Violence-related Trauma Research Articles

Social, family and trauma risk factors for common disorders in Israeli youth

Trauma exposure needs to be differentiated from trauma impacts in models of psychological disorder. Early life trauma experience is well established as a risk for psychological disorder in teenage and adult years. However, trauma experience is a broad category including personal (e.g. familial abuse, peer violence) and non-personal such as social deprivation and political violence related trauma. These factors are examined together in the Israeli context to gain understanding of their impact on emotional and behavioural disorders. MethodThis study examined self-report trauma experience, psychosocial risks and psychological disorder by questionnaire in 108 Israeli youth (aged 12–16). This comprised an underprivileged group from social services and a comparison group. Standardised questionnaires were used in translation to assess demographics, prior personal trauma, political violence trauma, parental bonding in earlier childhood and emotional and behavioural disorder. The aim was to see how social deprivation, ethnicity, poor parenting and peer problems related to exposure to personal trauma events, and whether this impinged on political violence trauma and psychological disorder. ResultsExposure to a range of personal childhood trauma events was related to peer problems and affectionless control from father and more common in Israeli Arab youth. Exposure to political trauma was more common among those less socially deprived. A dose-effect of political trauma on psychological disorder was supported. Logistic regression showed social deprivation, exposure to political trauma and peer problems provided the best model for conduct disorder and exposure to political violence and peer problems provided the best model for hyperactive disorder. Personal childhood trauma did not add to the models. DiscussionAll youth are vulnerable to disorder in conflict situations. Understanding issues of social deprivation, relationship with parents and peers and ethnicity add additional risks for psychological disorder in the Israeli context.

Patterns and prevalence of violence-related skull trauma in medieval London.

This study aims to identify the patterns and prevalence of violence-related skull trauma (including the cranium and mandible) among a large sample of skeletons from medieval London (1050-1550AD). In total, data from 399 skulls, representing six different sites from across medieval London, were analyzed for evidence of trauma and assessed for the likelihood that it was caused by violence. The sites include the three parish cemeteries of St Nicholas Shambles (GPO75), St Lawrence Jewry (GYE92), and St Benet Sherehog (ONE94); the two monastic houses of London Blackfriars (PIC87) and St Mary Graces (MIN86); and the early inmate cemetery from the medieval hospital of St Mary Spital (NRT85). The overall findings suggest that violence affected all aspects of medieval London society, but how that violence was characterized largely depended on sex and burial location. Specifically, males from the lay cemeteries appear to have been the demographic most affected by violence-related skull injuries, particularly blunt force trauma to the cranial vault. Using both archaeological and historical evidence, the results suggest that violence in medieval London may have been more prevalent than in other parts of medieval England, particularly rural environments, but similar to other parts of medieval Europe. However, more studies focusing on medieval trauma, and violence specifically, need to be carried out to further strengthen these results. In particular, males from the lay cemeteries were disproportionately affected by violence-related trauma, especially blunt force trauma. It perhaps indicates a means of informal conflict resolution as those of lower status did not always have the newly established medieval legal system available to them.

From fear to resilience: adolescents\u2019 experiences of violence in inner-city Johannesburg, South Africa

