skills and family adjustment in caregivers, children’s behaviour, resilience capacities, and attitudes towards peer violence. To assess programme delivery, fidelity, feasibility, and acceptability we will include an embedded process evaluation. This study aims to evaluate the improvement in parenting skills, child well-being, and family mental health after participation in FU, compared to no intervention. Even though this trial is to be conducted in a high-income country, such results complement the existing piloting experience in LMIC. with impact-related measures encouraging the adoption of such approaches globally and beyond the EU borders. Full article

Mood and anxiety disorders affect pregnant individuals and their families at increased rates throughout the perinatal period. Geographic, financial, and social barriers often preclude adequate diagnosis and treatment. The aim of this manuscript is to describe the consultation and care arms of the Michigan Clinical Consultation and Care (MC3) program, a statewide program designed to facilitate access to perinatal mental healthcare for OB/Gyn patients, and to describe the participants engaged in the program, examine the predictors of participant retention, and provide preliminary data regarding participants’ mental health outcomes. We enrolled 209 participants to the clinical care arm, of which 48 were lost to follow-up, while 107 remained enrolled at the time of data analysis. A total of 54 participants met their treatment goals. A total of 97% of participants asserted they were satisfied with the services they received. Black race and public insurance predicted faster attrition from the care arm treatment; risks for interpersonal violence exposure and substance use were unrelated to attrition. Preliminary mental health outcomes showed significant decreases in anxiety and depression, with the most dramatic decreases in the first month of treatment. Overall, the MC3 clinical care arm shows promising rates of adherence, excellent program satisfaction, and a positive impact on perinatal mental health, supporting continued program implementation and ongoing evaluation. Full article