BackgroundFor adolescents growing up in poor urban South African settings, violence is often a part of daily life and has lasting effects on physical and mental health outcomes in adulthood. We conducted a qualitative study to document and understand the forms of interpersonal violence experienced by adolescents living in Hillbrow, Johannesburg. In this article, we explore how violence is experienced differently by adolescent boys and girls, how they conceptualise ‘dangerous’ and ‘safe’ spaces in their neighbourhood and what gaps exist in available services for youth in Hillbrow.MethodsThe article draws on data collected in the formative phase of the ‘Wellbeing of Adolescents in Vulnerable Environments’ (WAVE) Study of challenges faced by adolescents (15–19 years) growing up in impoverished parts of five cities. This article reports on analysis using only data from the Johannesburg site. Using both purposive and snowball sampling to select participants, we conducted in-depth interviews (n = 20) and community mapping exercises with female (n = 19) and male (n = 20) adolescents living in Hillbrow, as well as key informant interviews with representatives of residential shelters, CBOs, and NGOs working with youth (n = 17). Transcripts were coded manually and analysed using an inductive thematic analysis approach.ResultsBoth girls and boys reported high exposure to witnessing violence and crime. For girls, the threat of sexual harassment and violence was pervasive, while boys feared local gangs, the threat of physical violence, and being drawn into substance-abuse. Home was largely a safe haven for boys, whereas for girls it was often a space of sexual violence, abuse and neglect. Some adolescents developed coping mechanisms, such as actively seeking out community theatres, churches and other places of sanctuary from violence. Community-based services and shelters that support adolescents reported a lack of resources, overall instability and difficulties networking effectively.ConclusionsAdolescents in Hillbrow commonly witnessed and had direct experience of many forms of violence in their environment, and these experiences differed markedly by gender. Interventions that build young peoples’ social capital and resilience are essential for reducing violence-related trauma and long-term health and social consequences for adolescents in this community.

Trauma admissions among victims of domestic violence at a tertiary care hospital in north-western Tanzania: an urgent call to action

Background: Despite the growing recognition of domestic violence as a public health and human rights concern, it remains rampant in developing countries and has a negative impact on the victim’s health. This study describes the injury characteristics and treatment outcome of trauma associated with domestic violence in north-western Tanzania.Methods: This was a descriptive prospective study of patients who were managed for domestic violence related trauma at Bugando Medical Centre in Mwanza, Tanzania from April 2009 to March 2014.Results: A total of 324 patients (M: F = 1: 10.6) were studied. Majority of the patients were in the second and third decades of life. The perpetrators were mainly husbands and ex-partners (55.5%). Suspecting sexual partner being unfaithful was the most common reason given by victims for domestic violence in 63.4% of cases. Blunt and sharp objects (56.8%) were the most common weapons used. Gunshot injuries were recorded in 0.6% of cases. The head/neck was commonly affected in 68.5%. Soft tissue injuries (77.8%) were the most frequent type of injuries. The majority of patients (65.4%) sustained mild injuries. Twenty-three (7.1%) patients were HIV positive. Surgical treatment was performed in only 34.6% of cases. Complication rate was 26.8%. The median hospital stay was 12 days. Mortality rate was 6.5%. The main predictors of mortality were advanced age (> 60 years), late presentation, severity of injury, severe head injury, HIV seropositivity, low CD 4 count (<200 cells), surgical site infection (p<0.001). More than two-thirds of patients were lost to follow up.Conclusion: Domestic violence related trauma remains rampant in northwestern Tanzania and contributes significantly to high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of domestic physical violence is necessary to reduce the morbidity and mortality resulting from these injuries.

Cannabis use and violence in three remote Aboriginal Australian communities: Analysis of clinic presentations

Anecdotal reports have linked cannabis use to violence in some remote Australian Aboriginal communities. We examine the relationship between cannabis use and presentations to local clinics for violence-related trauma at a population level. As part of a larger study, estimates of cannabis and alcohol use status were obtained for 264 randomly selected individuals aged 14-42. These estimates were collected from Aboriginal health workers and respected community informants using a previously validated approach. Clinic records for the sample were audited for physical trauma presentations between January 2004 and June 2006. One in 3 individuals (n = 88/264) presented to the clinic with physical trauma. Of these, the majority (65.9%, n = 58/88) had at least one presentation that was violence-related. Nearly 2 in every 3 of the total presentations for trauma following violence (n = 40/63) involved the use of a weapon. Hunting tools were most often used, followed by wooden or rock implements. Individuals who reported any current cannabis use were nearly 4 times more likely than nonusers to present at least once for violent trauma after adjusting for current alcohol use, age, and sex (OR = 3.8, 95% CI [1.5, 9.8]). Aboriginal individuals in these remote communities experience high rates of physical trauma and violence, often involving weapons. A comprehensive study is needed to explore the association between cannabis and violence. At the same time, an investment in local programmes is needed to address cannabis use and underlying risk factors for substance use and for violence.

Violence indicators in Quebrada de Humahuaca, Jujuy, Argentina: The Regional Development Period from a regional perspective

Quebrada de Humahuaca (Jujuy, Argentina) has been extensively studied by archaeologists. Studies have been focused mainly on the Late Regional Development Period (1250–1430 AD), which has been defined as a time of social conflict. In this paper we present bioarchaeological evidence of interpersonal violence related trauma found in populations of the region. A sample of 153 skulls from three sites of Quebrada de Humahuaca: Los Amarillos, La Huerta and Yacoraite, were analyzed, differentiating antemortem and perimortem fractures, cut marks as well as the presence of trophy skulls. The results were subjected to nonparametric statistical tests, in order to assess inter-site level differences, sex and age distribution.
 Bioarchaeological analysis determined a high frequency of interpersonal violence related trauma. Most registered injuries belonged to the antemortem type, demonstrating that the individuals of those events that had generated said cranial trauma had managed to survive. Interpersonal violence affected both men and women the same, registering no differences in neither sex nor age group, however evidence of trauma varied geographically from site to site. Statistical calculations reveal that the Yacoraite site is where the highest frequency of trauma was found, while La Huerta is where the highest level of trophy skulls was registered.

Incidence of postoperative acute renal failure among violence-related cardiovascular trauma patients: a review of our experience in 117 cases

Background: The purpose of this retrospective study was to determine the incidence of renal failure and hemodialysis (HD) in postoperative period after cardiovascular surgery associated with trauma. Methods: One hundred and seventeen cases of violence-related cardiovascular trauma patients had emergent surgery between 1996 and 2009. Cases were reviewed in three main groups: Cardiac trauma in 11 patients (Group A), vascular trauma in 78 patients (Group B), and cardiovascular trauma in 28 patients (Group C). Postoperative incidence of HD requirements with acute renal failure (ARF) was investigated in these groups of patients postoperatively. Results: Multiorgan deficiency developed in 10 patients from Group A, in 45 patients from Group B, and in 26 patients from Group C. Overall mortality was 81 cases in 117 patients. Total hospitalization periods were 21 ± 2, 17 ± 3, and 27 ± 1 days for Group A, Group B, and Group C, respectively. HD administrations were indicated in 3 patients in Group A, 41 patients in Group B, and 9 patients in Group C. No statistically significant difference presented in any study parameter between groups. Conclusions: Cardiovascular trauma is a common reason for emergent cardiovascular surgery. Postoperative renal failure occurs among these patients in a wide percentage. We strongly advocate a close and detailed follow-up of renal functions in these patients during the hospitalization period and immediate HD at indication.

Violence-related injury of children in Israel: age-dependent pattern

To characterize the population of children hospitalized as a result of violence. This retrospective study used data from the Israeli National Trauma Registry on patients aged 0-17 years hospitalized for trauma during 1998-2006. Of 65,430 patients, 2060 (3.1%) had violence-related injuries. Descriptive statistics and bivariate analysis were used to characterize injury patterns and multivariate analysis was used to identify factors associated with severe injury. Half the victims of violence < 18 years of age were 15-17 years old. Most were boys. Violence-related trauma occurred more often than other trauma in the street, at school or in a public place or leisure facility, but less often at home. Unarmed brawling and stabbing were the most common types of violence. Brawling affected Jewish children more, while non-Jewish children were more often injured by firearms. The boundaries of age groups with different injury rates corresponded to the 'institutional' childhood stages of the Israeli educational system: the violence-related injury rate dropped after the first year of life, stayed low during kindergarten, rose slightly during elementary school and rose steeply during secondary and high school. The percentage of males increased with each age group. The street became more dangerous with age, while school and home became safer. Adolescents aged 15-17 years, newborn infants and those injured by firearms had the highest risk of severe injury. Age and type of violence were the most important predictors of violence frequency and severity. Ethnicity lost importance when adjusted by these factors. Further research on their influence on violence-related injury is needed.

Epidemiology, treatment and outcome of patients after severe traumatic brain injury in European regions with different economic status

We hypothesized that the economic status of a region might influence quality of care and outcome of patients with severe brain trauma. Between January 2001 and December 2005, 13 centres enrolled patients with severe brain trauma. Data on accident, treatment and outcomes were collected prospectively. The regions were classified as 'high income' (Austria, five centres), 'upper middle income' (UMI) (Croatia, Slovakia, six centres) or 'lower middle income' (LMI) (Bosnia, Macedonia, two centres). Data on epidemiology, treatment and outcomes were compared according to this classification. Quality of care was assessed using a new scoring system. A total of 1172 data sets were analysed. Patients from the wealthier regions were significantly older. Low-level falls and traffic accidents contributed to more than two-third of all cases. Violence-related trauma was significantly more frequent in 'middle income' regions. Treatment quality was significantly different; treatment according to guidelines for brain trauma management was provided most frequently for patients from high-income regions. Compared with expected mortality rates, mortality was 6.5% lower in the 'high-income' centres, 2.4% lower in the 'UMI' centres and 13% higher in the 'LMI' centres. Advanced age, poor neurological status, high trauma severity and poor quality of care were associated with significantly lower odds for survival. The association between the economic status and outcome of brain trauma patients was due to the quality of care. Successful implementation of guidelines for brain trauma management requires a well-funded health care system.

A six-year descriptive analysis of hospitalisations for ambulatory care sensitive conditions among people born in refugee-source countries

BackgroundHospitalisation for ambulatory care sensitive conditions (ACSHs) has become a recognised tool to measure access to primary care. Timely and effective outpatient care is highly relevant to refugee populations given the past exposure to torture and trauma, and poor access to adequate health care in their countries of origin and during flight. Little is known about ACSHs among resettled refugee populations. With the aim of examining the hypothesis that people from refugee backgrounds have higher ACSHs than people born in the country of hospitalisation, this study analysed a six-year state-wide hospital discharge dataset to estimate ACSH rates for residents born in refugee-source countries and compared them with the Australia-born population.MethodsHospital discharge data between 1 July 1998 and 30 June 2004 from the Victorian Admitted Episodes Dataset were used to assess ACSH rates among residents born in eight refugee-source countries, and compare them with the Australia-born average. Rate ratios and 95% confidence levels were used to illustrate these comparisons. Four categories of ambulatory care sensitive conditions were measured: total, acute, chronic and vaccine-preventable. Country of birth was used as a proxy indicator of refugee status.ResultsWhen compared with the Australia-born population, hospitalisations for total and acute ambulatory care sensitive conditions were lower among refugee-born persons over the six-year period. Chronic and vaccine-preventable ACSHs were largely similar between the two population groups.ConclusionContrary to our hypothesis, preventable hospitalisation rates among people born in refugee-source countries were no higher than Australia-born population averages. More research is needed to elucidate whether low rates of preventable hospitalisation indicate better health status, appropriate health habits, timely and effective care-seeking behaviour and outpatient care, or overall low levels of health care-seeking due to other more pressing needs during the initial period of resettlement. It is important to unpack dimensions of health status and health care access in refugee populations through ad-hoc surveys as the refugee population is not a homogenous group despite sharing a common experience of forced displacement and violence-related trauma.

Hope, Meaning, and Growth Following the September 11, 2001, Terrorist Attacks

Positive psychologists found the increase of seven character strengths that encompass the so-called theological virtues, including hope and spirituality, in Americans after the September 11, 2001, attacks. Little is known about how they may affect post-September 11, 2001, mental health. Using multivariate analysis, this study investigated the relationship of hope and spiritual meaning with depression and anxiety in a sample of 457 students 3 months after September 11, 2001. Both characters contributed to lower levels of symptoms. In qualitative analysis, of 313 answers to an open-ended question regarding personal change, four categories emerged. The first three were consonant with other studies on posttraumatic growth (PTG), including changes in the self or behavior, relationships, and worldviews. The fourth category unique to September 11, 2001, was changes in political views. These findings offer further credence to the study of positive aspects resulting from violence-related trauma and highlight the needs for addressing the nature of traumatic events and PTG.

Posttraumatic Stress Disorder and Associated Functional Impairments During Pregnancy: Some Consequences of Violence Against Women

Despite the high prevalence of violence in the lives of women of reproductive age, and the adverse consequences posed to pregnant women suffering from PTSD, few studies have examined violence-related trauma and PTSD among pregnant women. A structured research interview was administered to a convenience sample of 85 prenatal care women to collect information regarding their experiences of violence victimization, PTSD symptoms related to violence-related traumatic events, and whether these symptoms impaired various aspects of the women's daily functioning. Results indicated that 69% of the women experienced a violent traumatic event, with the majority of events occurring before the current pregnancy and being perpetrated by the women's intimate partners. The traumatized women evidenced high levels of PTSD symptoms during pregnancy, with 58% of the women meeting criteria for a PTSD diagnosis. Moreover, many of the women with PTSD symptoms reported that the symptoms adversely affected aspects of their daily functioning.

Epidemiology and outcome of pediatric trauma treated by an emergency-physician-staffed advanced life-support unit.

The aim of this study was to describe the epidemiology and outcome of pediatric trauma in the setting of an emergency-physician-staffed mobile advanced life support (ALS) unit serving a predominantly urban area in Austria. In this retrospective chart review, all pediatric trauma patients (0-14 years of age) who were treated by a physician-staffed ALS unit in Innsbruck within a 3-year period were analyzed. In addition, hospital charts were assessed to determine the clinical course and the outcome of these patients. 113 injured children were treated by the physician-staffed ALS unit (1.5% of all runs) during the study period; a frequency of three pediatric trauma patients per month. On average, injuries were of moderate severity (2.6 +/- 1.3 on the NACA severity scale). Thirteen children (11.5%) sustained severe to life-threatening injuries and two of whom underwent out-of-hospital resuscitation. The majority of the injuries were caused by vehicular accidents and sports/recreation-related trauma; head trauma was the most frequent injury. Violence-related trauma including weapon-inflicted injuries was uncommon. 40% of the children were hospitalized. The overall outcome was favorable: 78% of the hospitalized children had no impairment at the time of discharge. By comparing the prehospital trauma diagnosis with the final diagnosis, we found that the vast majority of emergency-physician trauma diagnoses were accurate. Because the frequency of pediatric trauma is so low, ALS units may not gain adequate experience in the management of (severe) pediatric trauma, thus rendering regular training of paramount importance.

Creating Safe and Caring School Communities: Comer School Development Program Schools

Norris M. Haynes, Yale Child Study Center, Yale University* This article asserts that schoolwide interventions have the greatest potential for buffering students from violence outside of schools and for preventing violence within schools. It examines critical aspects of one such intervention, the Comer School Development Program (SDP), and explores the ways in which this program directly and indirectly impacts both the level of violence in the school and children's, parents', teachers', and school administrators' responses to it. By embracing children within a web of prosocial relationships and activities, the SDP is shown as creating a safe haven that supports their healthy development, fosters optimal learning, and discourages interpersonal violence. INTRODUCTION The devastating effects of violence on children's development and psychosocial adjustment are widely evident in the increasing number of children being treated for violence-related trauma or themselves being accused of perpetrating acts of violence on others (BoneyMcCoy & Finkelhor, 1995; Garbarino, Dubrow, Kostelny, & Pardo, 1992). Virtually constant exposure to real violence in their homes and communities and simulated violence in the media have rendered many of our nation's youth violence-impacted and violence-prone. Gun-toting individuals, drive-by shootings, and drug-related homicides previously confined to lurid dramatizations in the media are now everyday occurrences and pervasive influences on many children's development (Children's Defense Fund, 1994). Indeed, Kotlowitz's (1991) ruminations on the pervasive violence he found in the lives of two small boys growing up in an impoverished urban neighborhood prompted him to assert that such children are being robbed of their childhood. He and others have maintained that the increase in violence may be related to the failure of our nation's social institutions, including its families and schools, to adequately address the psycho-emotional and educational needs of children in holistic and collaborative ways (Bey & Turner, 1996). Forced to grow up at an unnaturally accelerated rate in order to physically and psychologically fend off assaults on their inner and outer selves, these young people cannot succeed on their own. Nor can we as a nation succeed in protecting them and restoring balance and integrity to their childhood unless we form communities of support around them to buffer them against the scourge of community and domestic violence. Insufficient attention has been paid by educational researchers to the quality of the human interactions that occur between children and adults at school. These interactions contribute substantially to the overall social climate of the school, which encompasses the attitudes, values, and behavior of students, school personnel, parents, and community members toward each other and toward the activities and programs occurring at the school. A healthy school climate supports children's healthy development and facilitates their acquisition of the effective social and intellectual skills they need to survive and thrive. An unhealthy one leads to conflict between children, parents, and school personnel and makes children's social and intellectual development difficult, if at all possible. In 1993, researchers at the Comer School Development Program (SDP) of the Yale Child Study Center in New Haven, Connecticut, conducted a national survey of parent, staff, and student perceptions of school climate (Haynes, Emmons, & Comer, 1994). The sample was randomly selected from a national cross-section of 150 elementary, middle, and high schools. Of the 11,963 middle school students who completed this survey, 22% indicated that some of their schoolmates carry guns or knives to school. Forty-three percent responded that the children at their school fight a lot, and 42% noted that many children at their schools are suspended due to violent behavior. …

Children's response to community violence: What do we know?

This article presents a framework for understanding the developmental significance of violence-related trauma in the lives of young children. It emphasizes the importance of the distinction between acute and chronic trauma. Acute trauma is more readily dealt with through “psychological first aid” and a “therapy of reassurance.” Chronic trauma requires a more systematic reconstruction of the child's “social map” of the world. The socioeconomic and demographic correlates of violent trauma predict an accumulation of risk factors in the child's life that compounds the problem of developmental disability. The problem community violence poses for the child must be understood in the larger context of greater risk for family disruption (including less than secure attachment) as well as domestic violence, poverty, and minority group status. The increasing incidence and prevalence of community violence poses a major challenge to the mental health of children.

Life stresses of slavery.

Skeletal evidence exists for life stresses of 120 Black individuals from 25 sites in Maryland, Virginia, and the Carolinas. Periods for statistical comparison are eighteenth century, 1690-1770; Catoctin Furnace, Maryland industrial slaves, 1790-ca.1820; 1800-ca.1860, nineteenth century; and a twentieth-century Black sample compiled from forensic (accidental deaths) cases. From these archaeological sources, skeletal age at death shifts from 36 years, female, and 30 years, male in eighteenth century (N = 29) to 34.8, female, and 36.3, male in nineteenth century (N = 56). Catoctin Furnace slaves' longevity may reflect special conditions for skilled males (34.6 years, female; 41.2 years, male (N = 16). Nutritional stresses are indicated by dental lesions, hypoplasias, stature, and skull base height and pelvic brim index. Occupational stress occurs in some adolescents and in many adults as exaggerated development of lifting muscles (deltoid and pectoral crests) and early vertebral and shoulder breakdown. Lead content of bone may reflect site of occupation. The most common pathology is anemia or sicklemia; parietal depressions and ulna fractures ("parry") indicate violence-related trauma.